Efficacy and safety of modified bilateral thoracoscopy-assisted Nuss procedure in adult patients with pectus excavatum.
نویسندگان
چکیده
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.
منابع مشابه
First Iranian Experience of the Minimally Invasive Nuss Procedure for Pectus Excavatum Repair: A Case Series and Literature Review
Pectus excavatum is the most common congenital deformity of the chest wall. The most frequently used techniques include Ravitch (costochondral resection) and Nuss (minimally invasive pectus repair of pectus excavatum [MIRPE]). The Nuss technique includes using temporary metallic bars without costochondral resection to correct the chest wall deformity. Modified MIRPE can be learned easily and pe...
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OBJECTIVES The minimally-invasive Nuss operation has been widely used for correcting pectus excavatum in children. However, a number of adult patients require reoperations for recurrence or other complications. This work aimed to investigate the early results of recurrent pectus excavatum repair using a modified Nuss procedure, which were seldom reported in adult patients. METHODS A retrospec...
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BACKGROUND Thoracoscopic Nuss funnel chest repair still has a significant complication rate. Bar dislocation, pneumothorax, pleural effusions, and pericarditis seem to be caused mechanical irritation by the bar. We intended to reduce these problems by further technical modification of the Nuss technique. METHODS Of 157 prospectively followed modified Nuss repairs, the last 57 patients had the...
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This compares outcome measures of current pectus excavatum (PEx) treatments, namely the Nuss and Ravitch procedures, in pediatric and adult patients. Original investigations that stratified PEx patients based on current treatment and age (pediatric=0-21; adult 17-99) were considered for inclusion. Outcome measures were: operation duration, analgesia duration, blood loss, length of stay (LOS), o...
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We present the case of a young 24-year-old woman with an important but symmetrical pectus carinatum, not associated with pectus excavatum, without cardiorespiratory symptoms but with significant psychosocial implications for the patient, solved by the minimally invasive technique described by Abramson(reversed Nuss procedure) - MIRPC (Minimally invasive Repair of Pectus carinatum). The sternal ...
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ورودعنوان ژورنال:
- European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
دوره 34 5 شماره
صفحات -
تاریخ انتشار 2008