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Experience in minimally invasive Nuss operation for 406 children with pectus excavatum
Qiang Shu1, Zhuo Shi, Wei-Ze Xu
1Department of Cardiothoracic Surgery, Children's Hospital, Zhejiang University School of Medicine, and Zhejiang Key Laboratory for Diagnosis and Treatment of Neonatal Diseases, Hangzhou, 310003, China.
Insights
Thoracoscopy-assisted Nuss operation offers a minimally invasive approach for pectus excavatum (PE) repair in children. This technique demonstrates excellent outcomes with reduced operative time, minimal blood loss, and fast recovery.
Area of Science:
- Pediatric Surgery
- Thoracic Surgery
- Minimally Invasive Procedures
Background:
- Pectus excavatum (PE) is a congenital chest wall deformity affecting children.
- Traditional surgical repair can be invasive with significant morbidity.
- Minimally invasive techniques aim to improve outcomes and reduce complications.
Purpose of the Study:
- To evaluate the efficacy and safety of thoracoscopy-assisted Nuss operation for pediatric PE.
- To identify the advantages of this minimally invasive approach compared to open procedures.
Main Methods:
- A cohort of 406 children with PE underwent minimally invasive Nuss operation.
- Data collected included patient demographics, operative details, complications, and outcomes.
- Follow-up ranged from 3 months to 6 years.
Main Results:
- The procedure was successful in all patients with no operative mortality.
- Average operative time was 45 minutes with minimal blood loss (<10 mL).
- Excellent or good repair results were achieved in 98.3% of patients, with a low complication rate.
Conclusions:
- Thoracoscopy-assisted Nuss operation is a safe and effective treatment for pediatric PE.
- Advantages include small incisions, short operative time, minimal blood loss, and rapid recovery.
- This technique yields satisfactory repair outcomes with reduced patient trauma.
Background:
This study was to investigate the advantages of thoracoscopy-assisted minimally invasive Nuss operation for the treatment of pectus excavatum (PE) in children.
Methods:
A total of 406 patients with PE (female: 93; male: 313) with an average age of 6.8 years (range: 3.5-17.5 years) were included in this study. Associated diseases included congenital heart disease in 9 patients and congenital pulmonary cyst in 2. The Haller index of the patients ranged from 3.35 to 7.23, with an average of 5.17±1.64. Minimally invasive Nuss operation was performed for all the patients.
Results:
The operations were performed successfully and no operative mortality occurred. The average blood loss during the operation was less than 10 mL and the operating time ranged from 30 to 85 minutes with an average of 45 minutes. The length of hospital stay ranged from 5 to 9 days with an average of 7 days. Struts were implanted in 12 (3.0%) of the 406 patients. Injury of the pericardium occurred in 1 patient during the operation. Early post-operative complications occurred in 9 patients with pneumothorax and 6 patients with pleural effusion, which were cured by puncture or drainage. Poor wound healing occurred in 4 patients (1.0%) and was cured by nutritional support. During a 3-month to 6-year follow-up, 2 patients had scoliosis and 3 patients had displacement of the strut, which was cured by a second Nuss operation. Allergy occurred in 2 patients: the symptoms were improved in 1 patient after conservative treatment, but the strut was removed in advance due to allergy in the other patient. Totally 154 patients (40.0%) underwent operation for strut removal. Excellent repair results were achieved in 387 (95.3%) patients, good repair results in 12 (3.0%), and fair results in 7 (1.7%).
Conclusions:
Thoracoscopy-assisted Nuss operation has many advantages including small and masked incision, short operative time, minimal blood loss, fast recovery, less trauma, and satisfactory outcomes of repair. Nuss is a safe and reliable technique for repair of PE.
