Clinical efficacy of thoracoscopy-assisted modified Nuss procedure in children with pectus excavatum: A retrospective analysis in a single center_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

TAO Shaolin , KANG Poming , FENG Yonggeng , FANG Chunshu , WU Licheng , DENG Bo ,  TAN Qunyou

Department of Thoracic Surgery, Daping Hospital, Army Medical University, Chongqing, 400042, P. R. China;

Corresponding author：

TAN Qunyou, Email: tanqy001@163.com

Keywords：

Pectus excavatum; children; Nuss operation; thoracoscopy-assisted surgery

DOI：

10.7507/1007-4848.202102001

Video：

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Objective To explore the clinical efficacy of thoracoscopy-assisted modified Nuss procedure for pectus excavatum (PE) in children.Methods The clinical data of patients with PE who underwent thoracoscopy-assisted modified Nuss procedure from October 2013 to October 2020 in Daping Hospital were retrospectively analyzed.Results A total of 86 patients were collected, including 79 males and 7 females with a mean age of 14.03±3.36 years. The operations were performed successfully in all patients without intraoperative cardiac vascular injury or perioperative death. The mean operation time was 87.30±33.45 min, bleeding volume was 19.94±14.60 mL, and the postoperative hospitalization stay time was 6.89±2.59 d. Early postoperative complications included 2 patients of pneumothorax, 2 patients of wound fat liquefaction and infection, 2 patients of bar flipping and displacement. One patient had bar displacement 1 year after the surgery. The total complication rate was 8.14%. All patients were followed up for 3-42 months. The bars were taken out about 36 months after the surgery. According to the evaluation criteria of orthopedic effect, 68 (79.07%) patients were excellent, 10 (11.63%) patients were good, 5 (5.81%) patients were moderate and 3 (3.49%) patients were poor.Conclusion Minimally invasive and individualized shaping via the Nuss procedure for PE children is safe and convenient, with satisfied effect. It is worthy of popularization in the clinic.

Citation： TAO Shaolin, KANG Poming, FENG Yonggeng, FANG Chunshu, WU Licheng, DENG Bo, TAN Qunyou. Clinical efficacy of thoracoscopy-assisted modified Nuss procedure in children with pectus excavatum: A retrospective analysis in a single center. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2023, 30(6): 867-872. doi: 10.7507/1007-4848.202102001 Copy

