A strategy for simulating and validating the Nuss procedure for the minimally invasive correction of pectus excavatum

Rechowicz, K; McKenzie, Frederic D.

doi:10.1109/bmei.2011.6098771

Cited by 5 publications

(5 citation statements)

References 13 publications

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“…Absorbable Polydionanone is used because we are unaware of data showing superiority of absorbable versus nonabsorbable material such as Fiberwire. Only 1.8% (18) of the 32 patients with varying degrees of displacement required repositioning. Pericarditis did not occur in any patient in the last 10 years.…”

Section: Resultsmentioning

confidence: 97%

“…In collaboration with Old Dominion University Modeling and Simulation Engineering Department, we have developed both manikin and computer-based simulators for training surgeons. 18,19…”

Section: Discussionmentioning

confidence: 99%

“…Concerns regarding surgeon preparation have led us to develop a Pectus Excavatum Workshop, and develop simulation. In collaboration with Old Dominion University Modeling and Simulation Engineering Department, we have developed both manikin and computer-based simulators for training surgeons 18,19 …”

Section: Discussionmentioning

confidence: 99%

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Recent Modifications of the Nuss Procedure

et al. 2020

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Objective: To review standardized Nuss correction of pectus excavatum and vacuum bell treatment over the last 10 years. Summary of Background Data: In 2010, we reported 21 years of the Nuss procedure in 1215 patients. Methods: Over the last 10 years, 2008-2018, we evaluated 1885 pectus excavatum patients. Surgery was indicated for well-defined objective criteria. A consistent operation was performed by 8 surgeons in 1034 patients, median 15 years, (range 6-46); 996 were primary, and 38 redo operations. Surgical patients' mean computed tomography index was 5.46. Mitral valve prolapse was present in 5.4%, Marfan syndrome in 1.1% and scoliosis in 29%. Vacuum bell treatment was introduced for 218 patients who did not meet surgical criteria or were averse to surgery. Results: At primary operation, 1 bar was placed in 49.8%; 2 bars, 49.4%; and 3 bars, 0.7%. There were no deaths. Cardiac perforation occurred in 1 patient who had undergone previous cardiac surgery. Paraplegia after epidural catheter occurred once. Reoperation for bar displacement occurred in 1.8%, hemothorax in 0.3%, and wound infection in 2.9%; 1.4% required surgical drainage. Allergy to stainless steel was identified in 13.7%. A good anatomic outcome was always achieved at bar removal. Recurrence requiring reoperation occurred in 3 primary surgical patients. Two patients developed carinate overcorrection requiring reoperation. Vacuum bell treatment produced better results in younger and less severe cases. Conclusions: A standardized Nuss procedure was performed by multiple surgeons in 1034 patients with good overall safety and results in primary repairs. Vacuum bell treatment is useful.

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Section: Resultsmentioning

confidence: 97%

“…In collaboration with Old Dominion University Modeling and Simulation Engineering Department, we have developed both manikin and computer-based simulators for training surgeons. 18,19…”

Section: Discussionmentioning

confidence: 99%

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Recent Modifications of the Nuss Procedure

et al. 2020

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“…The equipment was verified to measure distances from the probe accurately, and its ability to produce a 3D image was confirmed [1,2]. Measurements of accuracy and precision were made, and were found to be more than sufficient for use in a biological system [3–7]. The scanner was used on both male and female patients without breast development, obtaining images in the supine position, with a consistent position relative to the scanner.…”

Section: Methodsmentioning

confidence: 99%

Use of an Optical Scanning Device to Monitor the Progress of Noninvasive Treatments for Chest Wall Deformity: A Pilot Study

Kelly

Obermeyer

Kuhn

et al. 2018

Korean J Thorac Cardiovasc Surg

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BackgroundThe nonsurgical treatment of chest wall deformity by a vacuum bell or external brace is gradual, with correction taking place over months. Monitoring the progress of nonsurgical treatment of chest wall deformity has relied on the ancient methods of measuring the depth of the excavatum and the protrusion of the carinatum. Patients, who are often adolescent, may become discouraged and abandon treatment.MethodsOptical scanning was utilized before and after the intervention to assess the effectiveness of treatment. The device measured the change in chest shape at each visit. In this pilot study, patients were included if they were willing to undergo scanning before and after treatment. Both surgical and nonsurgical treatment results were assessed.ResultsScanning was successful in 7 patients. Optical scanning allowed a visually clear, precise assessment of treatment, whether by operation, vacuum bell (for pectus excavatum), or external compression brace (for pectus carinatum). Millimeter-scale differences were identified and presented graphically to patients and families.ConclusionOptical scanning with the digital subtraction of images obtained months apart allows a comparison of chest shape before and after treatment. For nonsurgical, gradual methods, this allows the patient to more easily appreciate progress. We speculate that this will increase adherence to these methods in adolescent patients.

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“…Design and methodology 3.1. Nuss procedure core system design Our Nuss procedure surgical planner 21 is based on a FEM of the PE ribcage ( Figure 2). However, since FEM does not ensure real-time performance, it cannot be directly implemented in the system.…”

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confidence: 99%

Development and validation methodology of the Nuss procedure surgical planner

Rechowicz

McKenzie

2013

SIMULATION

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Surgical planners are used to achieve the optimal outcome for surgery. They are especially desired in procedures where a positive aesthetic outcome is the primary goal, such as the Nuss procedure which is a minimally invasive surgery for correcting pectus excavatum (PE) -a congenital chest wall deformity which is characterized by a deep depression of the sternum. The Nuss procedure consists of placement of a metal bar(s) underneath the sternum, thereby forcibly changing the geometry of the ribcage. Because of the prevalence of PE and the popularity of the Nuss procedure, the demand to perform this surgery is greater than ever. Therefore, a Nuss procedure surgical planner is an invaluable planning tool ensuring an optimal physiological and aesthetic outcome. We propose the development and validation of the Nuss procedure planner. First, a generic model of the ribcage is developed. Then, the computed tomography (CT) data collected from actual patients with PE is used to create a set of patient-specific finite element models (FEM). Based on finite element analyses (FEA) a force-displacement data set is created. This data is used to train an artificial neural network (ANN) to generalize the data set. In order to evaluate the planning process, a methodology which uses an average shape of the chest for comparison with results of the Nuss procedure planner is developed. Haptic feedback and inertial tracking is also implemented. The results show that it is possible to utilize this approximation of the force-displacement model for a Nuss procedure planner and trainer.

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A strategy for simulating and validating the Nuss procedure for the minimally invasive correction of pectus excavatum

Cited by 5 publications

References 13 publications

Recent Modifications of the Nuss Procedure

Recent Modifications of the Nuss Procedure

Use of an Optical Scanning Device to Monitor the Progress of Noninvasive Treatments for Chest Wall Deformity: A Pilot Study

Development and validation methodology of the Nuss procedure surgical planner

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