21743 Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy

Name of the Procedure:

Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy

Summary

The Nuss procedure is a minimally invasive surgery to correct pectus excavatum (sunken chest) or pectus carinatum (protruding chest). It involves the insertion of a curved metal bar under the sternum to reshape the chest wall, using thoracoscopy to provide visual guidance during the surgery.

Purpose

The procedure aims to correct the structural deformities of the chest:

• Medical condition: Pectus excavatum or carinatum.
• Goals: To improve chest appearance, enhance lung function, and alleviate associated physical and psychological symptoms.

Indications

• Patients with moderate to severe pectus excavatum or carinatum.
• Symptoms may include chest pain, difficulty breathing, and poor posture.
• Criteria include physical examinations, imaging studies, and cardiopulmonary assessments indicating the need for correction.

Preparation

• Patients are usually required to fast for several hours before the procedure.
• Medication adjustments might be necessary.
• Preoperative assessments often include chest X-rays, CT scans, and cardiac evaluations.

Procedure Description

1. Anesthesia: The patient is placed under general anesthesia.
2. Thoracoscopy: Small incisions are made on the sides of the chest for the thoracoscope.
3. Bar Insertion: A curved metal bar is inserted under the sternum with guidance from the thoracoscope.
4. Bar Positioning: The bar is flipped to push the sternum outward into a normal position.
5. Stabilization: The bar is secured to the ribs to ensure stabilization.
6. Closure: Incisions are closed with sutures.

Duration

The procedure typically takes around 1 to 2 hours.

Setting

The Nuss procedure is performed in a hospital's surgical suite.

Personnel

• Surgeons specializing in thoracic surgery
• Anesthesiologists
• Surgical nurses
• Operating room technicians

Risks and Complications

• Common risks: Pain, infection, and bleeding.
• Rare risks: Bar displacement, pneumothorax, and damage to internal organs.
• Complications are managed with pain relief, antibiotics, or additional surgical interventions if necessary.

Benefits

• Expected benefits include an improved chest appearance and enhanced respiratory function.
• Benefits may be realized within weeks to months post-surgery.

Recovery

• Patients may stay in the hospital for a few days post-surgery.
• Post-procedure care includes pain management, wound care, and activity restrictions.
• Recovery time varies but typically requires avoiding strenuous activities for several weeks and follow-up appointments to monitor progress.

Alternatives

• Non-surgical options: Physical therapy and braces, though usually less effective for severe cases.
• Surgical options: Ravitch procedure, which involves a more invasive approach with removal of cartilage.
• Each alternative has different pros and cons, with the Nuss procedure often deemed less invasive and having quicker recovery.

Patient Experience

• During the procedure, the patient is fully sedated and unaware of the surgery.
• Post-surgery, the patient may experience pain and discomfort managed with pain medication.
• Gradual return to normal activities is expected, with specific instructions provided by the healthcare team for a safe recovery.