The Role of Three-Dimensional Printing in the Nuss Procedure: Three-Dimensional Printed Model-Assisted Nuss Procedure

Abstract

The Nuss procedure is a minimally invasive surgery for pectus excavatum. Success of the Nuss procedure is dependent on a previously bent pectus bar that is shaped to the desired curvature of the chest wall. Traditionally, the size and curvature of the metallic pectus bar are determined by trial and error. Herein, we introduce a novel design method for the metallic pectus bar to optimize the bar curvature and outcome after the Nuss procedure. From August 2016 through March 2017, 10 consecutive patients with pectus excavatum underwent the three-dimensional (3D) printed model-assisted Nuss procedure. The computed tomography images were used to generate a 3D thorax model of pectus excavatum. The 3D models of personalized pectus bar curvature were completed by computer-aided design. Herein, we report the demographic data, treatment outcomes, and radiographic findings. All patients with pectus excavatum received one pectus bar insertion. The mean age was 19.80 ± 4.73 years (range, 12 to 26). The mean preoperative Haller index was 3.48 ± 0.35 (range, 3.06 to 3.95). We advantageously utilized preoperative planning; the mean interval change of the Haller index was 20.71% ± 4.63%. With the benefit of 3D printed model simulation, the surgical duration was 59.8 ± 23.2 minutes (range, 32 to 107). No patient had adverse events after operation. Our initial results revealed that the 3D printed model-assisted Nuss procedure reduces the surgical duration and facilitates an optimal morphological outcome.