Clinical study on minimally invasive weaving technique for pectus carinatum_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

MO Yijun ¹ , LIN Lina ² , YAN Jun ¹ , ZHONG Chenghua ¹ , KUANG Jun ¹ , GUO Quanwei ¹ , TAN Jianfeng ¹ , LI Dongfang ¹ ,  ZHANG Jianhua ¹

1. Department of Thoracic Surgery, Shenzhen Hospital, Southern Medical University, Shenzhen, 518101, Guangdong, P.R.China;
2. School of Nursing, Xinhua College of Sun Yat-Sen University, Guangzhou, 510520, P.R.China;

Corresponding author：

ZHANG Jianhua, Email: 815460356@qq.com

Keywords：

Pectus carinatum; minimally invasive therapy; chest wall deformity; weaving technique

DOI：

10.7507/1007-4848.201901019

Video：

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Objective To explore the practical feasibility of the weaving technique for pectus carinatum.Methods From January 2011 to December 2018, a total of 51 patients with pectus carinatum, including 47 males and 4 females at age of 9-29 (13.7±2.9) years, were applied with minimally invasive waving technique for the correction. The steel plate was inserted through the subcutaneous layer, intercostal space and over the sternal surface under direct thoracoscopic vision. The number of implanted steel plates was determined by the degree of chest wall deformity. The steel plate was removed 2 years after surgery.Results All the operations were successfully completed, the average operation time was 63.9±15.8 min, the amount of bleeding was 19.8±8.8 mL, and the duration of postoperative hospitalization was 4.6±1.6 d. The adverse events included intercostal artery injury (n=2), pneumothorax (n=4), pleural effusion (n=3) and skin rupture (n=1). And there were 29 patients of moderate pain (numerical rating scale 4-6 points) on the first day after surgery, but no patient was asked to remove the steel palate due to intolerable discomfort. All patients were followed up after plate placement. Of the 51 patients, the plates were removed in 37 patients until 2 years after placement, and the duration of postoperative hospitalization was 1.4±0.5 d. After 33 (1-48) months of routine follow-up after the removal of the plate, 22 patients achieved excellent outcomes and 9 patients with good outcomes. Besides, there were 5 patients with fair outcome and 1 patient with poor outcome. No adverse effect was found in growth and development after the steel plate placement.Conclusion Minimally invasive weaving technique is a safe, feasible, effective and individualized operation for pectus carinatum with substantial thoracic reconstruction.

Citation： MO Yijun, LIN Lina, YAN Jun, ZHONG Chenghua, KUANG Jun, GUO Quanwei, TAN Jianfeng, LI Dongfang, ZHANG Jianhua. Clinical study on minimally invasive weaving technique for pectus carinatum. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2019, 26(11): 1119-1124. doi: 10.7507/1007-4848.201901019 Copy

