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Nuss bar procedure: past, present and future.

Donald Nuss¹, Robert J Obermeyer¹, Robert E Kelly¹

¹Department of Surgery, Eastern Virginia Medical School, 601 Children'S Lane, Norfolk, Virginia 23507, USA.

Annals of Cardiothoracic Surgery

|October 18, 2016

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Surgical repair of pectus excavatum evolved from open procedures to the minimally invasive Nuss technique. This closed repair, utilizing internal bracing, has become widely accepted, leading to improved outcomes and standardized protocols for this chest wall deformity.

Area of Science:

Thoracic surgery
Pediatric surgery
Surgical innovation

Background:

Pectus excavatum repair historically involved open procedures with significant morbidity.
Early techniques like rib resection and sternal osteotomy led to chest wall rigidity and physician reluctance.
The development of the Nuss procedure marked a paradigm shift in pectus excavatum treatment.

Approach:

The Nuss procedure employs a minimally invasive technique using thoracoscopy and a substernal bar for internal bracing.
This closed repair avoids cartilage and sternal resection, reducing chest wall rigidity.
Advancements include specialized instruments, stabilizers, pericostal sutures, and improved mediastinal protection.

Key Points:

The Nuss procedure has led to rapid improvements and modifications due to increased patient volume.

Keywords:

Pectus excavatum history minimally invasive repair post-operative management technique

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Cardiopulmonary studies reveal that severe pectus excavatum causes right-sided cardiac compression and reduced stroke volume.

Pulmonary restriction and obstruction correlate with deformity severity and cardiac displacement.

Conclusions:

The Nuss procedure has become the standard of care for pectus excavatum, with high success rates.
Standardized protocols and improved pain management enhance post-operative care.
Ongoing innovations promise further advancements in pectus excavatum treatment.