Cannula-assisted sternal displacement for VATS correction of pectus excavatum in three cats.

To describe a novel, video-assisted thoracoscopic surgery (VATS) approach used to treat pectus excavatum (PE) in a dog. A 5 month-old, 5.1kg, intact, female, Cockapoo. Case report. Clinical, imaging and surgical records of a dog with severe PE who underwent VATS-assisted sternal cast placement were reviewed and reported. Treatment involved introduction of a mild pneumothorax and use of VATS, allowing direct visualization and therefore safe passage of circumsternal sutures as they were placed to reduce the risk of vascular/cardiac or pulmonary penetration and intraoperative complication in this patient. Treatment involved introduction of a mild pneumothorax and use of VATS, allowing direct visualization and therefore safe passage of circumsternal sutures as they were placed to reduce the risk of vascular/cardiac or pulmonary penetration and intraoperative complications in this patient. The patient recovered well and had an excellent long-term outcome with significantly improved vertebral index and frontosagittal index. This modified technique resulted in an excellent outcome and minimized the risk of intraoperative complications during the surgical procedure in a dog. This novel VATS approach for PE correction may provide a useful technique to help reduce intraoperative risk during PE correction in dogs.

Preliminary study of efficacy of cup suction in the correction of typical pectus excavatum

Video-assisted thoracoscopic surgery (VATS) has become an established technique in both diagnostic and therapeutic thoracic surgery procedures. In an attempt to evaluate the current indications and outcome of this technique, 143 VATS procedures, which were performed over a three-year period, were retrospectively evaluated. Indications included lung biopsy in 46, recurrent or persistent pneumothorax in 42, and pleural disease in 16 patients. Other indications included sympathectomy in eight, mediastinal mass in three, pericardial window in three, metastasectomy in three, and staging of lung cancer in two patients. There was one postoperative death (0.7%), a patient with massive pleural effusion and end-stage renal and hepatic failure. Conversion to formal thoracotomy was necessary in six patients (4.2%), and was the result of adhesions in four, bleeding in one, and failure to identify the lesion in one patient. Diagnostic procedures were considered successful in 44 out of 46 lung biopsies (95.7%), 15 out of 16 pleural disease cases (93.8%), and two lung cancer staging cases. The other 79 therapeutic VATS procedures were all effective, both in the long and short term, apart from two cases of prolonged air leak after VATS for pneumothorax, one of which was considered a failure (2.4%). VATS should be available in each thoracic surgery unit. It is both safe and effective in a variety of diagnostic and therapeutic procedures.

Objective: To investigate the clinical efficacy and safety of the extrapleural approach versus the traditional intrathoracic approach in minimally invasive correction of pectus excavatum in children, providing a more scientific basis for selecting a more appropriate surgical method in clinical practice. Methods: This study included 50 children who underwent pectus excavatum correction at Harbin Children’s Hospital from January 2023 to January 2025. All patients were divided into two groups based on surgical approach: the observation group (n = 26) and the control group (n = 24). Children in the observation group underwent correction surgery via an extrapleural approach, while those in the control group underwent correction surgery via the traditional intrathoracic approach. Both groups underwent Nuss bar placement surgery under thoracoscopic guidance. Intraoperative indicators were compared between the two groups, including operative time, blood loss, pain scores at 24 and 48 hours postoperatively, hospital stay duration, thoracic correction outcomes, and the incidence of complications during a 6-month postoperative follow-up. Results: The intraoperative blood loss in the observation group was significantly lower than that in the control group (p < 0.05), and the pain scores at 24 and 28 hours postoperatively were also significantly lower (p < 0.05). The improvement in thoracic index postoperatively was relatively similar between the two groups, with no statistically significant difference (p > 0.05). During the 6-month postoperative follow-up period, no complications such as pneumothorax, hemothorax, pleural effusion, plate displacement, or infection occurred in the observation group, whereas the overall complication rate in the control group was 25%, showing a significant difference (p < 0.05). Conclusion: The extrapleural approach for corrective surgery can ensure the efficacy of thoracic deformity correction while reducing intraoperative blood loss, lowering the incidence of complications, alleviating postoperative pain, and accelerating recovery. It is a safe and effective approach for minimally invasive Nuss correction of pediatric pectus excavatum.

