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.

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

Special equipment for minimally invasive pectus carinatum repair includes 4-hole stabilizers, bendable rib protectors, and the Pioneer sternal cable system, in addition to the Zimmer Biomet pectus tray containing tunnelers and bars.

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 during minimally invasive pectus carinatum repair.

Bar length for pectus carinatum repair 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 during the dissection phase.

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

A rib protector is bent to the shape of the rib and a cable is threaded through its holes before being passed under the rib within the subperiosteal space.

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 using the Pioneer cable system.

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

Rib protectors prevent the cables from cutting through the ribs during pectus carinatum repair.

Excellent correction was achieved and maintained at one year after minimally invasive pectus carinatum repair in both demonstrated cases.

In addition to correction of the pectus, lateral chest wall expansion occurred after minimally invasive repair.