Recent experiences with minimally invasive pectus excavatum repair “nuss procedure”


Objective: To review the new technical modifications and results of 668 patients who have had pectus excavatum repair utilizing the minimally invasive technique. Methods: A retrospective chart review was conducted of 668 patients undergoing minimally invasive pectus repair from 1987 through July 2004. Since 1997, a standardized treatment pathway was implemented. Preoperative evaluation included computed tomography (CT) scan, pulmonary function tests, and cardiac evaluations with electrocardiogram and echocardiogram. Indications for operation included at least 2 of the following: progression of the deformity, Haller CT index greater than 3.25, mitral valve prolapse, cardiac compression or displacement, pulmonary function studies that indicate restrictive or obstructive airway disease, previous failed open or minimally invasive pectus repair. Technical and design modifications since 1998 have included routine thoracoscopy, the use of an introducer/dissector for creating the substernal tunnel, elevating the sternum, and routine use of a wired lateral stabilizer and polydioxanone suture (PDS) sutures around the bar and underlying rib to prevent bar displacement. The bar is removed as an outpatient procedure in 2 to 4 years. Results: In 668 patients undergoing minimally invasive pectus repairs, single bars were used in 78.1% and double in 21.7%. Lateral stabilizers were applied in 99.8% and were wired for further stability in 71%. Bar shifts before the use of stabilizers were 14.3%, which decreased to 4.6% after stabilizers were placed and 0.8% with a wired stabilizer and PDS sutures. Results were excellent in 78.5%, good in 13.1%, fair in 4.7% and failed in 3.7% after more than 1 year post bar removal. Conclusion: The minimally invasive technique has evolved into an effective method of pectus excavatum repair. Modifications of the technique have reduced complications. Long-term results continue to be excellent.

This is a preview of subscription content, access via your institution.


  1. 1.

    Nuss D, Kelly RE Jr, Croitoru DP, Katz ME. A 10-year review of a minimally invasive technique for the correction of pectus excavatum. J Pediatr 1998; 33: 545–52.

    CAS  Google Scholar 

  2. 2.

    Nuss D, Kelly RE Jr, Croitoru DP, et al. Repair of pectus excavatum. Ped Endosurg & Innovat Techn 1998; 2: 205–21.

    Google Scholar 

  3. 3.

    Croitoru DP, Kelly RE Jr, Goretsky MJ, Lawson ML, Swoveland B, Nuss D, et al. Experience and modification update for the minimally invasive Nuss technique for pectus excavatum repair in 303 patients. J Pediatr Surg 2002; 37: 437–45.

    PubMed  Article  Google Scholar 

  4. 4.

    Lawson ML, Mellins RB, Tabangin M, Kelly RE Jr, Croitoru DP; Goretsky MJ, et al. Impact of pectus excavatum on pulmonary function before and after repair with the Nuss procedure. J Pediatr Surg 2005; 40: 174–80.

    PubMed  Article  Google Scholar 

  5. 5.

    Lawson ML, Cash TF, Akers RA, Vasser E, Burke B, Tabangin M, et al. A pilot study of the impact of surgical repair on disease-specific quality of life among patients with pectus excavatum. J Pediatr Surg 2003; 38: 916–8.

    PubMed  Article  Google Scholar 

  6. 6.

    Coln D, Gunning T, Ramsey M, Swygert T, Vera R. Early experience with the Nuss minimally invasive correction of pectus excavatum in adults. World J Surg 2002; 26: 1217–21.

    PubMed  Article  Google Scholar 

  7. 7.

    Park HJ, Lee SY, Lee CS, Youm W, Lee KR. The Nuss procedure for pectus excavatum: Evolution of techniques and results on 322 patients. Ann Thorac Surg 2004; 1:289–95.

    Article  Google Scholar 

  8. 8.

    Sugita A, Sekiya S, Omori K. Nuss procedure for pectus excavatum in adult cases. Jpn J Pediatr Surg 2003; 35: 737–45.

    Google Scholar 

Download references

Author information



Corresponding author

Correspondence to Donald Nuss MB, ChB, FRCS(c), FACS, FAAP.

Additional information

Read at the Fifty-seventh Annual Meeting of the Japanese Association for Thoracic Surgery, Educational Lecture, Sapporo, October 20–22, 2004.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Nuss, D. Recent experiences with minimally invasive pectus excavatum repair “nuss procedure”. Jpn J Thorac Caridovasc Surg 53, 338–344 (2005).

Download citation

Key words

  • pectus excavatum
  • minimally invasive
  • Nuss procedure