Surgical aspects of thoracoscopy and efficacy of right thoracoscopy in minimally invasive repair of pectus excavatum.

OBJECTIVE

Minimally invasive repair of pectus excavatum has been established as the preferred technique for the repair of funnel chest deformity. Original techniques of pectus bar placement have been modified to improve the safety of the procedures. The aim of this study is to evaluate the efficacy of right thoracoscopy and to identify factors responsible for complications related to thoracoscopy in minimally invasive repair of pectus excavatum, along with a review of the literature.

METHODS

A retrospective analysis was performed on patients who have had a thoracoscopically assisted minimally invasive repair of pectus excavatum at the Department of Pediatric Surgery, Medical University of Graz, Austria, between 2000 and 2006. The port was inserted through the right lateral chest wall in all patients to obtain visual access for bar insertion.

RESULTS

Charts of 160 patients (130 male and 30 female) with an age range from 5 to 38 years were evaluated. Surgical time ranged from 25 to 255 minutes (mean 66 minutes). Complications primarily related to thoracoscopy were found in 16 patients (10%). There was 1 case of the port trocar piercing through the liver. Incomplete gas evacuation caused postoperative pneumothorax in 15 patients, 5 requiring thoracocentesis and 2 chest tubes.

CONCLUSIONS

Insertion of the port in the right lateral chest wall is safe and provides optimum visual access during the minimally invasive repair procedure. Careful interpretation of chest films can assist in judicious determination of the port site. Optimum pressures and near complete evacuation of the insufflation gases can drastically reduce complications. Alternative access sites such as port insertion above the level of bar placement or left-sided and/or bilateral thoracoscopy may not be necessary.