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The Journal of Thoracic and... Mar 2022To define the learning process of minimally invasive repair of pectus excavatum by the Nuss procedure through assessment of consecutive procedural metrics. (Observational Study)
Observational Study
OBJECTIVES
To define the learning process of minimally invasive repair of pectus excavatum by the Nuss procedure through assessment of consecutive procedural metrics.
METHODS
A single-center retrospective observational cohort study was conducted of all consecutive Nuss procedures performed by individual surgeons without previous experience between June 2006 and December 2018. Surgeons were proctored during their initial 10 procedures. The learning process after the proctoring period was evaluated using nonrisk-adjusted cumulative sum (ie, observed minus expected) failure charts of complications. An acceptable and unacceptable complication rate of 10% and 20% were used. Logarithmic trend lines were used to assess over-time performance regarding operation time.
RESULTS
Two-hundred twenty-two consecutive Nuss procedures by 3 general thoracic surgeons were evaluated. Cumulative sum charts showed an average performance from the first procedure after being proctored onward for all surgeons, whereas surgeon B demonstrated a statistically significant complication rate equal to or less than 10% after 59 cases. Post-hoc sensitivity analyses using a stricter acceptable and unacceptable complication rate of 6% and 12% also showed an average performance for all surgeons. Although, the median time between consecutive procedures ranged from 7 to 35 days, no frequency-outcome relationship was observed. In addition, surgeons required the same average operation time throughout their entire experience.
CONCLUSIONS
After a 10-procedure proctoring period, repair of pectus excavatum by the Nuss procedure is a safe procedure to adopt and perform without a typical (complication based) learning curve while performing at least 1 procedure per 35 days.
Topics: Adolescent; Clinical Competence; Female; Funnel Chest; Humans; Learning Curve; Male; Minimally Invasive Surgical Procedures; Operative Time; Orthopedic Procedures; Postoperative Complications; Retrospective Studies; Sternum; Time Factors; Treatment Outcome; Young Adult
PubMed: 33478832
DOI: 10.1016/j.jtcvs.2020.11.154 -
Quantitative Imaging in Medicine and... Jun 2023Preoperative radiological imaging in pectus excavatum sometimes coincidentally yields additional intrathoracic abnormalities. In the context of a larger research project...
BACKGROUND
Preoperative radiological imaging in pectus excavatum sometimes coincidentally yields additional intrathoracic abnormalities. In the context of a larger research project investigating replacement of CT scans by 3D-surface scanning as routine preoperative work-up for pectus excavatum, this study aims to quantify the incidence of clinically relevant intrathoracic abnormalities found incidentally using conventional CT in pectus excavatum patients.
METHODS
A single-center retrospective cohort study was conducted including pectus excavatum patients, receiving CT between 2012 and 2021 as part of their preoperative evaluation. Radiology reports were reviewed for additional intrathoracic abnormalities and scored into three subclasses: non-clinically relevant, potentially clinically relevant or clinically relevant findings. Also, two-view plain chest radiographs reports, if available, were evaluated for those patients with a clinically relevant finding. Subgroup analysis was performed to compare adolescents and adults.
RESULTS
In total, 382 patients were included, of whom 117 were adolescents. Although in 41 patients (11%) an additional intrathoracic abnormality was found, only two patients (0.5%) presented with a clinically relevant abnormality requiring additional diagnostics, postponing surgical correction. In only one of the two patients, plain chest radiographs were available, which did not show the abnormality. Subgroup analyses revealed no differences in (potentially) clinically relevant abnormalities between adolescents and adults.
CONCLUSIONS
The prevalence of clinically relevant intrathoracic abnormalities in pectus excavatum patients was low, supporting the notion that CT and plain radiographs can be safely replaced by 3D-surface scanning in the preoperative work-up for pectus excavatum repair.
PubMed: 37284105
DOI: 10.21037/qims-22-1366 -
Children (Basel, Switzerland) Mar 2022For decades, open surgical repair was the only available method to treat congenital and acquired chest wall deformities (CWDs). In 1998, D. Nuss described a minimally...
For decades, open surgical repair was the only available method to treat congenital and acquired chest wall deformities (CWDs). In 1998, D. Nuss described a minimally invasive procedure for surgical repair of Pectus excavatum (PE). Today, the Nuss procedure is performed with increasing frequency worldwide and considered as the "gold standard". After its introduction, the method experienced numerous modifications such as routine thoracoscopy and/or sternal elevation, increasing safety of the procedure. Placement of multiple bars and/or the so called cross-bar technique were introduced to correct complex CWDs. Standardized pain management, the introduction of cryo-analgesia and a standardized postoperative physiotherapy program including deep breathing exercises facilitate the establishment of an enhanced recovery after surgery (ERAS) process. However, the widespread use of the minimally invasive repair of pectus excavatum (MIRPE) procedure has been associated with a significant number of serious complications. Furthermore, several studies report near-fatal complications, not only during bar placement, but also during bar removal. This review focuses upon the most relevant modifications, including recent published surgical techniques of MIRPE, in order to describe current developments in the field.
