A novel approach to eliminate cardiac perforation in the nuss procedure

Pectus excavatum is the most common congenital abnormality of the chest wall. It may lead to adverse psychosocial development and preoccupation with a negative body image. The Nuss procedure is a minimally invasive approach for improving these patients' body image. The most dangerous complication is cardiac perforation from the insertion of the introducer. Our technique modifies this procedure to include a small subxiphoid incision and a novel sternal lift system that elevates the sternum. This facilitates the insertion of the introducer and placement of the pectus bar(s), and it reduces the risk of intraoperative cardiac perforation.