Thoracoscopyª²assisted Nuss procedure and its modification for repair of Pectus excavatum

    GAO Ya,ZHENG Baiª²Jun,GUO Xinª²Kui,LI Peng,GUO Zhengª²Tuan,DUAN Yiª²Tao,WU Xuanª²Lin,XU Quan,ZHANG Xianª²Sheng,LI Gongª²Cai

    Department of Pediatric Surgery,Second Hospital,Xi¬ðan Jiaotong University,Xi¬ðan 710004,China

    ¡¾Abstract¡¿ AIM: To review the results of Pectus excavatum (PE) repaired by the modified Nuss procedure and the measures for prevention of complications.METHODS: A retrospective review was conducted in 26 patients who had undergone repair of PE by the thoracoscopyª²assisted modified Nuss procedures from October 2001 to June 2004.Our technical modification included leftª²sided thoracoscopy,ECG monitoring,elevation of the sternum during the pectus clamp passage and a double 3ª²point bar fixation.RESULTS: Except for two patients with associated anomalies,the other 24 patients had a mean operation time of 52 (40~95) minutes with a less than 15 mL bleeding and a mean postoperative stay of 6 days.Early complications including pneumothorax was found in 3 cases and pleural infusion in one,and they all resolved spontaneously.One patient had a wound seroma without infection.All patients were followed up from 3 to 35 months.Marked improvement was observed in patients who had recurrent respiratory infection before surgery.The position of the bar,as displayed by lateral chest Xª²ray,was excellent in 15 cases and good in 4.Of the 5 cases who had the bar removed,4 had excellent result and 1 had good result as evaluated by Croitoru¬ðs criteria.CONCLUSION: Thoracoscopyª²assisted Nuss repair is an alternative repair for the symmetric PE with remarkable technical simplicity,miniª²invasiveness,rapid recovery and cosmetic advantage.The best age for this procedure should be 4~8 years.The author recommends a leftª²sided thoracoscopy,ECG monitoring and elevation of the sternum during the pectus clamp passage and a double 3ª²point bar fixation. ......