University of California San Francisco, Department of Surgery, San Francisco, CA, USA.
University of California San Francisco, Department of Surgery, San Francisco, CA, USA; University of California San Francisco Benioff Children's Hospitals, Division of Pediatric Surgery, San Francisco, California, USA.
J Pediatr Surg. 2022 Jun;57(6):1079-1082. doi: 10.1016/j.jpedsurg.2022.01.035. Epub 2022 Feb 1.
Minimally invasive repair of pectus excavatum or the Nuss procedure has become the standard operation for pectus excavatum repair. Pectus excavatum can be broadly divided into two categories: symmetric or asymmetric morphology. To optimize surgical outcomes of asymmetric pectus excavatum repair, previous work has proposed morphology-tailored bar shaping technique; the bar to be inserted is shaped asymmetrically to counter-balance the outer contour of the chest prior to the passage of the introducer across the chest. We describe an alternate approach that emphasizes precise introducer chest insertion and extraction and that highlights the direction of the introducer passage is from the higher asymmetric side to the lower contralateral side. The shape of the bar is determined after the introducer has been placed into the chest. This technique allows simultaneous compression of the higher asymmetric chest and elevation of the contralateral depressed side by the metal bar achieving excellent symmetric chest appearance. LEVEL OF EVIDENCE: Level V, Operative Technique.
微创修复漏斗胸或 Nuss 手术已成为漏斗胸修复的标准手术。漏斗胸可大致分为对称或不对称形态。为了优化不对称漏斗胸修复的手术效果，既往研究提出了形态定制的矫正棒塑形技术；在导针穿过胸部之前，将待插入的矫正棒塑形为非对称形状，以平衡胸部的外部轮廓。我们描述了一种替代方法，强调精确的导针胸部插入和提取，并强调导针通道的方向是从较高的不对称侧到较低的对侧。矫正棒的形状是在导针放入胸部后确定的。该技术可通过金属棒同时对较高的不对称胸部进行压缩和对侧凹陷侧进行抬高，从而实现极好的对称胸部外观。证据等级：V 级，手术技术。
