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Minimally Invasive Repair Of Pectus Excavatum Without VATS (VATS-less Nuss Procedure)
Serdar Evman;
Sureyyapasa Training and Research Hospital, Istsnbul, Turkey
BACKGROUND: Minimally invasive repair of pectus excavatum (Nuss) operation is the current choice of surgical treatment for pectus excavatum deformities. Technical pitfalls arise in patients with previous thoracic and/orcardiac surgical interventions, due to severe intrathoracic fibrous adhesions.
CASE PRESENTATION: A 29-year-old male patient presented withcomplaint of cosmetic deformity on his chest wall.No pathological finding was found, except forsymmetrical mild pectus excavatum (Figure 1a). Hismedical history revealed seven pneumothorax episodes(right sided four times and left sided three times) overthe last two years. He underwent bilateral apical wedgeresection and total pleurectomy operations, by videoassistedthoracoscopic surgery (VATS) for right andby mini-thoracotomy for left hemithorax. His thoraciccomputed tomography revealed a Haller Index of 3.5(Figure 1b). Based on these findings, we decided toperform Nuss procedure without directly entering the“hostile” thoracic cavity to prevent any parenchymalor cardiac damage.
CONCLUSIONS: Compared to the open Ravitch orstandard Nuss procedure, our non-thoracoscopicmodification can be considered safer and still aminimally invasive cosmetic procedure, with anadditional 1.5 cm subxiphoid incision. This novelapproach can be preferred, particularly in veryyoung patients with an undersized and insufficienthemithoracic cavity for videothoracoscope installation,or in patients having a previous thoracic surgery,andthose in whom severe intrathoracic adhesions areexpected.
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