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Technical modifications in stabilisers and in bar removal in the Nuss procedure

Department of Thoracic Surgery, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil

Received 3 November 2008; received in revised form 12 March 2009; accepted 23 March 2009.

^_* Corresponding author. Address: Av. Barão de Monte Mor n. 341, Apto. 241, Real Park, São Paulo 05687.010, Brazil. Tel.: +55 11 30697145; fax: +55 11 30697145. (Email: jribas{at}usp.br).

Pectus excavatum is a congenital deformity that can require surgical treatment. Since Nuss proposed a correction technique, several modifications have been proposed in order to achieve more safety and efficiency in the placement and removal of both bars. Our objective is to describe the technique of placing and removing the bars by proposing three technical modifications: two in bar placement and one in the bar removal. We describe two cases where Nuss bars were placed and one case where the bar was removed as per the technical modification proposed herein. According to the original technique, bar stabilisers were placed close to the lateral bar edges. We propose a more medial position in order to reduce bar displacement. New stabilisers were designed with central grooves in the posterior surface, which allow better sliding. The technical modification suitable for bar removal was the use of a protective film around the bars to protect the surrounding tissues from the sharp edges, and thereby minimise the risk of injuries. All the proposed modifications were performed without any additional surgical risk or perioperative complication. These three technical modifications can be easily and safely performed, and seem to reduce the risk of bleeding with no additional perioperative complications.

Key Words: Chest wall • Congenital malformations • Pectus excavatum • Minimally invasive surgical repair • Nuss technique