The vacuum bell for conservative treatment of pectus excavatum: the Basle experience

Haecker, Frank-Martin

doi:10.1007/s00383-010-2843-7

“…CT-scans showed that the device was able to lift the sternum and ribs immediately (17). Afterwards, several studies involving a larger pool of patients were done (19,20), and the first systematic review summarizing the results of 133 patients was published in 2011 (21). Furthermore, recent studies confirmed the efficacy of VB therapy in carefully selected patients (22)(23)(24).…”

Section: Introductionmentioning

confidence: 73%

Vacuum bell therapy

Haecker

¹

,

Sesia

²

2016

Ann. Cardiothorac. Surg.

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Background: For specific therapy to correct pectus excavatum (PE), conservative treatment with the vacuum bell (VB) was introduced more than 10 years ago in addition to surgical repair. Preliminary results using the VB were encouraging. We report on our 13-year experience with the VB treatment including the intraoperative use during the Nuss procedure and present some technical innovations.Methods: A VB with a patient-activated hand pump is used to create a vacuum at the anterior chest wall.Three different sizes of vacuum bells, as well as a model fitted for young women, exist. The appropriate size is selected according to the individual patient's age and ventral surface. The device should be used at home for a minimum of 30 minutes (twice a day), and may be used up to a maximum of several hours daily. The intensity of the applied negative pressure can be evaluated with an integrated pressure gauge during followup visits. A prototype of an electronic model enables us to measure the correlation between the applied negative pressure and the elevation of the anterior chest wall.Results: Since 2003, approx. 450 patients between 2 to 61 years of age started the VB therapy. Age and gender specific differences, depth of PE, symmetry or asymmetry, and concomitant malformations such as scoliosis and/or kyphosis influence the clinical course and success of VB therapy. According to our experience, we see three different groups of patients. Immediate elevation of the sternum was confirmed thoracoscopically during the Nuss procedure in every patient. Conclusions:The VB therapy has been established as an alternative therapeutic option in selected patients suffering from PE. The initial results up to now are encouraging, but long-term results comprising more than 15 years are so far lacking, and further evaluation and follow-up studies are necessary.

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“…The most common complaints are shortness of breath with exercise, lack of endurance, and chest pain. If the patient has a mild deformity and does not fulfill the abovementioned criteria for surgical correction, then he/she will be started on a deep breathing with breath holding and posture exercise program, and may be offered non-operative treatment with the Vacuum Bell (19,20). These patients are typically re-evaluated every 3 to 6 months to ensure that they are complying with the conservative treatment and to check whether the deformity is improving or progressing.…”

Section: Pre-operative Evaluationmentioning

confidence: 99%

“…New approaches to the problem will also appear, as exemplified by Klobe's Vacuum Bell, which is now finding a place as the treatment of choice in younger patients with a soft and malleable chest who have a mild to moderate deformity (19,20). At one time there was only one procedure available for patients with pectus excavatum and that was the Ravitch procedure.…”

Section: Futurementioning

confidence: 99%

Nuss bar procedure: past, present and future

Nuss¹,

Obermeyer²,

Kelly³

2016

Ann. Cardiothorac. Surg.

