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Efficacy and safety of modified bilateral thoracoscopy-assisted Nuss procedure in adult patients with pectus excavatum

^a Division of Thoracic Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
^b Department of Anesthesiology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC

Received 3 June 2008; received in revised form 29 July 2008; accepted 30 July 2008.

^_* Corresponding author. Address: Division of Thoracic Surgery, Department of Surgery, Tri-Service General Hospital, 325, Section 2, Cheng-Kung Road, Taipei 114, Taiwan, ROC. Tel.: +886 2 87927167; fax: +886 2 23644697. (Email: ndmc0928{at}yahoo.com.tw).

Objective: Several modifications for increasing the efficacy and safety of the minimally invasive surgery (Nuss procedure) for repair of pectus excavatum in pediatric patients were presented. In this study, we apply a modified bilateral thoracoscopic approach to adapt the Nuss procedure to adult patients. Methods: We prospectively included all adult patients with pectus excavatum corrected by modified bilateral thoracoscopy-assisted Nuss repair from July 2005 to December 2007. Technical modifications included patient positioning, surgical wounds designing, and routine use of the bilateral thoracoscopy viewing before and during mediastinal dissection. The endoscopic appearances and early complications were recorded. Results: Ninety-six adult patients (80 men, 16 women) with a mean age of 24.5 years (18–42 years) were included. Six patients were repaired due to previous failed Ravitch procedure. Pleural, mediastinal adhesions or small aberrant vessels in the mediastinal pleura were found in 19 patients. Two pectus bars were inserted in 22 patients (22.9%). The median operative time is 80 min (range from 50 to 185 min). The blood loss was mostly less than 10 cc (83 in 96 patients). In early complications, pneumothorax occurred in one (1%) patient. There was no mediastinal injury, bleeding complications, or requirement of chest tube insertion postoperatively. The mean length of hospital stay was 7.2 days (range 5–13 days). Conclusions: The modified bilateral thoracoscopy-assisted Nuss repair for adult patients could eliminate the risk of cardiopulmonary injuries. It could allow direct inspections in mediastinum and facilitate mediastinal dissection, especially in patients with recurrence, history of previous thoracic procedure or double-bar insertion. Other methods for ensuring safety such as substernal dissection or elevation may be unnecessary.

Key Words: Pectus excavatum • Nuss procedure • Adult • Thoracoscopy