Sternal elevation techniques during the minimally invasive repair of pectus excavatum

Area of Science:

• Thoracic surgery
• Pediatric surgery
• Surgical innovation

Background:

• Minimally invasive repair of pectus excavatum (MIRPE), also known as the Nuss procedure, is a common surgical technique.
• Sternal elevation techniques (SETs) are increasingly employed during MIRPE to enhance surgical outcomes.
• The effectiveness and safety of various SETs require thorough evaluation.

Purpose of the Study:

• To review the literature on sternal elevation techniques (SETs) used during MIRPE.
• To compare the efficacy and safety of different SETs, including the vacuum bell.
• To evaluate the routine use of the vacuum bell for sternal elevation in MIRPE.

Main Methods:

• Literature review of studies published between January 1998 and September 2018.
• Analysis of reported effects and side effects of various SETs during MIRPE.
• Comparison with personal experience using the vacuum bell for sternal elevation in MIRPE over 13 years.

Main Results:

• SETs, particularly in adult patients, improve visualization and safety during MIRPE.
• SETs facilitate pectus introducer advancement, retrosternal dissection, and pectus bar placement, reducing the risk of cardiac/pericardial injury.
• The vacuum bell, used intraoperatively in 131 patients, proved safe and effective, facilitating dissection and bar insertion without additional incisions, with only mild, temporary hematoma observed.

Conclusions:

• Routine use of SETs during MIRPE is increasingly reported to enhance procedural safety.
• The vacuum bell is a safe, effective, and advantageous SET for MIRPE, offering benefits over other techniques.
• Routine intraoperative use of the vacuum bell during MIRPE is recommended.