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Pediatric Surgery International

, Volume 30, Issue 1, pp 113–117 | Cite as

Technical innovation in minimally invasive repair of pectus excavatum

  • Michal RyglEmail author
  • M. Vyhnanek
  • A. Kucera
  • V. Mixa
  • M. Kyncl
  • J. Snajdauf
Technical Innovation

Abstract

The aim of study was to introduce technical innovation of MIRPE which reduces the risk of cardiac injury. Modification of MIRPE method with semiflexible thoracoscope and sternum elevating technique has been used. Volkmann bone hook has been inserted percutaneously to the sternum. The hook elevates the sternum forward and enlarges the retrosternal space for safer passage of thoracoscopically guided introducer. Using semiflexible thoracoscope allows better view from various angles via one site of insertion. During the period 2005–2012, the MIRPE was performed on 29 girls and 151 boys; the mean age at the time of surgery was 15.9 years (range 13–18.7 years). The mean Haller index was 4.7 (range 2.7–20.5). The most common complication was pneumothorax (3.3 %) and the incidence of bar displacement was 2 %. The most serious complication was cardiac perforation when inserting Lorenz introducer. This occurred in a 16-year-old girl; she required urgent sternotomy with right atrial repair and recovered well. External elevation of sternum with the hook was used since this case. Subsequent 113 patients underwent surgery without any serious complications. Technical innovation using semiflexible thoracoscope and hook elevation of the sternum reduces the risk of cardiac injury. The hook opens the anterior mediastinum space effectively and makes the following dissection relatively safe and straightforward.

Keywords

Pectus excavatum Minimally invasive repair of pectus excavatum Semiflexible thoracoscope Wolkmann bone hook Sternum elevating technique 

Notes

Acknowledgments

Authors would like to thank Ms Jana Kalousová M.D. for expert consultation.

Conflict of interest

The authors declare that they have no conflict of interest.

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Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Michal Rygl
    • 1
    Email author
  • M. Vyhnanek
    • 1
  • A. Kucera
    • 1
  • V. Mixa
    • 2
  • M. Kyncl
    • 3
  • J. Snajdauf
    • 1
  1. 1.Department of Pediatric Surgery, 2nd Faculty of Medicine and Teaching Hospital in MotolCharles University in PraguePrague 5Czech Republic
  2. 2.Department of Anaesthesia and Intensive Care Medicine, 2nd Faculty of Medicine and Teaching Hospital in MotolCharles University in PraguePrague 5Czech Republic
  3. 3.Department of Imaging Methods, 2nd Faculty of Medicine and Teaching Hospital in MotolCharles University in PraguePrague 5Czech Republic

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