The use of a vacuum bell in minimally invasive repair of pectus excavatum

Abstract

BACKGROUND: Along with the widespread use of D. Nuss surgery, the number of complications and deaths has increased. In order to increase the safety of the procedure, various methods of sternal elevation are used. One of these methods is the use of a vacuum bell. This method allows you to perform the elevation of the sternum by creating a negative pressure. AIM: This article describes our experience of intraoperative and preoperative use of a vacuum bell when performing thoracoplasty according to Nass in our own modification METHODS: The experience of treating 15 patients aged 8 to 17 years (average age 15.0±2.6 years) operated by the D. Nuss method using vacuum bell is considered. Indications for intraoperative elevation of the sternum were cases of deep pectus excavatum (PE) (Haller index more than 4.5), a variant of the “Grand Canyon" deformation and PE after sternotomy. Also, the vacuum bell was used as a preoperative preparation. RESULTS: In patients who used a vacuum bell before surgery as preparation, the depth of deformation significantly decreased and at the time of surgery, the average depth of deformation was 6.7±4.0 mm, versus 28.0±6.0 mm before treatment. There was also a decrease in pain syndrome in the postoperative period, a reduction in the use of extended epidural anaesthesia and nonsteroidal anti-inflammatory drugs. With the intraoperative use of a vacuum bell in patients with PE after sternotomy, the elevation of the sternum was confirmed by thoracoscopy. No intra- and postoperative complications were observed in 14 (93%) patients who used a vacuum bell during thoracoplasty by Nass. In one case, a patient who had previously undergone a sternotomy had massive bleeding as a result of a heart injury. CONCLUSION: The use of a vacuum bell during thoracoplasty by Nass has proven to be a safe, non-invasive and effective method of sternum elevation, both intraoperatively and as a preoperative preparation.