Technique of enlarged retrosternal tunnel in Nuss procedure

Abstract

OBJECTIVE: The Nuss procedure for pectus excavatum involves the risk of cardiopulmonary injury during the creation of retrosternal tunnel. This study describes the enlargement of retrosternal tunnel during Nuss procedure to prevent such problems caused by the inability to directly visualize the left pleural cavity.METHODS: From January 2018 to August 2021, 132 patients with pectus excavatum who underwent the Nuss procedure were divided into the modified group and the conventional group , according to the surgical method performed. The preoperative, intraoperative and postoperative indicators of the two groups were compared. In 70 consecutive patients undergoing the modified Nuss procedure, the separation was expanded by inserting the introducer bluntly and creating a retrosternal tunnel width of 4-5 cm in a coronal horizontal position. Once the pericardium, left parietal pleura and lung had been observed from the right thoracic cavity during the separation, the parietal pleura was punctured to induce a left pneumothorax and left lung collapse. Under thoracoscopic guidance, the introducer was passed through the left intercostal space.RESULTS: All children completed the surgery successfully; there were no cases of death, pericardial or cardiopulmonary injury, or bar displacement. There was no statistical significance in other indicators except age between two groups.CONCLUSION: Coronal plane enlargement of the retrosternal tunnel during the Nuss procedure allows direct visualization of the pericardium, left parietal pleura, and left lung, which has the promise of reducing the incidence of serious complications such as intraoperative cardiopulmonary injury and does not increase the incidence of general complications.