Sternal elevation by the crane technique during pectus excavatum repair: A quantitative analysis
Erik R de Loos1, Jean H T Daemen1,2, Nadine A Coorens1
1Division of General Thoracic Surgery, Department of Surgery, Zuyderland Medical Center, Heerlen, The Netherlands.
JTCVS Techniques
|October 14, 2021
Summary
The crane technique effectively reduces pectus excavatum deformity by 78% during the Nuss procedure. This method also elevates the anterior chest wall over a broad area, aiding surgical access.
Area of Science:
- Thoracic surgery
- Pediatric surgery
- Surgical techniques
Background:
- The crane technique is utilized to elevate the sternum for safe mediastinal access during the Nuss procedure.
- Objective quantification of the crane technique's sternal elevation effects using 3D imaging was lacking.
Purpose of the Study:
- To objectively measure the sternal elevation achieved by the crane technique during the Nuss procedure.
- To evaluate the reduction in pectus excavatum depth and the surface area of chest elevation.
Main Methods:
- Prospective cohort study of patients undergoing the Nuss procedure.
- 3D surface imaging acquired pre-incision, post-sternal lift, and post-bar implantation.
- Quantitative comparison of sternal elevation and pectus excavatum depth reduction.
Main Results:
- Thirty patients (90% male, median age 15.5 years) were included.
- Crane technique provided a median 78% reduction in sternal depression, with a residual depth of 3 mm.
- Reduction efficacy decreased with greater initial sternal depth (correlation -0.86); maximum anterior chest elevation was 26 mm.
Conclusions:
- The crane technique is effective for sternal elevation, achieving significant pectus excavatum reduction.
- The technique's effectiveness diminishes with increasing deformity depth.
- The crane technique elevates the anterior chest wall over a large surface area.
