Pectus tunneloscopy: making Nuss procedure for pectus excavatum safe

Abstract

Pectus tunneloscopy is a real-time endovision surgical technique, providing safe introduction of the bar across the crucial retrosternal tunnel blind spot.

A Simplified Method to Pass the Bar Through the Mediastinum in the Nuss Technique

“…In a previous report, de Campos and colleagues [3] reported the removal of the bar with its sharp edges covered by a protective film. Darlong [4] recently suggested a way to increase Nuss procedure safety by using a transparent hollow polyvinylchloride tube to perform a so-called tunneloscopy and pass the bar through the mediastinum under tunnelscopic vision.…”

Single-centre Indian case series using X or cross bar for Nuss procedure in pectus excavatum

“…They usually do not have symptomatic respiratory or cardiac dysfunction during normal sedentary activities. We have been performing a rather modified version of the Nuss procedure for pectus excavatum in India since 2012 using video-endoscope, pectus tunneloscopy along with various fixation devices and our described sutureless moon bridge system for a stable bar [2,3]. A few reports on Nuss procedure for pectus excavatum from India can be traced back to Puri et al who reported 2 cases in pediatric age group in 2003 [4].…”

Left anterolateral emergency thoracotomy during the Nuss procedure: Lifesaving shortcut

“…Several modifications of the procedure have been suggested to improve safety. To enhance visualization (besides the use of 30° 5 mm scopes) bilateral thoracoscopy and the use of a transparent hollow tube to guide thoracoscopy, namely “tunneloscopy”, have been proposed . In addition, sternum elevation methods have been argued for widening the space corresponding to the anterior mediastinum.…”

“…To enhance visualization (besides the use of 30°5 mm scopes) bilateral thoracoscopy and the use of a transparent hollow tube to guide thoracoscopy, namely "tunneloscopy", have been proposed. 4 In addition, sternum elevation methods have been argued for widening the space corresponding to the anterior mediastinum. The Crane technique consists of sternum fixation by means of a towel clip, a bone hook or a sutured wire followed by its attachment to a body retractor; by using a vacuum bell, or by inserting either two Langenbeck retractors inside both hemithoraces or a new elevator (with the same curvature as the introducer via the existing incisions) further scarring can be avoided.…”