Minimally Invasive Repair of Pectus Carinatum

Pectus carinatum can be corrected by a number of surgical and non-surgical techniques.

Minimally invasive repair of pectus carinatum (Abramson or reverse Nuss procedure) can correct the pectus without cartilage resection.

The two patients were 16-year-old boys who had onset of pectus carinatum at adolescence.

Correction pressures between 6 and 7 pounds per square inch indicate moderate stiffness of the chest wall.

Special equipment for this procedure includes 4-hole stabilizers, bendable rib protectors, and the Pioneer sternal cable system, in addition to the Zimmer Biomet pectus tray.

The procedure is performed under general anesthesia with an epidural catheter for intraoperative and postoperative analgesia.

Prophylactic antibiotics are given, and a Foley catheter is inserted and kept for 24 hours.

Bar length is determined by measuring the distance between the two mid-axillary lines at the highest point of the carinatum after correction.

The end of the bar on each side should correspond to the intercostal space between the two ribs where the stabilizers will be anchored.

Ribs are cleared of all muscle attachments for a distance of approximately 3 centimeters.

A 1-inch periosteal incision is made in the rib, and the periosteum is separated from the underlying bone anteriorly and posteriorly.

A rib protector of similar size to the measured subperiosteal space is bent to the shape of the rib, and a cable is threaded through its holes.

A small piece of dental wire is used to label the rib protector to facilitate removal from behind the rib in 2 to 3 years.

A tunnel is created between the muscles and the bony chest wall using a long curved clamp and finger dissection from both sides meeting at the midpoint, completed with the least curved pectus tunneler.

Sternal wire is placed around a notch in the bar just distal to the stabilizer to lock the bar and stabilizer in position.

With pressure on the chest to achieve a corrected position, the crimps are locked on the anterior surface of the stabilizer.

The bar is tightly anchored to 4 ribs, 2 on each side, with the process performed twice on each side.

The rib protectors prevent the cables from cutting through the ribs.

Excellent correction was achieved and maintained at one year after repair in both patients.

In addition to correction of the pectus, lateral chest wall expansion occurred.