BACKGROUND: Pectus excavatum is a malformation characterized by deformities of the cartilaginous parts of the ribs and sternum of varying severity and accounts for 75%–91% of all chest wall deformities. Surgical treatment of pectus excavatum in children remains an urgent issue, despite the considerable number of existing surgical correction techniques. These techniques are not universally applicable, especially for asymmetric and rigid forms, requiring ongoing modification and improvement. CASE DESCRIPTION: A 17-year-old patient underwent surgical correction of a severe pectus excavatum complicated by a history of cardiac surgery, namely, median sternotomy and mitral valve prosthesis placement. The surgical procedure involved the release of major vital anatomical structures, the use of an external fixation device providing high corrective force during surgery, and gradual intraoperative correction under cardiac function monitoring. DISCUSSION: Correction of severe pectus excavatum following prior median sternotomy is associated with a high risk of complications, including fatal events such as asystole or massive hemorrhage. In such cases, a minimally invasive thoracoplasty with an additional subxiphoid approach and sternal elevation using an external fixation device is recommended. Conventional sternal elevation techniques (e.g., bone hooks, sutures, and clamps) have been found to be not advisable for pronounced rigid deformities owing to the risk of sternal injury. Moreover, isolated thoracoscopy using the standard MIRPE technique does not ensure the integrity of intrathoracic structures, and traditional bar-flipping maneuver for immediate and forced correction of pectus excavatum is inappropriate. CONCLUSION: Patients with pectus excavatum exceeding the threshold for severe deformity, particularly those with previous cardiac surgery, require a treatment different from standard thoracoplasty. The presented approach, involving the release of major vital anatomical structures and gradual intraoperative correction under cardiac monitoring with an external fixation device, is recommended for managing such complex clinical cases.

Objective The aim of this study was to evaluate the efficacy and safety of the approach of the Nuss procedure for the correction of pectus excavatum in children without thoracoscopy.Methods From Oct 2007 and May 2009,48 patients with pectus excavatum underwent Nuss procedure.Among them 22 were done under the thoracoscopic guidance,and the other 26 in a non-thoracoscopic way,in which,a bilateral extrapleural tunnel to the edge of sternum was created using a blunt dissection via a bilateral thoracic skin incision.Without introducing the thoracoscopy into the thoracic cavity,a steel bar was inserted in the entirely extrapleural tunnel and turned as the standard Nuss procedure.Results All 48 patients recovered uneventfully.There were no postoperative deaths and serious complications.A single alloy steel bar(23-40 cm)was used in all patients.In the non-video-assisted extrapleural group(n=26),no pneumothorax occurred,the operating time(after anesthesia)ranged from 24～38 minutes[mean(25.4±2.6)mins],blood loss was minimal(range,5-10 ml),and the hospital stay was ranged from 3-6 days[mean(4.5±1.1)days].In the thoracoscopic group(n=22),the corresponding figures were 40 to 60 minutes[mean(53.5±3.4)mins)],10 to 15ml,5-8days[mean(7.0±2.2)days],respectively.No recurrent of the funnel chest occurred during the 3-18 months(median 10.4 monthes)of follow-up.The bar displacement occurred in 1 case 2 months after operation,which was replaced with satisfied result.Conclusion The non-thoracoscopic approach of the Nuss procedure is a safe and less traumatic procedure for the correction of pectus excavatum. Key words: Funnel chest; Thoracic surgical procedures; Nuss procedure

