Nuss procedure without videothoracoscopy.

Area of Science:

• Thoracic surgery
• Minimally invasive procedures
• Congenital chest wall deformities

Background:

• The Nuss procedure is standard for pectus excavatum.
• Previous thoracic surgery can cause adhesions, complicating the Nuss procedure.
• Recurrent spontaneous pneumothorax may necessitate extensive pleural procedures.

Purpose of the Study:

• To describe a modified Nuss technique for pectus excavatum repair.
• To address technical challenges in patients with prior thoracic surgery and adhesions.
• To present a safe and effective alternative approach for complex cases.

Main Methods:

• A modified Nuss operation was performed on a patient with a history of bilateral apical wedge resection and total pleurectomy.
• The pleura was opened bilaterally.
• Retrosternal release was achieved using digital palpation via a subxiphoid incision.
• Videothoracoscopic visualization was not utilized.

Main Results:

• The modified technique allowed for safe guidance of the introducer and pectus bar.
• Successful correction of the pectus excavatum deformity was achieved.
• The approach mitigated risks associated with severe intrathoracic adhesions.

Conclusions:

• This modified Nuss procedure offers a viable solution for pectus excavatum repair in complex cases with prior thoracic surgery.
• Digital palpation via a subxiphoid incision is a safe alternative to videothoracoscopy for retrosternal dissection.
• The technique potentially reduces operative time and complexity in challenging pectus excavatum reconstructions.