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Translational Pediatrics Jun 2023
PubMed: 37427063
DOI: 10.21037/tp-23-236 -
Frontiers in Surgery 2023The conventional technique for pectus excavatum repair was pushing up the depressed chest wall by turning over the convexity of the bent pectus bar. We developed a new...
INTRODUCTION
The conventional technique for pectus excavatum repair was pushing up the depressed chest wall by turning over the convexity of the bent pectus bar. We developed a new concept in which a total crane lift was used as the source of power to elevate the depressed sternum without using pectus bar leverage. This study aims to verify the efficacy of exclusively crane-powered pectus excavatum repair in recent years.
METHODS
Among the 3622 pectus deformity repairs since 1999, 691 cases repaired with the total crane power between 2017 and 2022 were enrolled. The mean age was 12.0 years (3-45). The operative technique involved wire/screw crane elevation of the sternum, the entire chest wall remodeling with the cross or parallel bars, the bridge/claw bar fixations, and other adjunctive techniques. Outcome analysis included morphological variations, patterns of pectus bar placement, and complication rates.
RESULTS
The crane technique and pectoscopy (100%) were used. The bar placements were parallel (22.0%) and cross-bar (47.5%). The bar fixations were the claw fixators for a single bar (30.5%) and the bridge plates for multiple bars (69.5%). The flare-buster and magic strings were liberally used. No serious complications or catastrophic events occurred, but minor complications occurred in 16.9%: pneumothorax in 7.4% (51), pleural effusion in 1.6% (11), and wound problems in 0.4% (3). There was no case of bar displacement.
DISCUSSION
The crane-powered pectus excavatum repair showed excellent results with minimal complications and no bar displacement. This innovative approach, part of the NeoPectus surgery, represents a significant advancement in correcting pectus excavatum deformities by utilizing a crane machine to elevate the chest wall.
PubMed: 38192491
DOI: 10.3389/fsurg.2023.1267009 -
Journal of Thoracic Disease Jul 2023
PubMed: 37559640
DOI: 10.21037/jtd-22-1753 -
Frontiers in Surgery 2023Since the 1970s, magnetic force has been used to augment modern surgical techniques with the aims of minimizing surgical trauma and optimizing minimally-invasive... (Review)
Review
Since the 1970s, magnetic force has been used to augment modern surgical techniques with the aims of minimizing surgical trauma and optimizing minimally-invasive systems. The majority of current clinical applications for magnetic surgery are largely centered around gastrointestinal uses-such as gastrointestinal or bilioenteric anastomosis creation, stricturoplasty, sphincter augmentation, and the guidance of nasoenteric feeding tubes. However, as the field of magnetic surgery continues to advance, the development and clinical implementation of magnetic devices has expanded to treat a variety of non-gastrointestinal disorders including musculoskeletal (pectus excavatum, scoliosis), respiratory (obstructive sleep apnea), cardiovascular (coronary artery stenosis, end-stage renal disease), and genitourinary (stricture, nephrolithiasis) conditions. The purpose of this review is to discuss the current state of innovative magnetic surgical devices under clinical investigation or commercially available for the treatment of non-gastrointestinal disorders.
PubMed: 37942002
DOI: 10.3389/fsurg.2023.1253728 -
Journal of Thoracic Disease Mar 2021National data is limited on pectus excavatum, the most common chest wall deformity which is often repaired using the Ravitch and Nuss procedures. The purpose of the...
BACKGROUND
National data is limited on pectus excavatum, the most common chest wall deformity which is often repaired using the Ravitch and Nuss procedures. The purpose of the study was to describe demographics and outcomes of adult patients who underwent surgical repair of pectus excavatum via open and minimally invasive thoracoscopic methods.
METHODS
A retrospective analysis of the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database from 2015 to 2018 was performed, capturing patients 18 years or older with pectus excavatum as the postoperative diagnosis. Patients were placed into two groups of minimally invasive (Nuss) and open (Ravitch) repair procedure code. Baseline characteristics and postoperative outcomes were analyzed.