Scoliosis is associated with pectus excavatum. However, the change in the degree of scoliosis after pectus excavatum correction has not been clarified. This study examined how the correction of pectus excavatum influences the status of pre-existing scoliosis. A total of 779 pectus excavatum patients operated between 2007 and 2011 using the pectus bar were retrospectively analysed. Preoperative severity and postoperative change of scoliosis in accordance with the severity of pectus excavatum were evaluated. Cobb angle, Haller index and sternal tilt degree were measured from pre- and postoperative whole-spine anteroposterior radiographs and chest computed tomography. Sixty-three (8%) patients had scoliosis (Cobb angle >10°). No significant correlation was noted between postoperative changes in Cobb angle, Haller index or sternal tilt angle. Preoperative severity of scoliosis showed a positive correlation with postoperative changes in Cobb angle ( r = 0.527, P < 0.001). In analyses between groups with mild and moderate scoliosis (Cobb angle <15° and >15°, respectively), the mean postoperative Cobb angle was decreased in mild scoliosis (-2.88°) but was increased in moderate scoliosis (3.86°; P < 0.001). Regarding the 'improvement' and 'aggravation' of scoliosis after pectus correction, preoperative severity of scoliosis was the only significant factor in univariable and multivariable analysis. Pectus excavatum repair using a pectus bar may improve scoliosis, but when the preoperative Cobb angle exceeds 15°, scoliosis may be aggravated. Therefore, pectus excavatum with concomitant moderate scoliosis requires extra caution during repair. This preliminary result suggests further investigation into the effect of chest cage remodelling on spine dynamics.

Objective To evaluate the efficacy of using sternal suspension technique in correcting pectus excavatum after open repair of congenital heart disease and improve the safety of this technique. Methods A retrospective study was conducted for 8 cases of pectus excavatum treated with sternal suspension procedure after open repair of congenital heart disease from October 2005 to October 2018 in our institution, 5 males and 3 females. The median age of patients was 5.75 years (range 3.75-12.33 years) and the median Haller index was 4.20(range 3.60-5.19). All patients underwent cardiac ultrasound and chest CT scan to evaluate the severity retrosternal adhesions. Results All patients underwent the sternal suspension procedure successfully with a median operation time 55 min (range 30-230 min) and a median blood loss of 2 ml (range 2-120 ml). There was one patient suffered pneumothorax after operation. The patients were followed up for 4 months to 13 years with an excellent and good outcome. Conclusion Sternal suspension technique is a safe and effective procedure for pectus excavatum. To improve the security and reduce the incidence of cardiac injury, sternal suspension technique is a promising alternative for pectus patients with severe adhesion after open repair of congenital heart disease. Key words: Pectus excavatum; Sternal suspension; Nuss procedure; Congenital heart disease

Correction of pectus excavatum using a sternal elevator: preliminary report

Minimally invasive bar repair for ‘redo’ correction of pectus excavatum

Aim: Simultaneous surgical correction of pectus excavatum (PE) and cardiac pathology has been increasingly considered in recent years. This approach may reduce the technical challenges and complication risks compared to performing chest wall correction as a separate procedure in patients with a history of median sternotomy. Although the literature on its feasibility, safety, and long-term outcomes is limited, current evidence suggests potential benefits when applied in appropriately selected patients. Materials and Methods: This single-center retrospective study included four patients who underwent simultaneous correction of PE and open-heart surgery via median sternotomy between 2015 and 2023. Demographic, operative, and postoperative data were collected. All patients underwent the Nuss procedure after intracardiac intervention. Results: The cohort comprised four males, mean age 37.0±26.2 years (range: 20-78). Concomitant procedures were atrial septal defect repair, aortic root replacement, mitral valve replacement, and multi-vessel coronary artery bypass grafting. One or two pectus bars were placed in each case, with no intraoperative complications. One patient (25%) died postoperatively from cardiac arrhythmia unrelated to chest wall repair. Among survivors, complications were limited to one pleural effusion. Two patients underwent elective bar removal. Median follow-up was 58 months (range: 14-108). Conclusion: Simultaneous PE repair during median sternotomy for cardiac surgery is technically feasible and safe. It eliminates the need for staged procedures, minimizes retrosternal dissection risks, and optimizes surgical exposure. Careful planning and intraoperative coordination are critical for successful outcomes. These findings support the broader adoption of this strategy in selected patients with coexisting thoracic and cardiac anomalies.

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.