1.	Jaroszewski DE, Velazco CS, Pulivarthi VSKK, et al. Cardiopulmonary function in thoracic wall deformities: What do we really know? Eur J Pediatr Surg, 2018, 28(4): 327-346.
2.	Fibla JJ, Molins L. Minimally invasive treatment of pectus excavatum. Minerva Chir, 2016, 71(1): 38-45.
3.	Hadolt B, Wallisch A, Egger JW, et al. Body-image, self-concept and mental exposure in patients with pectus excavatum. Pediatr Surg Int, 2011, 27(6): 665-670.
4.	Takanari K, Toriyama K, Kambe M, et al. Nuss procedure for patients with pectus excavatum with a history of intrathoracic surgery. J Plast Reconstr Aesthet Surg, 2019, 72(6): 1025-1029.
5.	Mennie N, Frawley G, Crameri J, et al. The effect of thoracoscopy upon the repair of pectus excavatum. J Pediatr Surg, 2018, 53(4): 740-743.
6.	Bhatnagar V, Sharma N, Dhua A, et al. Surgical correction of pectus excavatum using a rib graft strut following excision of costal cartilages. J Indian Assoc Pediatr Surg, 2019, 24(4): 252-256.
7.	Pilegaard HK. Single centre experience on short bar technique for pectus excavatum. Ann Cardiothorac Surg, 2016, 5(5): 450-455.
8.	Jayaramakrishnan K, Wotton R, Bradley A, et al. Does repair of pectus excavatum improve cardiopulmonary function? Interact Cardiovasc Thorac Surg, 2013, 16(6): 865-870.
9.	Nuss D, Kelly RE, 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.
10.	Tikka T, Kalkat MS, Bishay E, et al. A 20-year review of pectus surgery: An analysis of factors predictive of recurrence and outcomes. Interact Cardiovasc Thorac Surg, 2016, 23(6): 908-913.
11.	Garzi A, Prestipino M, Rubino MS, et al. Complications of the "Nuss procedure" in pectus excavatum. Transl Med UniSa, 2020, 22: 24-27.
12.	王磊, 胡丰庆, 王明松, 等. 漏斗胸的手术设计与新型改良Nuss手术. 中国胸心血管外科临床杂志, 2020, 27(8): 900-906.
13.	Abdullah F, Harris J. Pectus excavatum: More than a matter of aesthetics. Pediatr Ann, 2016, 45(11): e403-e406.
14.	Zhang DK, Tang JM, Ben XS, et al. Surgical correction of 639 pectus excavatum cases via the Nuss procedure. J Thorac Dis, 2015, 7(9): 1595-1605.
15.	陶麒麟, 贾兵, 闫宪刚, 等. 单切口改良Nuss手术矫治儿童漏斗胸. 中国微创外科杂志, 2016, 16(2): 127-130.
16.	Baccarani A, Aramini B, Casa GD, et al. Pectoralis muscle transposition in association with the ravitch procedure in the management of severe pectus excavatum. Plast Reconstr Surg Glob Open, 2019, 7(9): e2378.
17.	Nuss D, Obermeyer RJ, Kelly RE. Pectus excavatum from a pediatric surgeon's perspective. Ann Cardiothorac Surg, 2016, 5(5): 493-500.
18.	刘文英. 关于漏斗胸手术治疗的若干问题. 临床小儿外科杂志, 2016, 15(2): 110-113.
19.	Esteves E, Paiva KC, Calcagno-Silva M, et al. Treatment of pectus excavatum in patients over 20 years of age. J Laparoendosc Adv Surg Tech A, 2011, 21(1): 93-96.
20.	Durry A, Gomes Ferreira C, Tricard T, et al. Minimally invasive repair of pectus excavatum in children: Results of a modified Nuss procedure. Ann Chir Plast Esthet, 2017, 62(1): 8-14.
21.	Esteva Miró C, Núñez García B, Pérez-Gaspar M, et al. Applicability of Clavien-Dindo classification in Nuss procedure surgical complications. Cir Pediatr, 2020, 33(4): 154-159.
22.	Pilegaard HK. Nuss technique in pectus excavatum: A mono-institutional experience. J Thorac Dis, 2015, 7(Suppl 2): S172-S176.
23.	Kabbaj R, Burnier M, Kohler R, et al. Minimally invasive repair of pectus excavatum using the Nuss technique in children and adolescents: indications, outcomes, and limitations. Orthop Traumatol Surg Res, 2014, 100(6): 625-630.
24.	Hebra A, Kelly RE, Ferro MM, et al. Life-threatening complications and mortality of minimally invasive pectus surgery. J Pediatr Surg, 2018, 53(4): 728-732.
25.	Park HJ, Kim JJ, Park JK, et al. Effects of Nuss procedure on thoracic scoliosis in patients with pectus excavatum. J Thorac Dis, 2017, 9(10): 3810-3816.

