Video-assisted-thoracoscopic surgery in left-to-right Nuss procedure for pectus excavatum for prevention of serious complications - technical aspects based on 1006 patients.

Abstract

IntroductionAdditional use of the video-assisted thoracoscopic surgery (VATS) technique in the Nuss procedure has been globally accepted for the improvement of safety of surgical treatment as well as for decreased frequency of serious intraoperative and postoperative complications.AimTo evaluate VATS in surgical treatment of patients with pectus excavatum by the left-to-right Nuss procedure for prevention of serious intra- and postoperative complications.Material and methodsFrom 2002 to 2016, 1006 patients with pectus excavatum aged 7 to 62 years (mean: 18.6) underwent the Nuss procedure. There were 796 males and 210 females. The clinical records of all patients were analyzed retrospectively. The follow-up varied from 1 to 172 months (mean: 80.7 ±43).ResultsThe early 30-day postoperative mortality was zero. Early thoracoscopy-dependent postoperative complications, the majority transient and non-life-threatening, occurred in 35.6% of patients. The most frequent complication was pneumothorax, diagnosed in 24.5% of patients. Two patients required repeat surgery. One patient required VATS pleurectomy due to persistent postoperative air leakage. In another patient left thoracotomy following bleeding from the pleural cavity was performed.ConclusionsThe use of VATS in the left-to-right Nuss procedure for pectus excavatum ensures the safety of surgical treatment and minimizes the occurrence of serious intra- and postoperative complications concerning injury of the mediastinum, lung, diaphragm or abdominal cavity.

365 Patients with Pectus Excavatum Undergoing Video-Assisted Thoracoscopic Surgery for the Nuss Procedure: A 5-Year Single-Institution Experience

“…Our nding was consistent with previous reports when both revealed that elderly patients need to put more metal bars compared to younger patients [21], [22]. The number of patients receiving 2 metal bars was lower in our study than in previous studies [21], [22]. For instance, in an early report by Pilegaard HK, 121 patients were inserted with 1 metal bar (66.8%), 57 cases were inserted with 2 metal bars (32%), and 2 cases were inserted with 3 metal bars (1.2%) [22].…”

“…The 2-bar insertion was indicated for most elderly patients with severe PE and wide concave area; no case was placed with 3 metal bars. Our nding was consistent with previous reports when both revealed that elderly patients need to put more metal bars compared to younger patients [21], [22]. The number of patients receiving 2 metal bars was lower in our study than in previous studies [21], [22].…”

“…For instance, in an early report by Pilegaard HK, 121 patients were inserted with 1 metal bar (66.8%), 57 cases were inserted with 2 metal bars (32%), and 2 cases were inserted with 3 metal bars (1.2%) [22]. Of 1006 PE patients in Krystian Pawlak's recent series from July 2002 to September 2016, one bar was implanted in 452 (44.9%) patients, two bars were inserted into 545 (54.2%) patients, whilst three bars were inserted into 9 (0.9%) patients [21]. The patient's chest wall became more solid after puberty and harder to bend;…”

An Initial 5-Year Single-Center Experience of 365 Patients Undergoing the Video-Assisted Thoracoscopic Surgery for Nuss Procedure for Pectus Excavatum in Resource-Scare Setting

“…No case in our institution had three metal bars placed yet. Our finding was consistent with previous reports when both revealed that the number of implanted steel bars was greater with age (18)(19)(20). Compared to previous studies (19,20), the number of patients receiving two metal bars was lower in our study.…”

“…Our finding was consistent with previous reports when both revealed that the number of implanted steel bars was greater with age (18)(19)(20). Compared to previous studies (19,20), the number of patients receiving two metal bars was lower in our study. The patient's chest wall becomes more solid after puberty and harder to bend; hence, introducing more than one bar is done to prevent postoperative pain and pressure on the chest wall by preventing displacement of the bar.…”