Bodenstein Lawrence, Notrica David M
1 Division of Pediatric Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, New York.
2 Department of Surgery, Phoenix Children's Hospital, Phoenix, Arizona.
J Laparoendosc Adv Surg Tech A. 2019 Jun;29(6):865-868. doi: 10.1089/lap.2018.0407. Epub 2019 Apr 4.
Pectus excavatum is an anomaly of chest wall development in which anterior ribs curve inward and the sternum is displaced toward the vertebral column. The Nuss procedure is a minimally invasive technique in which one or more metal bars are implanted to brace the sternum in a corrected position. Over time, the chest wall remodels into an anatomically corrected shape and the bar(s) are removed at a later date. During the procedure, passage of an introducer instrument and then the repair bar(s) may shear the intercostal muscles from the adjacent ribs. This creates larger than necessary defects in the chest wall, improper or unstable bar placement, and inadequate repair. We report a new surgical instrument for guiding the introducer through the contralateral chest wall. This capture-guidance instrument (CGI) redirects and channels forces to keep the introducer true while preventing muscle stripping during passage of the introducer and repair bar(s). The CGI has been piloted at two pectus centers with a notable decrease in intercostal muscle stripping. The CGI addresses the problem of shear and intercostal muscle stripping during traversal of the chest as part of Nuss repair of pectus excavatum.
漏斗胸是一种胸壁发育异常，其前肋骨向内弯曲，胸骨向脊柱移位。努斯手术是一种微创手术，其中植入一根或多根金属棒以将胸骨支撑在矫正位置。随着时间的推移，胸壁会重塑成解剖学上矫正的形状，然后在以后的某个时间取出金属棒。在手术过程中，导引器械以及随后的修复棒的通过可能会将肋间肌与相邻肋骨分离。这会在胸壁上造成比必要的更大的缺损、金属棒放置不当或不稳定以及修复不足。我们报告了一种用于引导导引器穿过对侧胸壁的新型手术器械。这种捕获引导器械（CGI）会重新引导并传递力量，以在导引器和修复棒通过期间防止肌肉剥离的同时保持导引器的正确方向。CGI已在两个漏斗胸治疗中心进行了试用，肋间肌剥离明显减少。CGI解决了在漏斗胸努斯修复手术中穿过胸部时的剪切和肋间肌剥离问题。
