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Published in: Pediatric Surgery International 6/2012

01-06-2012 | Original Article

A new sternum elevator reduces severe complications during minimally invasive repair of the pectus excavatum

Authors: Satoshi Takagi, Takuto Oyama, Nishihira Tomokazu, Koji Kinoshita, Taro Makino, Hiroyuki Ohjimi

Published in: Pediatric Surgery International | Issue 6/2012

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Abstract

Introduction

Although the Nuss procedure for pectus excavatum is widely employed, a variety of complications have been reported with relatively high frequency; those that involve cardiac and pericardial injuries can be life threatening. To reduce such dangers, we present here a newly developed sternal elevator.

Materials and methods

The elevator is horseshoe shaped. Its elevator side has the same curvature as a Nuss introducer, so that interference between devices is minimal and no extra skin incision is needed for the elevator insertion. The elevator holds the sternum forward and enlarges the retrosternal space for safer passage of thoracoscopically guided introducer.

Results

The authors have used the elevator for 61 pectus excavatum cases between March 2004 and December 2009 without any major complications. The entire process of substernal tunneling was endoscopically observed, which eliminated any blunt and blind dissection, even in a significantly depressed funnel chest case. With the device, the sternum was effectively elevated again for the placement of the second plate in 30 cases.

Conclusion

Our newly developed sternum elevator makes the Nuss procedure safer and more affordable without introducing any extra scarring.
Literature
1.
go back to reference Nuss D, Kelly RE Jr, Croitoru DP, Katz ME (1998) A 10-year review of a minimally invasive technique for the correction of pectus excavatum. J Pediatr Surg 33(4):545–552 (pii:S0022-3468(98)90314-1)PubMedCrossRef Nuss D, Kelly RE Jr, Croitoru DP, Katz ME (1998) A 10-year review of a minimally invasive technique for the correction of pectus excavatum. J Pediatr Surg 33(4):545–552 (pii:S0022-3468(98)90314-1)PubMedCrossRef
2.
go back to reference Shamberger RC (2000) Cardiopulmonary effects of anterior chest wall deformities. Chest Surg Clin N Am 10(2):245–252PubMed Shamberger RC (2000) Cardiopulmonary effects of anterior chest wall deformities. Chest Surg Clin N Am 10(2):245–252PubMed
4.
go back to reference Kelly RE Jr, Shamberger RC, Mellins RB, Mitchell KK, Lawson ML, Oldham K, Azizkhan RG, Hebra AV, Nuss D, Goretsky MJ, Sharp RJ, Holcomb GW 3rd, Shim WK, Megison SM, Moss RL, Fecteau AH, Colombani PM, Bagley TC, Moskowitz AB (2007) Prospective multicenter study of surgical correction of pectus excavatum: design, perioperative complications, pain, and baseline pulmonary function facilitated by internet-based data collection. J Am Coll Surg 205(2):205–216. doi:10.1016/j.jamcollsurg.2007.03.027 PubMedCrossRef Kelly RE Jr, Shamberger RC, Mellins RB, Mitchell KK, Lawson ML, Oldham K, Azizkhan RG, Hebra AV, Nuss D, Goretsky MJ, Sharp RJ, Holcomb GW 3rd, Shim WK, Megison SM, Moss RL, Fecteau AH, Colombani PM, Bagley TC, Moskowitz AB (2007) Prospective multicenter study of surgical correction of pectus excavatum: design, perioperative complications, pain, and baseline pulmonary function facilitated by internet-based data collection. J Am Coll Surg 205(2):205–216. doi:10.​1016/​j.​jamcollsurg.​2007.​03.​027 PubMedCrossRef
5.
go back to reference Park HJ, Lee SY, Lee CS (2004) Complications associated with the Nuss procedure: analysis of risk factors and suggested measures for prevention of complications. J Pediatr Surg 39(3):391–395 (pii:S0022346803008704)PubMedCrossRef Park HJ, Lee SY, Lee CS (2004) Complications associated with the Nuss procedure: analysis of risk factors and suggested measures for prevention of complications. J Pediatr Surg 39(3):391–395 (pii:S0022346803008704)PubMedCrossRef
6.
go back to reference Boehm RA, Muensterer OJ, Till H (2004) Comparing minimally invasive funnel chest repair versus the conventional technique: an outcome analysis in children. Plast Reconstr Surg 114(3):668–673 (discussion 674–665. pii:00006534-200409010-00007)PubMedCrossRef Boehm RA, Muensterer OJ, Till H (2004) Comparing minimally invasive funnel chest repair versus the conventional technique: an outcome analysis in children. Plast Reconstr Surg 114(3):668–673 (discussion 674–665. pii:00006534-200409010-00007)PubMedCrossRef
