Safe surgical technique of mediastinum dissection in Nuss procedure

Abstract

Though the Nuss procedure for Pectus Excavatum is widely performed as minimal invasive surgery, some fatal cases have been reported due to cardiac or vascular injury during the mediastinum dissection. To avoid these complications, we started a new method using a lifting hook, Maryland dissector for laparoscopy. The surgical method 1. Two 5 mm ports of the thoracoscope are inserted. 2. The surgical view of anterior mediastinum is made by artificial pneumothorax. 3. The sternum is lifted with a lifting hook. 4. The dissection of the anterior mediastinum is started with the Maryland dissector. The layer of the avascular area can be easily ascertained by pneumomediastinum and the contralateral thoracic cavity can be seen.

We evaluated the operation time and complications in patients under 15 years of age who underwent the Nuss procedure, categorized according to the operation method into Group A (new method), Group B (the introducer only without the lifting hook). The anterior dissection times were 111.3, and 220.5 seconds (p < 0.05), for Group A (n = 21), Group B (n = 34), respectively. The complication rate were 4.8% and 8%, respectively. Anterior dissection of our method shortens the time of operation and reduces the occurrence of complications.