Pectus Excavatum FAQ
Lee Health: Pioneering Healthcare Innovation
The Nuss Operation, also known as minimally invasive repair of pectus excavatum (MIRPE), is primarily considered for patients with significant pectus excavatum deformity. This condition, often referred to as "sunken chest" or "funnel chest," occurs when the breastbone (sternum) is abnormally depressed, causing the chest to appear concave.
Lee Physician Group's very own pectus excavatum expert, Dr. Andre Hebra, answers the questions he receives from concerned parents in Southwest Florida.
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Pediatric Surgery - Golisano Children's Health Center
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Golisano Pediatric Surgery - Summerlin Rd
Dr. Hebra emerged as a trailblazer in the early stages of laparoscopic surgical methods with a distinct focus on minimal access surgery and robotic techniques.
He has made significant contributions to healthcare innovation with over 100 peer-reviewed scientific articles and book chapters to his credit. Recognized for his original research and outstanding teaching, he consistently earns placement in the esteemed "Best Doctors in America" listings.
Notably, Dr. Hebra spearheaded outcomes research addressing the management of congenital chest anomalies, leading to enhanced care protocols for pediatric patients with pectus excavatum and carinatum.
Understanding the Nuss Operation for Pectus Excavatum
The Minimally Invasive Operation for the repair of Pectus Excavatum, also known as the Nuss Operation, is a completely different surgery from what it used to be. The open Ravitch operation required making an incision in the anterior chest - the front of the chest - and then removing segments of all the ribs affected by the pectus.
The outer layer of the cartilage ribs (perichondrium) is preserved to allow the ribs to grow back. The sternum must be fractured in at least one area to allow for it to be bent in the appropriate position. Complications of the open operation include bleeding, infection, injury to the lungs and pleura, and the possible need for replacement of chest drains. The result is rated as very good but it does leave a long scar on the chest.
With the new technique (known as the Nuss operation or the minimally invasive repair), it is not necessary to create any large incisions or to remove/fracture any ribs or cartilage, or sternum. The surgeon can approach the chest with small lateral chest wall incisions and, using a special camera (thoracoscope), the surgeon can visualize the inside of the chest so that a stainless steel bar can be placed to correct the deformity.
Again, this is accomplished without cutting anything, without breaking bones, without removing any cartilage. The duration of the entire operation is much shorter. With the open repair, the operation may take 4 to 5 hrs. With the Nuss technique, the operation is typically completed in just about an hour.
How does the minimally invasive operation work?
The minimally invasive operation (Nuss technique) is done through 2 small lateral chest wall incisions -- one on each side of the chest, lateral to the nipple area. A small 5 mm camera is inserted into the chest. This will allow the surgeon to have direct visualization of the placement of the bar and all the important structures inside the chest (such as the heart, blood vessels, and lungs). The surgeon will also elevate the sternum during the procedure for precise placement of the bar behind the point of maximal depression of the sternum. The curved stainless steel curved bar is placed via the two small lateral chest wall incisions.
The bar is available in different lengths according to age and patient size. Then the bar is selected at the time of surgery and is bent (curved) by the surgeon after certain measurements of the chest are taken. The bar will have a smooth concave shape to it to allow for its placement behind the sternum.
The bar is passed through the small lateral chest wall incision, under the sternum, in front of the heart, all the way to the other side of the chest with active sternal elevation. The bar is then flipped, such that the sternum is raised and the entire chest wall is immediately remodeled. The entire maneuver is done under thoracoscopic visualization.
Essentially, the operation allows for the placement of an internal “brace”. The brace (pectus bar) will displace the ribs and the sternum forward, keeping them in that “new” position until complete remodeling of the chest wall has occurred. This process typically takes two years. Fort that reason, the bar is left in place for at least two to three years.