7.
go back to reference Uemura S, Nakagawa Y, Yoshida A, Choda Y (2003) Experience in 100 cases with the Nuss procedure using a technique for stabilization of the pectus bar. Pediatr Surg Int 19(3):186–189. doi:10.1007/s00383-002-0915-z PubMed Uemura S, Nakagawa Y, Yoshida A, Choda Y (2003) Experience in 100 cases with the Nuss procedure using a technique for stabilization of the pectus bar. Pediatr Surg Int 19(3):186–189. doi:10.​1007/​s00383-002-0915-z PubMed
8.
go back to reference Nuss D, Croitoru DP, Kelly RE Jr, Goretsky MJ, Nuss KJ, Gustin TS (2002) Review and discussion of the complications of minimally invasive pectus excavatum repair. Eur J Pediatr Surg 12(4):230–234. doi:10.1055/s-2002-34485 PubMedCrossRef Nuss D, Croitoru DP, Kelly RE Jr, Goretsky MJ, Nuss KJ, Gustin TS (2002) Review and discussion of the complications of minimally invasive pectus excavatum repair. Eur J Pediatr Surg 12(4):230–234. doi:10.​1055/​s-2002-34485 PubMedCrossRef
9.
go back to reference Croitoru DP, Kelly RE Jr, Goretsky MJ, Lawson ML, Swoveland B, Nuss D (2002) Experience and modification update for the minimally invasive Nuss technique for pectus excavatum repair in 303 patients. J Pediatr Surg 37(3):437–445 (pii:S0022346802303683)PubMedCrossRef Croitoru DP, Kelly RE Jr, Goretsky MJ, Lawson ML, Swoveland B, Nuss D (2002) Experience and modification update for the minimally invasive Nuss technique for pectus excavatum repair in 303 patients. J Pediatr Surg 37(3):437–445 (pii:S0022346802303683)PubMedCrossRef
10.
go back to reference Miller KA, Woods RK, Sharp RJ, Gittes GK, Wade K, Ashcraft KW, Snyder CL, Andrews WM, Murphy JP, Holcomb GW 3rd (2001) Minimally invasive repair of pectus excavatum: a single institution’s experience. Surgery 130(4):652–657. doi:10.1067/msy.2001.116917 (discussion 657-659)PubMedCrossRef Miller KA, Woods RK, Sharp RJ, Gittes GK, Wade K, Ashcraft KW, Snyder CL, Andrews WM, Murphy JP, Holcomb GW 3rd (2001) Minimally invasive repair of pectus excavatum: a single institution’s experience. Surgery 130(4):652–657. doi:10.​1067/​msy.​2001.​116917 (discussion 657-659)PubMedCrossRef
11.
go back to reference Hebra A, Swoveland B, Egbert M, Tagge EP, Georgeson K, Othersen HB Jr, Nuss D (2000) Outcome analysis of minimally invasive repair of pectus excavatum: review of 251 cases. J Pediatr Surg 35(2):252–257 (discussion 257–258. pii:S0022-3468(00)90019-8)PubMedCrossRef Hebra A, Swoveland B, Egbert M, Tagge EP, Georgeson K, Othersen HB Jr, Nuss D (2000) Outcome analysis of minimally invasive repair of pectus excavatum: review of 251 cases. J Pediatr Surg 35(2):252–257 (discussion 257–258. pii:S0022-3468(00)90019-8)PubMedCrossRef
14.
go back to reference Moss RL, Albanese CT, Reynolds M (2001) Major complications after minimally invasive repair of pectus excavatum: case reports. J Pediatr Surg 36(1):155–158 (pii:S0022346801420410)PubMedCrossRef Moss RL, Albanese CT, Reynolds M (2001) Major complications after minimally invasive repair of pectus excavatum: case reports. J Pediatr Surg 36(1):155–158 (pii:S0022346801420410)PubMedCrossRef
15.
go back to reference Willekes CL, Backer CL, Mavroudis C (1999) A 26-year review of pectus deformity repairs, including simultaneous intracardiac repair. Ann Thorac Surg 67(2):511–518 (pii:S0003-4975(99)00015-6)PubMedCrossRef Willekes CL, Backer CL, Mavroudis C (1999) A 26-year review of pectus deformity repairs, including simultaneous intracardiac repair. Ann Thorac Surg 67(2):511–518 (pii:S0003-4975(99)00015-6)PubMedCrossRef
16.
go back to reference Hamajima A, Suzuki N, Kuroiwa M, Suzuki M, Sakamoto J, Tsuchida Y (2003) A technique for the Nuss procedure using a U-shaped elevator. Jpn J Pediatr Surg 35:722–726 Hamajima A, Suzuki N, Kuroiwa M, Suzuki M, Sakamoto J, Tsuchida Y (2003) A technique for the Nuss procedure using a U-shaped elevator. Jpn J Pediatr Surg 35:722–726
Metadata
Title
A new sternum elevator reduces severe complications during minimally invasive repair of the pectus excavatum
Authors
Satoshi Takagi
Takuto Oyama
Nishihira Tomokazu
Koji Kinoshita
Taro Makino
Hiroyuki Ohjimi
Publication date
01-06-2012
Publisher
Springer-Verlag
Published in
Pediatric Surgery International / Issue 6/2012
Print ISSN: 0179-0358
Electronic ISSN: 1437-9813
DOI
https://doi.org/10.1007/s00383-012-3087-5

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