Uniportal VATS for pectus excavatum: the Southern Switzerland experience

S. Cafarotti, E. Memoli, M. Patella, G. Rugel, E.M. Minerva, C.M. Mendoza, A. Tessitore, F. Hamitaga

Thoracic Surgery Department, Ente Ospedaliero Cantonale, Università della Svizzera Italiana, Bellinzona, Switzerland. stefano.cafarotti@eoc.ch

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• Respiratory Medicine

OBJECTIVE: The Nuss procedure is a minimally invasive approach used to treat the pectus excavatum. One to three curved metal bars are inserted behind the sternum in order to push it into a normal position. A bilateral thoracoscopy, with 3 or 4 incisions on each side, has been reported as a safe method to repair the chest. The aim of this observational cohort study is to evaluate the safety and efficacy of the modified uniportal thoracoscopic Nuss procedure.

PATIENTS AND METHODS: A retrospective review on 248 consecutive patients treated in Southern Switzerland in the last 5 years for chest deformity was performed. Conservative treatment with vacuum bel or dinamic compression was performed in 235 cases. Thirteen patients with pectus excavatum were surgically treated with a modified single-incision thoracoscopic approach and introduction of a single retrosternal Nuss Bar. Demographics, clinical characteristics, surgical data and results were analyzed and discussed.

RESULTS: The male/female ratio was 11/2, with mean age of 20.75 (±5.05) years. The Haller index was 3.65±0.5. The operative duration was 68. 2±13.3 min and hospitalization stay ranged from 2 to 10 days. There was no instance of intraoperative cardiac perforation or macrovascular injury. No pleural effusion or infection was reported. The overall complication rate after a postoperative follow-up of 24.6±3 months was 7.6%, without mortality, major bleeding, infectious complications, displacement or recurrence. Patients satisfaction and postoperative pain were also analyzed.

CONCLUSIONS: The modified single-incision thoracoscopic Nuss procedure is both safe and effective for pectus excavatum correction with non-recurrence after two years.

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