A Rounded Dissector to Reduce Complications in the Minimally Invasive Repair (Nuss) of Pectus Excavatum in Adolescents and Adults

Introduction

The MIRPE (minimally invasive repair of pectus excavatum) technique, first described by Nuss in 1998, initially used a pair of large forceps to create a tunnel for pectus bar implantation [[1]]. These forceps were sufficiently stable and rigid for intervention in the small and highly elastic children's thoraces. Published reports of promising results in children encouraged adolescents and young adults also to undergo this type of thorax remodeling [[2], [3]]. But the forceps, adequate for dealing with children's thoraces, were not rigid enough to get through the thoraces of adults. What was needed was a long and rigid dissector. A form-fitting dissector, available in three different sizes (pectus introducer W. Lorenz®, Surgical, Jacksonville, Florida, USA), flat, bent and with a rounded tip for easy perforation of the thoracic wall was developed to meet this need. In contrast to forceps, the dissector has a handy grip to securely hold and move this instrument through the thoracic space. The dissector, too, flat and with sharp edges, proved to be insufficiently rigid to elevate the anterior thoracic wall during transthoracic dissection, especially in sturdy adolescent or athletic thoraces. Here we report on complications that developed in four cases as result of additional maneuvers necessitated by the flat dissector's insufficient rigidity.

References

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