RESULTS
A total of 168 adult patients were captured. Most of these patients were white (84.52%) male (69.64%) and 26 years old on average. Median operative time was longer in the open repair group [250 (IQR, 173-308) versus 122 (IQR, 94-160) minutes, P<0.0001]. Median length of stay was five days (IQR, 4-6) in the open group and three days (IQR, 2-4) in the minimally invasive group (P=0.2873).
CONCLUSIONS
Complications after repair of pectus excavatum occur at similar rates between open and minimally invasive repair. Though minimally invasive repair decreases operative time and may decrease length of stay, the decision of type of procedure depends upon clinical scenario and factors unique to the individual patient.
PubMed: 33841932
DOI: 10.21037/jtd-20-2422 -
JTCVS Techniques Dec 2023
PubMed: 38152168
DOI: 10.1016/j.xjtc.2023.09.024 -
Interactive Cardiovascular and Thoracic... Jul 2021Pectus bar removal is the final step of minimally invasive repair of pectus excavatum. Complication rates related to bar removal have been reported in 2-15% of patients...
OBJECTIVES
Pectus bar removal is the final step of minimally invasive repair of pectus excavatum. Complication rates related to bar removal have been reported in 2-15% of patients and severe, near-fatal and fatal complications have been reported. No systematic assessment of complication severity or risk factors associated with bar removal has been reported in large study populations. The aim of this paper is to investigate the safety of the bar removal procedure with regard to complication rates and severities as well as assessment of risk factors.
METHODS
Between 2003 and 2019, 1574 patients underwent the bar removal procedure. Medical records were assessed retrospectively and complications registered. Complications were categorized in infections, bleedings and other complications. The severity of the surgical complications was systematically classified using the validated Clavien-Dindo classification. Furthermore, risk factors associated with complications were assessed.
RESULTS
The overall complication rate was 4.1% (Clavien-Dindo classification I-IV), mainly consisting of bleedings (1.3%) and infections (1.5%). Five cases of severe bleedings were registered (0.3%, Clavien-Dindo classification IV). Risk factors associated with complications during bar removal were greater age and removal of more than one bar.
CONCLUSIONS
The bar removal procedure is a safe and effective procedure. Both age and number of bars inserted should be considered prior to surgical correction of pectus excavatum as these factors predict complications related to bar removal.
Topics: Funnel Chest; Humans; Incidence; Minimally Invasive Surgical Procedures; Retrospective Studies; Risk Factors
PubMed: 34310684
DOI: 10.1093/icvts/ivab077 -
Translational Pediatrics Feb 2023Pectus excavatum is the most common congenital chest wall anomaly, the hallmark of which is the caved-in appearance of the anterior chest. A growing body of literature... (Review)
Review
BACKGROUND AND OBJECTIVE
Pectus excavatum is the most common congenital chest wall anomaly, the hallmark of which is the caved-in appearance of the anterior chest. A growing body of literature exists surrounding methods of surgical correction, though considerable variability in management remains. The primary objectives of this review are to outline the current practices surrounding the care of pediatric patients with pectus excavatum and present emerging trends in the field that continue to impact the care of these patients.
METHODS
Published material in English was identified utilizing the PubMed database using multiple combinations of the keywords: pectus excavatum, pediatric, management, complications, minimally invasive repair of pectus excavatum, MIRPE, surgery, repair, and vacuum bell. Articles from 2000-2022 were emphasized, though older literature was included when historically relevant.
KEY CONTENT AND FINDINGS
This review highlights contemporary management principles of pectus excavatum in the pediatric population, comprising preoperative evaluation, surgical and non-surgical treatment, postoperative considerations including pain control, and monitoring strategies.
CONCLUSIONS
In addition to providing an overview of pectus excavatum management, this review highlights areas that remain controversial including the physiologic effects of the deformity and the optimal surgical approach, which invite future research efforts. This review also features updated content on non-invasive monitoring and treatment approaches such as three-dimensional (3D) scanning and vacuum bell therapy, which may alter the treatment landscape for pectus excavatum in order to reduce radiation exposure and invasive procedures when able.
PubMed: 36891368
DOI: 10.21037/tp-22-361 -
The Journal of Thoracic and... Mar 2022
Topics: Funnel Chest; Humans; Treatment Outcome
PubMed: 33514462
DOI: 10.1016/j.jtcvs.2020.12.086