Technical innovation in minimally invasive repair of pectus excavatum

Rygl, Michal; Vyhnánek, M; Kucera, Alexander; Mixa, Vladimír; Kynčl, Martin; Šnajdauf, J

doi:10.1007/s00383-013-3435-0

Cited by 21 publications

(12 citation statements)

References 20 publications

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“…Statistical comparison of HI with other studies: Kelly et al [13], Peter et al [22], Yoshida et al [31], Mortellaro et al [19], and Rygl et al [25] found statistically significant difference at the significance level a = 0.01 (Table 9). …”

Section: Ct Evaluationmentioning

confidence: 81%

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Metrical evaluation of Slovak patients with pectus excavatum

et al. 2015

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Anthropometry provides feasible and non-invasive method of pectus deformities evaluation. Based on the study results, anthropometry should be performed prior to CT examination in order to select patients for surgical treatment. Anthropometric measurements are helpful in accurate documentation of growth, longitudinal observation of the patient, and can support decision concerning the type of surgery.

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Section: Ct Evaluationmentioning

confidence: 81%

“…Rygl et al [25] from the Czech Republic followed 204 patients with PE aged 13-28 years (mean age 16.6 years). The mean value in the HI group was 4.7.…”

Section: Discussionmentioning

confidence: 99%

Metrical evaluation of Slovak patients with pectus excavatum

et al. 2015

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“…This can be accomplished by using Park et al's Crane technique 19,20 with either a Thompson or Rultract retractor, 21 a vacuum bell in younger patients, 22 or by inserting a hook under the sternum inferiorly or laterally. 23 Other techniques include the use of a subxiphoid incision to dissect the retrosternal space with a finger. The surgeon's finger dissects and creates the space between pericardium and sternum before placing the bar.…”

Section: How To Minimize Complications During Pectus Repairmentioning

confidence: 99%

Minor and Major Complications Related to Minimally Invasive Repair of Pectus Excavatum

Hebra

2018

Eur J Pediatr Surg

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The technique for minimally invasive repair of pectus excavatum (MIRPE) has been adopted by most surgeons as the preferred method for treatment of this condition. However, there is limited awareness about the complications related to the procedure. Most importantly, the prevalence and potential for life-threatening complications have frequently been underestimated. The purpose of this communication is to increase awareness of the risk of minor and major (life-threatening) complications, as well as the operative steps and modifications which have been developed to prevent them. One of the most common complications reported in the early series of MIRPE cases was bar displacement, frequently requiring reoperation. Fortunately, technical modifications to the technique have resulted in a decrease in the incidence of such events from 10 to less than 2%. It is important for surgeons to have a good understanding of the potential complications, particularly the major type of complications post-MIRPE and postpectus bar removal. Although rare, the risk of mortality is real and it is the surgeon's responsibility to ensure optimal patient safety when performing this procedure. Factors such as operative technique, patient age, pectus severity and asymmetry, previous chest surgery, and the surgeon's experience play a role in the overall incidence of adverse events. These preventable events can be avoided with proper training, mentoring, and careful patient selection.

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“…A second option, in younger patients with a flexible chest, is to elevate the sternum by using the Vacuum Bell. A third option is to elevate the sternum by using a retractor inserted either through an additional sub-xiphoid incision or laterally" (27,28). A fourth option is to elevate the sternum by using Bilateral skin incisions are made at the previously marked sites between the anterior and mid axillary lines.…”

Section: Surgical Techniquementioning

confidence: 99%

Nuss bar procedure: past, present and future

Nuss¹,

Obermeyer²,

Kelly³

2016

Ann. Cardiothorac. Surg.

243

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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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Technical innovation in minimally invasive repair of pectus excavatum

Cited by 21 publications

References 20 publications

Metrical evaluation of Slovak patients with pectus excavatum

Metrical evaluation of Slovak patients with pectus excavatum

Minor and Major Complications Related to Minimally Invasive Repair of Pectus Excavatum

Nuss bar procedure: past, present and future

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