Minimally invasive repair of pectus excavatum: A novel morphology-tailored, patient- specific approach Hyung Joo Park, MD, Jin Yong Jeong, MD, Won Min.

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Presentation transcript:

Minimally invasive repair of pectus excavatum: A novel morphology-tailored, patient- specific approach Hyung Joo Park, MD, Jin Yong Jeong, MD, Won Min Jo, MD, Jae Seung Shin, MD, In Sung Lee, MD, Kwang Taik Kim, MD, Young Ho Choi, MD The Journal of Thoracic and Cardiovascular Surgery Volume 139, Issue 2, Pages 379-386 (February 2010) DOI: 10.1016/j.jtcvs.2009.09.003 Copyright © 2010 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Crane technique: elevation of the depressed sternum before mediastinal passage of the introducer and pectus bar. A, An operating table mount crane system elevates the sternum via a wire suture passing through the patient's sternum. B, Wire suture(s) is (are) delivered through the sternum at the xiphoid process or the lateral side of the sternal body. C, Suture needle strictly passes through the bone between the outer and inner tables of the sternum. The Journal of Thoracic and Cardiovascular Surgery 2010 139, 379-386DOI: (10.1016/j.jtcvs.2009.09.003) Copyright © 2010 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 Morphology-tailored bar shaping (left column: pre-repair vs right column: post-repair). A, Symmetric bar (bridge shape) for symmetric type (type 1). B, Asymmetric bar for eccentric asymmetry (type 2A). C, Seagull bar for unbalanced type (type 2B): a notch to avoid elevation. D, The crest compression technique for excavatum-carinatum complex: To compress the protruded part of the chest wall, the hinge point is set exactly on the crest (∗). By rotation of the bar, the crest was compressed by the negative momentum of the lever action; the “compression-elevation dual action” of the bar. All the results of repair are a symmetric configuration (right). The Journal of Thoracic and Cardiovascular Surgery 2010 139, 379-386DOI: (10.1016/j.jtcvs.2009.09.003) Copyright © 2010 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 Trends of complication and reoperation rate changes. Analysis of 1170 patients from 1999 to 2008 revealed that the multipoint bar fixation technique at point 1 (arrow) and routine hemo-vac drainage at point 2 (arrow) are attributed to major reductions of complications. The secondary peak (∗) of the total complication, mainly due to wound seroma and pneumothorax, was resolved by intrapleural and wound drainage with hemo-vac catheter. MPF, Multiple point fixation; HVD, hemo-vac drainage. The Journal of Thoracic and Cardiovascular Surgery 2010 139, 379-386DOI: (10.1016/j.jtcvs.2009.09.003) Copyright © 2010 The American Association for Thoracic Surgery Terms and Conditions