PubMed: 35455522
DOI: 10.3390/children9040478 -
Acta Ortopedica Brasileira 2021To analyze reformatted sagittal sternal tomography images and classify sternal body curvature types, and compare different types of populations with one another and...
OBJECTIVE
To analyze reformatted sagittal sternal tomography images and classify sternal body curvature types, and compare different types of populations with one another and with normal individuals.
METHODS
In total, 50 controls and 167 pectus patients were selected for chest CT to analyze the median sagittal plane, of whom 89 had mean age, 12 ± 10 years) and 78 (mean age, 14 ± 10 years). Clinical types of were classified as inferior, superior, or lateral and localized or broad The following types of sternal patterns were defined: gradual vertical curve, gradual posterior curve, gradual anterior curve, proximal third curve, middle third curve, distal third curve, anterior rectilinear, vertical rectilinear, and posterior rectilinear. Statistical analyses were performed to compare the different types of with one another and with the control group.
RESULTS
Patients with different thoracic deformities, but with similar sternal curvature patterns, were observed. Some types of sternal curvature were significantly more frequent in certain types of (p < 0,05). The gradual vertical curve and anterior rectilinear types prevailed in controls (p < 0,05).
CONCLUSION
Some sternal curvature patterns were more frequent than the others in certain types of and the controls.
PubMed: 34629950
DOI: 10.1590/1413-785220212905243733 -
European Review For Medical and... Sep 2020The 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...
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.
Topics: Adult; Female; Funnel Chest; Humans; Male; Switzerland; Thoracic Surgery, Video-Assisted; Young Adult
PubMed: 32964990
DOI: 10.26355/eurrev_202009_22843 -
American Journal of Translational... 2022To observe the effects of minimally invasive surgical repair of pectus excavatum (NUSS) on the degree of chest flatness, cardiopulmonary function, and bone metabolism...
Effect of minimally invasive repair of pectus excavatum on postoperative chest flatness, cardiopulmonary function, and bone metabolism indexes in children at different ages.
OBJECTIVE
To observe the effects of minimally invasive surgical repair of pectus excavatum (NUSS) on the degree of chest flatness, cardiopulmonary function, and bone metabolism indexes in children of various age groups.
METHODS
In this retrospective study, 62 children with pectus excavatum admitted to our hospital were divided into two groups: group A (3-12 years old) and group B (>12 years old), with 31 cases in each group. All of them were treated with NUSS. The treatment effectiveness, perioperative indexes (operation time, blood loss, ground time, and hospitalization time), degree of chest flatness, cardiopulmonary function, bone metabolism indicators, and complications were compared between the two groups.
RESULTS
There was no significant difference between patients in the two groups in terms of operation time, blood loss, ground time, and hospitalization time (all P>0.05). The overall response rate to treatment in group A (93.55%) was higher than that of group B (70.97%; P<0.05). Three months after the operation, the chest flatness as well as serum alkaline phosphatase and its bone isoform levels in both groups were decreased, while left ventricular ejection fraction, cardiac index, stroke volume, FEV1, and peak expiratory flow levels were increased compared to before the operation, and the improvement in the above indicators of group A was better than Group B (all P<0.05). There was no significant difference in the incidence of complications between the two groups (16.13% 9.68%; P>0.05).
CONCLUSION
NUSS surgery can achieve satisfactory results in treating children with pectus excavatum at different ages. However, in a certain age range, a younger age indicates a better effect. NUSS procedure effectively improves postoperative flat chest, cardiopulmonary function, and bone metabolism indexes.
PubMed: 35836855
DOI: No ID Found -
JMA Journal Apr 2024
PubMed: 38721088
DOI: 10.31662/jmaj.2023-0162 -
Wiadomosci Lekarskie (Warsaw, Poland :... 2021The aim of the study was to analyze cardiac function during Nuss procedure under the combination of general anesthesia with dif f erent variants of the regional block. (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
The aim of the study was to analyze cardiac function during Nuss procedure under the combination of general anesthesia with dif f erent variants of the regional block.
PATIENTS AND METHODS
Materials and methods: The observative prospective study included 60 adolescents (boys/girls=47/13) undergone Nuss procedure for pectus excavatum correction under the combination of general anaesthesia and regional blocks. The patients were randomized into three groups (n=20 in each) according to the perioperative regional analgesia technique: standart epidural anaesthesia (SEA), high epidural anaesthesia (HEA) and bilateral paravertebral anaesthesia (PVA). The following parameters of cardiac function were analyzed: heart rate, estimated cardiac output (esCCO), cardiac index (esCCI), stroke volume (esSV) and stroke volume index (esSVI) using non-invasive monitoring.