Nuss surgery is effective in correcting pectus excavatum (PE), with a recurrence rate of 1.2-27%. Re-do surgery is successful but still has a 6% failure rate. Patients with obstructive sleep apnea (OSA) experience repetitive PE-associated sternal depression during sleep. As the prevalence of OSA among PE patients is higher than the average, co-existing OSA in PE patients might negatively affect the efficacy of Nuss surgery. This study aimed to evaluate the impact of co-existing OSA on Nuss surgery in patients with PE. In total, 20 adult patients with PE only and 9 patients with PE and OSA were analyzed. Polysomnography was performed before Nuss surgery to evaluate OSA. Sternovertebral distance (SVD) and radiographic Haller index (RHI) were recorded before surgery and at 3, 6, and 24 months postoperatively. The results showed that percentage changes in SVD in patients with PE only at 3, 6, and 24 months postoperatively were significantly increased compared with those in the patients with PE and OSA (31.1% vs. 14.1% at 3 months; 37.5% vs. 21.4% at 6 months; 42.5% vs. 19.2% at 24 months). Meanwhile, percentage changes in RHI were significantly lower in patients with PE alone than in the patients with PE and OSA (-22.9% vs. -9.3% at 3 months; -27.9% vs. -18.7% at 6 months; -30.6% vs. -16.7% at 24 months). This study showed that co-existing OSA might reduce the efficacy of Nuss surgery for patients with PE. We recommend that patients with PE should be evaluated and treated for OSA before surgery to prevent surgical failure after bar removal.

Objective: Pectus excavatum is a deformity that occurs at the lower part of the sternum of the thorax, including the xiphoid process. Deformity generally causes cosmetic and psychosocial problems. Life-threatening conditions may ensue in patients with severe deformities. Ravitch surgery and Nuss's minimally invasive surgical procedures are the main procedures for correcting the pectus excavatum. A rare method of pectus excavatum is the stabilization of the sternum by using sternal plates. In this report, we present a case; successful pectus excavatum repair using the sternal plate simultaneously in a 48-year-old male patient who underwent Bentall operation due to ascending aortic aneurysm and aortic valve insufficiency. Case presentation: The patient was admitted with complaint of dyspnea. Examinations including clinical examinations, echocardiography, computed tomography and pulmonary tests revealed pectus excavatum, with Haller index&amp;qt;3.5, reduced forced vital capacity 72% and ascending aorta aneurysm of 5.7 cm and moderate aortic valve regurgitation. The decision to proceed with simultaneous aortic root and aortic valve replacement with pectus excavatum correction was taken. The operation were performed successfully under cardiopulmonary bypass without complications. Patient was discharged on 9th postoperative day. Conclusion: In patients with pectus excavatum deformity who undergo cardiac surgery (in our case ascending aorta and aortic valve replacement) with median sternotomy, simultaneous sternal repair using a sternal plate is safe and preferable because it positively affects cardiac and pulmonary surgical outcomes. Therefore, we recommend simultaneous sternal plate application in patients with pectus excavatum who will have a cardiac operation.

Objective To study thoracic re-remodeling and therapeutic effect after the bar removal for pectus excavatum corrected by minimal-invasive technique. Methods 145 cases with pectus excavatum, male 115, femal 30; adults in 59, children 86; corrected by minimal -invasive technique improved and performed by the same group surgeon. Bar removed 12-82 months after the procedure, appraising index of curative effects include in chest appearance, thoracic index, thoracic computer tomography(CT) and the distance between the behind of sternum to the anterior border of thoracic spine in the sagittal view. Results The chest shape was good. Thoracic index: before bar removal 2.36±0.32 in children, 2.60±0.45 in adults; after that, 2.77±0.44 in children, 3.04±0.56 in adults. There was all subsidence on the each point of the sternum, descent the maximum at the inferior end of the midsternum, (15.18±7.95)mm in children, (14.93±8.81)mm in adults, comparing with bar removal before and after. There was statistical significance. Not the signs of compressing the heart on the CT view. The time interval of the bar removed 3-year in children, 5-year in adults without affecting the development of the patients’ thorax. Conclusion The sternum descended slightly after bar removal when pectus excavatum corrected to expecting effects. After that, thoracic remodeling again, the chest shape well. Key words: Pectus excavatum Minimally invasive surgery Thoracic remodeling Early efficacy