(1)
Department of Paediatric Surgery, Consultant Paediatric & Neonatal Surgeon, University Hospital Southampton NHS Foundation Trust, Southampton, UK
(2)
Consultant Paediatric & Neonatal Surgeon, University Hospital Southampton NHS Foundation Trust, Southampton, UK
Abstract
Minimally invasive pectus excavatum repair involves placement of a retrosternal steel bar through bilateral thoracic incisions, with the attendant risks of pericardial/cardiac puncture, haemothorax, and pneumothorax. These risks are minimised by performing the procedure under thoracoscopic guidance.
Keywords
Minimally invasive pectus excavatum repairWire tethering suturesBilateral thoracoscopy9.1 General Information
Minimally invasive pectus excavatum repair involves placement of a retrosternal steel bar through bilateral thoracic incisions, with the attendant risks of pericardial/cardiac puncture, haemothorax, and pneumothorax. These risks are minimised by performing the procedure under thoracoscopic guidance.
9.2 Working Instruments
Introducer, Nuss bar, and stabilisers
5-mm camera port and 30° thoracoscope
Water seal system to evacuate pneumothorax
9.3 Positioning, Port Siting and Ergonomic Considerations (Figs. 9.1 and 9.2)
Fig. 9.1
The patient is positioned supine, with the arms outstretched and secured on armboards. Under general anaesthesia, a thoracic epidural catheter is inserted and the right main bronchus is blocked. The surgeon and thoracoscopist stand to the right, with the assistant and scrub nurse to the left of the patient. A Steri-Drape (3 M Healthcare, St. Paul, MN, USA) is used to minimise the risk of implant contamination. Thoracic insufflation using a pressure of 8 mm Hg and low flow of 1 L/min provides a good view of the right thoracic cavity
Fig. 9.2
A 5-mm thoracoscopic port is positioned on the right side, one or two intercostal spaces below the planned right thoracic incision
9.4 Relevant Anatomy (Figs. 9.3, 9.4 and 9.5)
Fig. 9.3
Pectus deformity observed via thoracoscope. The right internal thoracic (mammary) artery and vein are seen