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Repair of pectus excavatum began at the beginning of the 20 th century before endotracheal intubation was standard practice. Surgeons therefore developed techniques that corrected the deformity using an open procedure via the anterior chest wall. Initial techniques were unsatisfactory, but by the 1930s the partial rib resection and sternal osteotomy technique had been developed and was used in combination with external traction post-operatively to prevent the sternum from sinking back into the chest. In 1949, Ravitch recommended complete resection of the costal cartilages and complete mobilization of the sternum without external traction, and in 1961 Adkins and Blades introduced the concept of a substernal strut for sternal support. The wide resection resulted in a very rigid anterior chest wall, and in some instances, the development of asphyxiating chondrodystrophy. The primary care physicians therefore became reluctant to refer the patients for repair. In 1987, Nuss developed a minimally invasive technique that required no cartilage or sternal resection and relied only on internal bracing by means of a sub-sternal bar, which is inserted into the chest through two lateral thoracic incisions and guided across the mediastinum with the help of thoracoscopy. After publication of the procedure in 1998, it became widely accepted and a flood of new patients suddenly started to appear, which allowed for rapid improvements and modifications of the technique. New instruments were developed specifically for the procedure, complications were recognized, and the steps taken to prevent them included the development of a stabilizer and the use of pericostal sutures to prevent bar displacement. Various options were developed for sternal elevation prior to mediastinal dissection to prevent injury to the mediastinal structures, allergy testing was implemented, and pain management improved. The increased number of patients coming for repair permitted studies of cardiopulmonary function, which showed that patients with a severe degree of pectus excavatum have right-sided cardiac compression, decreased filling, and decreased stroke volume. The degree of pulmonary restriction and obstruction is related to the degree of deformity and degree of cardiac displacement into the left chest. The indications for surgical repair have been clearly outlined, the procedure has been standardized, and post-operative management protocols are now available. A review of our prospective database showed that 98% of patients have a good to excellent outcome. This review of the "Past" outlines the progression of the surgical techniques during the 20 th century, the review of the "Present" outlines the important modifications and results of the closed technique, and the review of the "Future" outlines the various new options that are becoming available for the treatment of pectus excavatum.

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“…More recently these patients have been offered treatment with the Vacuum Bell (19,20) The advent of the MIRPE resulted in a dramatic increase in the number of patients presenting for repair (15,21). This large increase in the numbers of patients undergoing repair has allowed many centers to develop technical refinements, thereby making the procedure even safer and has allowed numerous pre-and post-operative studies to be performed, showing that pectus excavatum causes significant cardiac and pulmonary compression and dysfunction which is markedly improved after repair (22)(23)(24).…”

Section: Surgical Indicationsmentioning

confidence: 99%

Nuss bar procedure: past, present and future

Nuss¹,

Obermeyer²,

Kelly³

2016

ASVIDE

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Repair of pectus excavatum began at the beginning of the 20 th century before endotracheal intubation was standard practice. Surgeons therefore developed techniques that corrected the deformity using an open procedure via the anterior chest wall. Initial techniques were unsatisfactory, but by the 1930s the partial rib resection and sternal osteotomy technique had been developed and was used in combination with external traction post-operatively to prevent the sternum from sinking back into the chest. In 1949, Ravitch recommended complete resection of the costal cartilages and complete mobilization of the sternum without external traction, and in 1961 Adkins and Blades introduced the concept of a substernal strut for sternal support. The wide resection resulted in a very rigid anterior chest wall, and in some instances, the development of asphyxiating chondrodystrophy. The primary care physicians therefore became reluctant to refer the patients for repair. In 1987, Nuss developed a minimally invasive technique that required no cartilage or sternal resection and relied only on internal bracing by means of a sub-sternal bar, which is inserted into the chest through two lateral thoracic incisions and guided across the mediastinum with the help of thoracoscopy. After publication of the procedure in 1998, it became widely accepted and a flood of new patients suddenly started to appear, which allowed for rapid improvements and modifications of the technique. New instruments were developed specifically for the procedure, complications were recognized, and the steps taken to prevent them included the development of a stabilizer and the use of pericostal sutures to prevent bar displacement. Various options were developed for sternal elevation prior to mediastinal dissection to prevent injury to the mediastinal structures, allergy testing was implemented, and pain management improved. The increased number of patients coming for repair permitted studies of cardiopulmonary function, which showed that patients with a severe degree of pectus excavatum have right-sided cardiac compression, decreased filling, and decreased stroke volume. The degree of pulmonary restriction and obstruction is related to the degree of deformity and degree of cardiac displacement into the left chest. The indications for surgical repair have been clearly outlined, the procedure has been standardized, and post-operative management protocols are now available. A review of our prospective database showed that 98% of patients have a good to excellent outcome. This review of the "Past" outlines the progression of the surgical techniques during the 20 th century, the review of the "Present" outlines the important modifications and results of the closed technique, and the review of the "Future" outlines the various new options that are becoming available for the treatment of pectus excavatum.

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The vacuum bell for conservative treatment of pectus excavatum: the Basle experience

Cited by 80 publications

References 21 publications

Vacuum bell therapy

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