RESULTS
Results: Induction of anesthesia and regional blocks led to a signif i cant decrease in esCCO (-9.4%) and esCCI (-9.8%), while esSV and esSVI remained almost unchanged in all groups (H=4.9; p=0.09). At this stage, the decrease in cardiac output was mainly due to decreased heart rate. At the stage of sternal elevation we found an increase in esSV, which was more pronounced in the groups of epidural blocks (+23.1% in HEA and +18.5% in SEA). After awakening from anesthesia and tracheal extubation esSV was by 11% higher than before surgery without ingergroup dif f erence.
CONCLUSION
Conclusions: The Nuss procedure for pectus excavatum correction lead to improved cardiac function. increase in stroke volume and its index were more informative than cardiac output and cardiac index which are dependent on heart rate that is under the inf l uence of anaesthesia technique.
Topics: Adolescent; Anesthesia; Female; Funnel Chest; Humans; Male; Minimally Invasive Surgical Procedures; Prospective Studies; Treatment Outcome
PubMed: 34537725
DOI: No ID Found -
Frontiers in Pediatrics 2022The outcome of vacuum bell (VB) treatment for preschool patients with pectus excavatum (PE) is poorly understood. We aim to investigate the short-term treatment effect...
OBJECTIVE
The outcome of vacuum bell (VB) treatment for preschool patients with pectus excavatum (PE) is poorly understood. We aim to investigate the short-term treatment effect of VB with a three-dimensional scanner and assess the clinical and demographic factors that might influence treatment outcomes.
METHODS
We conducted a chart review study to review the records of preschool patients with PE who received VB treatment in a tertiary hospital from January 1, 2021, through January 1, 2022. Demographic data and chest wall deformity assessments were recorded at follow-up, including the anterior chest wall depths and depth ratio (DR). The demographic and clinical factors influencing treatment outcomes were tested using a logistic regression model.
RESULTS
139 patients who accepted vacuum bell treatment were included in the final study analysis, with a mean age of 4.6 years and a BMI of 14.9. Forty-three patients (30.9%) with a depth of less than 3 mm met the termination criteria and showed cosmetic results. The changes in depths ( < 0.001) and DR ( < 0.001) were statistically significant in 55 patients with three or four follow-ups. Multifactor logistic regression analysis showed that initial depth (OR 0.69, 95% CI 0.58-0.84, < 0.001) and treatment period (OR 1.58, 95% CI 1.23-2.04, < 0.001) were independent predictors of achieving complete correction.
CONCLUSION
VB is an effective treatment modality in preschool patients in the short-term follow-up, which is influenced by the depth of depression and the duration of treatment. However, further prospective studies are needed to confirm these results.
PubMed: 36313864
DOI: 10.3389/fped.2022.1008437 -
BMC Pediatrics Mar 2024Pectus excavatum, the most common chest wall deformity, is frequently treated with Nuss procedure. Here we will describe non-invasive procedure and analyze the variables...
BACKGROUND
Pectus excavatum, the most common chest wall deformity, is frequently treated with Nuss procedure. Here we will describe non-invasive procedure and analyze the variables associated vacuum bell therapy for patients with pectus excavatum.
METHODS
Retrospective case-control study in a single center between July 2018 and February 2022, including patients with pectus excavatum treated with vacuum bell. Follow-up was continued to September 2022. The Haller index and Correction index was calculated before and after treatment to analysis the effectiveness of vacuum bell therapy.
RESULTS
There were 98 patients enrolled in the treatment group, with 72 available for analysis, and the follow-up period ranged from 1.1 to 4.4 years (mean 3.3 years). When analyzing with the Haller Index, 18 patients (25.0%) showed excellent correction, 13 patients (18.1%) achieved good correction, and 4 patients (5.6%) had fair correction. The remaining patients had a poor outcome. Characteristics predicting a non-poor prognosis included initial age ≤ 11 years (OR = 3.94, p = 0.013) and patients with use over 24 consecutive months (OR = 3.95, p = 0.013). A total of 9 patients (12.5%) achieved a CI reduction below 10. Patients who started vacuum bell therapy at age > 11 had significantly less change compared to those who started at age ≤ 11 (P < 0.05). Complications included chest pain (5.6%), swollen skin (6.9%), chest tightness (1.4%) and erythema (15.3%).
CONCLUSIONS
A certain percentage of patients with pectus excavatum can achieve excellent correction when treated with pectus excavatum therapy. Variables predicting better outcome including initial age ≤ 11 years both in HI and CI and vacuum bell use over 24 consecutive months in HI. In summary, pectus excavatum is an emerging non-invasive therapy for pectus excavatum and will be widely performed in a certain group of patients.
Topics: Humans; Child; Funnel Chest; Retrospective Studies; Case-Control Studies; Vacuum; Thoracic Wall
PubMed: 38461230
DOI: 10.1186/s12887-024-04615-3