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Modification of the Nuss Procedure: The Single-incision Technique.

Aizawa T, Togashi S, Domoto T, Sasaki K, Kiyosawa T, Sekido M - Plast Reconstr Surg Glob Open (2014)

Bottom Line: To facilitate passing of the bar, a traction guide was created according to our unique method.There was no need for a bar stabilizer, and no severe intraoperative complications occurred.All patients exhibited satisfactory short-term results; however, 1 patient suffered from bar rotation and required repeat surgery for fixation.

View Article: PubMed Central - PubMed

Affiliation: Department of Plastic and Reconstructive Surgery, National Defense Medical College, Saitama, Japan; Department of Plastic and Reconstructive Surgery, Shonai Amarume Hospital, Yamagata, Japan; and Department of Plastic and Reconstructive Surgery, Tsukuba University, Ibaraki, Japan.

ABSTRACT

Summary: The Nuss procedure is a prevalent minimally invasive surgery for pectus excavatum. Although the Nuss procedure has the advantage of leaving less obtrusive scars, the standard technique requires at least 3 skin incisions to insert several instruments. We experienced 7 cases of the modified Nuss procedure using a single incision during a 7-year period. To facilitate passing of the bar, a traction guide was created according to our unique method. There was no need for a bar stabilizer, and no severe intraoperative complications occurred. All patients exhibited satisfactory short-term results; however, 1 patient suffered from bar rotation and required repeat surgery for fixation. Two patients underwent bar removal via the same single incision without any difficulties.

No MeSH data available.


Related in: MedlinePlus

The suture needle with silken thread passes through the slit of the introducer, invading the skin and muscle (A). Once the introducer is pulled out, the silken thread is placed in the dissected tunnel (B).
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Figure 1: The suture needle with silken thread passes through the slit of the introducer, invading the skin and muscle (A). Once the introducer is pulled out, the silken thread is placed in the dissected tunnel (B).

Mentions: The incision is 3 cm long along the anterior axillary line of the right lateral chest. A 5-mm 45-degree thoracoscope is used to provide clear visualization. The bar introducer and trocar port are inserted through the common skin incision at the same time. Due to the elasticity of the dermis, the introducer and thoracoscope are located distant enough so as to not interfere with each other. Dissection for bar placement on the right side of the chest is then performed under the pectoral muscles. To reach the retrosternal space, the introducer penetrates through the pleura from a point slightly medial to the highest point of the anterior chest wall. After crossing the mediastinum, the site of dissection is moved into the submuscular plane on the left side of the chest. Pleural penetration of the left side is also performed slightly medial to the highest point. After dissecting the submuscular layers, a guide is employed to facilitate the insertion of the pectus bar. There is a slit on the tip of the bar introducer; a needle stick with #0 silken thread is made directly through the overlying skin and muscle, and the needle is passed through the slit of introducer then passed back through the skin and muscle. Once the introducer is pulled out, the silken thread is placed in the dissected tunnel as a guide (Fig. 1). The silken thread is then fastened to the pectus bar. With an assistant tracking the other end of the silken thread, the bar is passed through the dissected tunnel smoothly and safely.


Modification of the Nuss Procedure: The Single-incision Technique.

Aizawa T, Togashi S, Domoto T, Sasaki K, Kiyosawa T, Sekido M - Plast Reconstr Surg Glob Open (2014)

The suture needle with silken thread passes through the slit of the introducer, invading the skin and muscle (A). Once the introducer is pulled out, the silken thread is placed in the dissected tunnel (B).
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4255899&req=5

Figure 1: The suture needle with silken thread passes through the slit of the introducer, invading the skin and muscle (A). Once the introducer is pulled out, the silken thread is placed in the dissected tunnel (B).
Mentions: The incision is 3 cm long along the anterior axillary line of the right lateral chest. A 5-mm 45-degree thoracoscope is used to provide clear visualization. The bar introducer and trocar port are inserted through the common skin incision at the same time. Due to the elasticity of the dermis, the introducer and thoracoscope are located distant enough so as to not interfere with each other. Dissection for bar placement on the right side of the chest is then performed under the pectoral muscles. To reach the retrosternal space, the introducer penetrates through the pleura from a point slightly medial to the highest point of the anterior chest wall. After crossing the mediastinum, the site of dissection is moved into the submuscular plane on the left side of the chest. Pleural penetration of the left side is also performed slightly medial to the highest point. After dissecting the submuscular layers, a guide is employed to facilitate the insertion of the pectus bar. There is a slit on the tip of the bar introducer; a needle stick with #0 silken thread is made directly through the overlying skin and muscle, and the needle is passed through the slit of introducer then passed back through the skin and muscle. Once the introducer is pulled out, the silken thread is placed in the dissected tunnel as a guide (Fig. 1). The silken thread is then fastened to the pectus bar. With an assistant tracking the other end of the silken thread, the bar is passed through the dissected tunnel smoothly and safely.

Bottom Line: To facilitate passing of the bar, a traction guide was created according to our unique method.There was no need for a bar stabilizer, and no severe intraoperative complications occurred.All patients exhibited satisfactory short-term results; however, 1 patient suffered from bar rotation and required repeat surgery for fixation.

View Article: PubMed Central - PubMed

Affiliation: Department of Plastic and Reconstructive Surgery, National Defense Medical College, Saitama, Japan; Department of Plastic and Reconstructive Surgery, Shonai Amarume Hospital, Yamagata, Japan; and Department of Plastic and Reconstructive Surgery, Tsukuba University, Ibaraki, Japan.

ABSTRACT

Summary: The Nuss procedure is a prevalent minimally invasive surgery for pectus excavatum. Although the Nuss procedure has the advantage of leaving less obtrusive scars, the standard technique requires at least 3 skin incisions to insert several instruments. We experienced 7 cases of the modified Nuss procedure using a single incision during a 7-year period. To facilitate passing of the bar, a traction guide was created according to our unique method. There was no need for a bar stabilizer, and no severe intraoperative complications occurred. All patients exhibited satisfactory short-term results; however, 1 patient suffered from bar rotation and required repeat surgery for fixation. Two patients underwent bar removal via the same single incision without any difficulties.

No MeSH data available.


Related in: MedlinePlus