Back to the future: a case series of minimally invasive repair of pectus excavatum with regular instruments

Miguel Lia Tedde, Silvia Yukari Togoro, Robert Stephen Eisinger, Erica Mie Okumura, Angelo Fernandes, Paulo Manuel Pêgo-Fernandes, Jose Ribas Milanez de Campos, Miguel Lia Tedde, Silvia Yukari Togoro, Robert Stephen Eisinger, Erica Mie Okumura, Angelo Fernandes, Paulo Manuel Pêgo-Fernandes, Jose Ribas Milanez de Campos

Abstract

Objective: Minimally invasive repair of pectus excavatum (MIRPE) is a surgical treatment for PE. During the procedure, a specialized introducer is used to tunnel across the mediastinum for thoracoscopic insertion of a metal bar. There have been reported cases of cardiac perforation during this risky step. The large introducer can be a dangerous lever in unskilled hands. We set out to determine the safety and feasibility of using regular instruments (i.e., not relying on special devices or tools) to create the retrosternal tunnel during MIRPE.

Methods: This was a preliminary study of MIRPE with regular instruments (MIRPERI), involving 28 patients with PE. We recorded basic patient demographics, chest measurements, and surgical details, as well as intraoperative and postoperative complications.

Results: Patients undergoing MIRPERI had Haller index values ranging from 2.58 to 5.56. No intraoperative complications occurred. Postoperative complications included nausea/vomiting in 8 patients, pruritus in 2, and dizziness in 2, as well as atelectasis, pneumothorax with thoracic drainage, pleural effusion, and dyspnea in 1 patient each.

Conclusions: In this preliminary study, the rate of complications associated with MIRPERI was comparable to that reported in the literature for MIRPE. The MIRPERI approach has the potential to improve the safety of PE repair, particularly for surgeons that do not have access to certain special instruments or have not been trained in their use.

Figures

Figure 1. Thoracic schematic diagram of the…
Figure 1. Thoracic schematic diagram of the thorax, with measurements: the sagittal distance between the posterior aspect of the sternum (A) and the anterior spine (B); the sagittal distance between the posterior sternum (C) in its hypothetical corrected position and the anterior spine (B), minus the distance between the posterior sternum in its actual position and the anterior spine (B); the side-to-side distance (D-E); the sagittal depth of the right and left hemithoraces (F-G and H-J); and the sternal rotation angle (F-C-H).
Figure 2. Tunnel dissection with regular instruments…
Figure 2. Tunnel dissection with regular instruments from the left side.
Figure 3. Thoracoscopic view of retrosternal tunnel…
Figure 3. Thoracoscopic view of retrosternal tunnel dissection from the left hemithorax.
Figure 4. Chest tube passed through the…
Figure 4. Chest tube passed through the retrosternal tunnel.
Figure 5. Computed tomography scan of patient…
Figure 5. Computed tomography scan of patient 4 (Haller index of 30.3).

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