Hybrid Nuss Procedure for Pectus Excavatum With Severe Retrosternal Adhesions After Sternotomy Shuai Li, MD, Dehua Yang, PhD, Yazhen Ma, MD, Shao-tao.

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Hybrid Nuss Procedure for Pectus Excavatum With Severe Retrosternal Adhesions After Sternotomy Shuai Li, MD, Dehua Yang, PhD, Yazhen Ma, MD, Shao-tao Tang, MD, Li Yang, MD, Shiwang Li, MD, Guoqing Cao, MD, Kang Li, PhD, Xi Zhang, MM, Xingjian Hu, PhD The Annals of Thoracic Surgery Volume 103, Issue 5, Pages 1573-1577 (May 2017) DOI: 10.1016/j.athoracsur.2016.10.001 Copyright © 2017 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 (A, B) Blunt dissection of the retrosternal space using the surgeon’s finger (arrow). The Annals of Thoracic Surgery 2017 103, 1573-1577DOI: (10.1016/j.athoracsur.2016.10.001) Copyright © 2017 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Elevation of the sternum using a retractor with appropriate power. The Annals of Thoracic Surgery 2017 103, 1573-1577DOI: (10.1016/j.athoracsur.2016.10.001) Copyright © 2017 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 (A) General operation scene. (B) Dissection using hemostatic forceps (Hf) through a subxiphoid incision using thoracoscope as close to the bottom of the sternum (s) as possible; arrow indicates the tense adhesion between myocardium and sternum. (C) View by thoracoscope from incision in right side of chest. (f = finger; h = heart; i = introducer; s = sternum.) The Annals of Thoracic Surgery 2017 103, 1573-1577DOI: (10.1016/j.athoracsur.2016.10.001) Copyright © 2017 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 Postoperative photograph of chest. The Annals of Thoracic Surgery 2017 103, 1573-1577DOI: (10.1016/j.athoracsur.2016.10.001) Copyright © 2017 The Society of Thoracic Surgeons Terms and Conditions