1.	Kuru P, Cakiroglu A, Er A, et al. Pectus excavatum and pectus carinatum: associated conditions, family history, and postoperative patient satisfaction. Korean J Thorac Cardiovasc Surg, 2016, 49(1): 29-34.
2.	Robicsek F, Sanger PW, Taylor FH, et al. The surgical treatment of chondrosternal prominence (pectus carinatum). J Thorac Cardiovasc Surg, 1963, 45: 691-701.
3.	Steinmann C, Krille S, Mueller A, et al. Pectus excavatum and pectus carinatum patients suffer from lower quality of life and impaired body image: a control group comparison of psychological characteristics prior to surgical correction. Eur J Cardiothorac Surg, 2011, 40(5): 1138-1145.
4.	Knudsen MV, Grosen K, Pilegaard HK, et al. Surgical correction of pectus carinatum improves perceived body image, mental health and self-esteem. J Pediatr Surg, 2015, 50(9): 1472-1476.
5.	Ravitch MM. Operative correction of pectus carinatum (pigeon breast). Ann Surg, 1960, 151(5): 705-714.
6.	Fonkalsrud EW, Mendoza J. Open repair of pectus excavatum and carinatum deformities with minimal cartilage resection. Am J Surg, 2006, 191(6): 779-784.
7.	Abramson H, D'Agostino J, Wuscovi S. A 5-year experience with a minimally invasive technique for pectus carinatum repair. J Pediatr Surg, 2009, 44(1): 118-123.
8.	Park HJ, Kim KS. The sandwich technique for repair of pectus carinatum and excavatum/carinatum complex. Ann Cardiothorac Surg, 2016, 5(5): 434-439.
9.	Kálmán A. Initial results with minimally invasive repair of pectus carinatum. J Thorac Cardiovasc Surg, 2009, 138(2): 434-438.
10.	Saxena AK, Willital GH. Valuable lessons from two decades of pectus repair with the Willital-Hegemann procedure. J Thorac Cardiovasc Surg, 2007, 134(4): 871-876.
11.	Fonkalsrud EW, Anselmo DM. Less extensive techniques for repair of pectus carinatum: the undertreated chest deformity. J Am Coll Surg, 2004, 198(6): 898-905.
12.	Del Frari B, Schwabegger AH. Ten-year experience with the muscle split technique, bioabsorbable plates, and postoperative bracing for correction of pectus carinatum: the Innsbruck protocol. J Thorac Cardiovasc Surg, 2011, 141(6): 1403-1409.
13.	Martinez-Ferro M, Fraire C, Bernard S. Dynamic compression system for the correction of pectus carinatum. Semin Pediatr Surg, 2008, 17(3): 194-200.
14.	Wahba G, Nasr A, Bettolli M. A less intensive bracing protocol for pectus carinatum. J Pediatr Surg, 2017, 52(11): 1795-1799.
15.	de Beer SA, Gritter M, de Jong JR, et al. The dynamic compression brace for pectus carinatum: intermediate results in 286 patients. Ann Thorac Surg, 2017, 103(6): 1742-1749.
16.	Yuksel M, Lacin T, Ermerak NO, et al. Minimally invasive repair of pectus carinatum. Ann Thorac Surg, 2018, 105(3): 915-923.
17.	Nuss D, Kelly RE Jr, Croitoru DP, et al. A 10-year review of a minimally invasive technique for the correction of pectus excavatum. J Pediatr Surg, 1998, 33(4): 545-552.
18.	李堂江, 杨小红. 改良NUSS胸廓成形术治疗儿童鸡胸疗效观察. 遵义医学院学报, 2016, 39(1): 73-75.
19.	赵寅生, 张辉, 曲毅, 等. 漏斗胸微创矫正术钢板微创治疗鸡胸的效果及不良反应. 海南医学, 2018, 29(6): 858-859.
20.	杜杰, 胡型锑, 赵琦峰, 等. Abramson微创手术治疗鸡胸6例分析. 温州医学院学报, 2013, 43(11): 734-736.
21.	赵富东, 储生雷, 赵玉彪, 等. 用Nuss胸廓成形术治疗大龄儿童鸡胸的可行性研讨. 当代医药论丛, 2018, 16(19): 42-43.
22.	Del Frari B, Sigl S, Schwabegger AH. Complications related to pectus carinatum correction: lessons learned from 15 years' experience. Management and literature review. Plast Reconstr Surg, 2016, 128(2): 317e-329e.
23.	Knudsen MV, Pilegaard HK, Grosen K. Pain and sensory disturbances following surgical repair of pectus carinatum. J Pediatr Surg, 2018, 53(4): 733-739.

