The Nuss procedure made safer: an effective and simple sternal elevation manoeuvre

Area of Science:

• Thoracic Surgery
• Pediatric Surgery
• Surgical Innovation

Background:

• The Nuss procedure is a standard surgical repair for pectus excavatum.
• Creating a substernal tunnel for bar placement carries risks, including cardiac perforation.
• Fatal complications necessitate safer procedural modifications.

Purpose of the Study:

• To describe two technical modifications to the Nuss procedure.
• To demonstrate the prevention of cardiac and pericardial injury during tunnel creation.
• To enhance the safety of pectus excavatum repair.

Main Methods:

• A modified Nuss procedure was performed on 25 patients with pectus excavatum.
• Techniques included initial left haemithorax entry and sternal elevation using a retractor.
• These modifications aimed to displace the heart inferiorly and improve surgical field visualization.

Main Results:

• Modified techniques expanded the anterior mediastinum, improving visualization of the introducer tip.
• Reduced friction between the introducer and pericardium was achieved.
• Surgeon's finger guidance and enhanced haemostasis confirmation were facilitated.
• The risk of pericardial sac and cardiac injury was markedly reduced.

Conclusions:

• The described modifications significantly decrease the risk of cardiac injury during the Nuss procedure.
• These technical adjustments offer a safer approach to pectus excavatum repair.
• Enhanced visualization and procedural control contribute to improved patient safety.