1. Jaroszewski DE, Velazco CS, Pulivarthi VSKK, et al. Cardiopulmonary function in thoracic wall deformities: What do we really know? Eur J Pediatr Surg, 2018, 28(4): 327-346.
2. Fibla JJ, Molins L. Minimally invasive treatment of pectus excavatum. Minerva Chir, 2016, 71(1): 38-45.
3. Hadolt B, Wallisch A, Egger JW, et al. Body-image, self-concept and mental exposure in patients with pectus excavatum. Pediatr Surg Int, 2011, 27(6): 665-670.
4. Takanari K, Toriyama K, Kambe M, et al. Nuss procedure for patients with pectus excavatum with a history of intrathoracic surgery. J Plast Reconstr Aesthet Surg, 2019, 72(6): 1025-1029.
5. Mennie N, Frawley G, Crameri J, et al. The effect of thoracoscopy upon the repair of pectus excavatum. J Pediatr Surg, 2018, 53(4): 740-743.
6. Bhatnagar V, Sharma N, Dhua A, et al. Surgical correction of pectus excavatum using a rib graft strut following excision of costal cartilages. J Indian Assoc Pediatr Surg, 2019, 24(4): 252-256.
7. Pilegaard HK. Single centre experience on short bar technique for pectus excavatum. Ann Cardiothorac Surg, 2016, 5(5): 450-455.
8. Jayaramakrishnan K, Wotton R, Bradley A, et al. Does repair of pectus excavatum improve cardiopulmonary function? Interact Cardiovasc Thorac Surg, 2013, 16(6): 865-870.
9. Nuss D, Kelly RE, 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.
10. Tikka T, Kalkat MS, Bishay E, et al. A 20-year review of pectus surgery: An analysis of factors predictive of recurrence and outcomes. Interact Cardiovasc Thorac Surg, 2016, 23(6): 908-913.
11. Garzi A, Prestipino M, Rubino MS, et al. Complications of the "Nuss procedure" in pectus excavatum. Transl Med UniSa, 2020, 22: 24-27.
12. 王磊, 胡丰庆, 王明松, 等. 漏斗胸的手术设计与新型改良Nuss手术. 中国胸心血管外科临床杂志, 2020, 27(8): 900-906.
13. Abdullah F, Harris J. Pectus excavatum: More than a matter of aesthetics. Pediatr Ann, 2016, 45(11): e403-e406.
14. Zhang DK, Tang JM, Ben XS, et al. Surgical correction of 639 pectus excavatum cases via the Nuss procedure. J Thorac Dis, 2015, 7(9): 1595-1605.
15. 陶麒麟, 贾兵, 闫宪刚, 等. 单切口改良Nuss手术矫治儿童漏斗胸. 中国微创外科杂志, 2016, 16(2): 127-130.
16. Baccarani A, Aramini B, Casa GD, et al. Pectoralis muscle transposition in association with the ravitch procedure in the management of severe pectus excavatum. Plast Reconstr Surg Glob Open, 2019, 7(9): e2378.
17. Nuss D, Obermeyer RJ, Kelly RE. Pectus excavatum from a pediatric surgeon's perspective. Ann Cardiothorac Surg, 2016, 5(5): 493-500.
18. 刘文英. 关于漏斗胸手术治疗的若干问题. 临床小儿外科杂志, 2016, 15(2): 110-113.
19. Esteves E, Paiva KC, Calcagno-Silva M, et al. Treatment of pectus excavatum in patients over 20 years of age. J Laparoendosc Adv Surg Tech A, 2011, 21(1): 93-96.
20. Durry A, Gomes Ferreira C, Tricard T, et al. Minimally invasive repair of pectus excavatum in children: Results of a modified Nuss procedure. Ann Chir Plast Esthet, 2017, 62(1): 8-14.
21. Esteva Miró C, Núñez García B, Pérez-Gaspar M, et al. Applicability of Clavien-Dindo classification in Nuss procedure surgical complications. Cir Pediatr, 2020, 33(4): 154-159.
22. Pilegaard HK. Nuss technique in pectus excavatum: A mono-institutional experience. J Thorac Dis, 2015, 7(Suppl 2): S172-S176.
23. Kabbaj R, Burnier M, Kohler R, et al. Minimally invasive repair of pectus excavatum using the Nuss technique in children and adolescents: indications, outcomes, and limitations. Orthop Traumatol Surg Res, 2014, 100(6): 625-630.
24. Hebra A, Kelly RE, Ferro MM, et al. Life-threatening complications and mortality of minimally invasive pectus surgery. J Pediatr Surg, 2018, 53(4): 728-732.
25. Park HJ, Kim JJ, Park JK, et al. Effects of Nuss procedure on thoracic scoliosis in patients with pectus excavatum. J Thorac Dis, 2017, 9(10): 3810-3816.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Clinical efficacy of thoracoscopy-assisted modified Nuss procedure in children with pectus excavatum: A retrospective analysis in a single center

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