1. Kuru P, Cakiroglu A, Er A, et al. Pectus excavatum and pectus carinatum: associated conditions, family history, and postoperative patient satisfaction. Korean J Thorac Cardiovasc Surg, 2016, 49(1): 29-34.
2. Robicsek F, Sanger PW, Taylor FH, et al. The surgical treatment of chondrosternal prominence (pectus carinatum). J Thorac Cardiovasc Surg, 1963, 45: 691-701.
3. Steinmann C, Krille S, Mueller A, et al. Pectus excavatum and pectus carinatum patients suffer from lower quality of life and impaired body image: a control group comparison of psychological characteristics prior to surgical correction. Eur J Cardiothorac Surg, 2011, 40(5): 1138-1145.
4. Knudsen MV, Grosen K, Pilegaard HK, et al. Surgical correction of pectus carinatum improves perceived body image, mental health and self-esteem. J Pediatr Surg, 2015, 50(9): 1472-1476.
5. Ravitch MM. Operative correction of pectus carinatum (pigeon breast). Ann Surg, 1960, 151(5): 705-714.
6. Fonkalsrud EW, Mendoza J. Open repair of pectus excavatum and carinatum deformities with minimal cartilage resection. Am J Surg, 2006, 191(6): 779-784.
7. Abramson H, D'Agostino J, Wuscovi S. A 5-year experience with a minimally invasive technique for pectus carinatum repair. J Pediatr Surg, 2009, 44(1): 118-123.
8. Park HJ, Kim KS. The sandwich technique for repair of pectus carinatum and excavatum/carinatum complex. Ann Cardiothorac Surg, 2016, 5(5): 434-439.
9. Kálmán A. Initial results with minimally invasive repair of pectus carinatum. J Thorac Cardiovasc Surg, 2009, 138(2): 434-438.
10. Saxena AK, Willital GH. Valuable lessons from two decades of pectus repair with the Willital-Hegemann procedure. J Thorac Cardiovasc Surg, 2007, 134(4): 871-876.
11. Fonkalsrud EW, Anselmo DM. Less extensive techniques for repair of pectus carinatum: the undertreated chest deformity. J Am Coll Surg, 2004, 198(6): 898-905.
12. Del Frari B, Schwabegger AH. Ten-year experience with the muscle split technique, bioabsorbable plates, and postoperative bracing for correction of pectus carinatum: the Innsbruck protocol. J Thorac Cardiovasc Surg, 2011, 141(6): 1403-1409.
13. Martinez-Ferro M, Fraire C, Bernard S. Dynamic compression system for the correction of pectus carinatum. Semin Pediatr Surg, 2008, 17(3): 194-200.
14. Wahba G, Nasr A, Bettolli M. A less intensive bracing protocol for pectus carinatum. J Pediatr Surg, 2017, 52(11): 1795-1799.
15. de Beer SA, Gritter M, de Jong JR, et al. The dynamic compression brace for pectus carinatum: intermediate results in 286 patients. Ann Thorac Surg, 2017, 103(6): 1742-1749.
16. Yuksel M, Lacin T, Ermerak NO, et al. Minimally invasive repair of pectus carinatum. Ann Thorac Surg, 2018, 105(3): 915-923.
17. Nuss D, Kelly RE Jr, Croitoru DP, et al. A 10-year review of a minimally invasive technique for the correction of pectus excavatum. J Pediatr Surg, 1998, 33(4): 545-552.
18. 李堂江, 杨小红. 改良NUSS胸廓成形术治疗儿童鸡胸疗效观察. 遵义医学院学报, 2016, 39(1): 73-75.
19. 赵寅生, 张辉, 曲毅, 等. 漏斗胸微创矫正术钢板微创治疗鸡胸的效果及不良反应. 海南医学, 2018, 29(6): 858-859.
20. 杜杰, 胡型锑, 赵琦峰, 等. Abramson微创手术治疗鸡胸6例分析. 温州医学院学报, 2013, 43(11): 734-736.
21. 赵富东, 储生雷, 赵玉彪, 等. 用Nuss胸廓成形术治疗大龄儿童鸡胸的可行性研讨. 当代医药论丛, 2018, 16(19): 42-43.
22. Del Frari B, Sigl S, Schwabegger AH. Complications related to pectus carinatum correction: lessons learned from 15 years' experience. Management and literature review. Plast Reconstr Surg, 2016, 128(2): 317e-329e.
23. Knudsen MV, Pilegaard HK, Grosen K. Pain and sensory disturbances following surgical repair of pectus carinatum. J Pediatr Surg, 2018, 53(4): 733-739.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Clinical study on minimally invasive weaving technique for pectus carinatum

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