Which clinical observations led to the development of minimally invasive surgery for pectus excavatum?

Updated: Oct 30, 2018
  • Author: Andre Hebra, MD; Chief Editor: Girish D Sharma, MD, FCCP, FAAP  more...
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Answer

The clinical observations that provided the rationale for developing a less invasive operation that would allow for the anatomical correction of pectus excavatum deformity are listed below. [12]

First, children have a very soft and malleable chest. Second, the phenomenon of chest remodeling is well known in adult patients with emphysema who develop a barrel-shaped chest. If the chest wall in older adults can be reconfigured, the same should be possible in children and teenagers because of the increased malleability of their anterior chest wall. Third, the use of braces and internal fixating devices has allowed orthopedic surgeons and orthodontists to correct skeletal anomalies such as scoliosis, club foot, and maxillomandibular malocclusion. The anterior chest wall, which is quite malleable, is ideal for this type of correction.

Such observations resulted in a technique in which a convex stainless-steel bar is placed under the sternum through a small lateral thoracic incision to correct the condition known as funnel chest. Thus, the minimally invasive repair of pectus excavatum (MIRPE), also known as the Nuss technique, was born. [13]

A study reported a novel method with a new steel bar for minimally invasive surgical correction of pectus excavatum. The procedure was performed with a new steel bar through bilateral thoracic minimally invasive incisions using a thoracoscope for guidance. The bar was installed or removed by pushing and pulling without turning it over. [14]


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