The use of a vacuum bell in minimally invasive repair of pectus excavatum

Abstract

BACKGROUND: Along with the widespread use of D. Nuss surgery, the number of complications and deaths has increased. In order to increase the safety of the procedure, various methods of sternal elevation are used. One of these methods is the use of a vacuum bell. This method allows you to perform the elevation of the sternum by creating a negative pressure.

AIM: This article describes our experience of intraoperative and preoperative use of a vacuum bell when performing thoracoplasty according to Nass in our own modification

METHODS: The experience of treating 15 patients aged 8 to 17 years (average age 15.0±2.6 years) operated by the D. Nuss method using vacuum bell is considered. Indications for intraoperative elevation of the sternum were cases of deep pectus excavatum (PE) (Haller index more than 4.5), a variant of the “Grand Canyon" deformation and PE after sternotomy. Also, the vacuum bell was used as a preoperative preparation.

RESULTS: In patients who used a vacuum bell before surgery as preparation, the depth of deformation significantly decreased and at the time of surgery, the average depth of deformation was 6.7±4.0 mm, versus 28.0±6.0 mm before treatment. There was also a decrease in pain syndrome in the postoperative period, a reduction in the use of extended epidural anaesthesia and nonsteroidal anti-inflammatory drugs.

With the intraoperative use of a vacuum bell in patients with PE after sternotomy, the elevation of the sternum was confirmed by thoracoscopy. No intra- and postoperative complications were observed in 14 (93%) patients who used a vacuum bell during thoracoplasty by Nass. In one case, a patient who had previously undergone a sternotomy had massive bleeding as a result of a heart injury.

CONCLUSION: The use of a vacuum bell during thoracoplasty by Nass has proven to be a safe, non-invasive and effective method of sternum elevation, both intraoperatively and as a preoperative preparation.

Keywords

pectus excavatum / thoracoplasty by D. Nuss / intraoperative vacuum bell therapy / conservative treatment / Vacuum Bell

References

[1] Croitoru DP, Kelly RE, Goretsky MJ, et al. Experience and modification update for the minimally invasive Nuss technique for pectus excavatum repair in 303 patients. J Pediatr Surg. 2002;37(3):437-445. doi: 10.1053/jpsu.2002.30851

[2] Croitoru D.P., Kelly R.E., Goretsky M.J., et al. Experience and modification update for the minimally invasive Nuss technique for pectus excavatum repair in 303 patients // J Pediatr Surg. 2002. Vol. 37, N 3. Р. 437-445. doi: 10.1053/jpsu.2002.30851

[3] Zou J, Luo C, Liu Z, Cheng C. Cardiac arrest without physical cardiac injury during Nuss repair of pectus excavatum. J Cardiothorac Surg. 2017;12(1):61. EDN: YVOSXY doi: 10.1186/s13019-017-0624-2

[4] Zou J., Luo C., Liu Z., Cheng C. Cardiac arrest without physical cardiac injury during Nuss repair of pectus excavatum // J Cardiothorac Surg. 2017. Vol. 12, N 1. Р. 61. EDN: YVOSXY doi: 10.1186/s13019-017-0624-2

[5] Takahashi T, Okazaki T, Yamataka A, Uchida E. Usefulness of Kent retractor and lifting hook for Nuss procedure. Pediatr Surg Int. 2015;31(11):1103-1105. EDN: ZJMQAD doi: 10.1007/s00383-015-3764-2

[6] Takahashi T., Okazaki T., Yamataka A., Uchida E. Usefulness of Kent retractor and lifting hook for Nuss procedure // PediatrSurg Int. 2015. Vol. 31, N 11. Р. 1103-1105. EDN: ZJMQAD doi: 10.1007/s00383-015-3764-2

[7] Becmeur F, Ferreira CG, Haecker F-M, et al. Pectus excavatum repair according to Nuss: is it safe to place a retrosternal bar by a transpleural approach under thoracoscopic vision? J Laparoendosc Adv Surg Tech A. 2011;21(8):757-761. doi: 10.1089/lap.2011.0035

[8] Becmeur F., Ferreira C.G., Haecker F.M., et al. Pectus excavatum repair according to Nuss: Is it safe to place a retrosternal bar by a transpleural approach under thoracoscopic vision? // J LaparoendoscAdvSurg Tech A. 2011. Vol. 21, N 8. Р. 757-761. doi: 10.1089/lap.2011.0035

[9] Bouchard S, Hong AR, Gilchrist BF, Kuenzler KA. Catastrophic cardiac injuries encountered during the minimally invasive repair of pectus excavatum. Semin Pediatr Surg. 2009;18(2):66-72. doi: 10.1053/j.sempedsurg.2009.02.002

[10] Bouchard S., Hong A.R., Gilchrist B.F., Kuenzler K.A. Catastrophic cardiac injuries encountered during the minimally invasive repair of pectus excavatum // SeminPediatr Surg. 2009. Vol. 18, N 2. Р. 66-72. doi: 10.1053/j.sempedsurg.2009.02.002

[11] Hebra A. Minor and major complications related to minimally invasive repair of pectus excavatum. Eur J Pediatr Surg. 2018;28(4):320-326. doi: 10.1055/s-0038-1670690

[12] Hebra A. Minor and major complications related to minimally invasive repair of pectus excavatum // Eur J Pediatr Surg. 2018. Vol. 28, N 4. Р. 320-326. doi: 10.1055/s-0038-1670690

[13] Razumovsky AY, Alkhasov AB, Mitupov ZB, et al. 15 year experience with the treatment of sunken chest in children. Detskayakhirurgiya (Russian Journal of Pediatric Surgery). 2016;20(6):284-287. EDN: XRFYZP doi: 10.18821/1560-9510-2016-20-6-284-287

[14] Разумовский А.Ю., AлхасовA.Б., МитуповЗ.Б., и др. 15-летний опыт лечения воронкообразной деформации грудной клетки у детей // Детская хирургия. Журнал им. Ю.Ф. Исакова. 2016. Т. 20, № 6. С. 284-287. EDN: XRFYZP doi: 10.18821/1560-9510-2016-20-6-284-287

[15] Sacco-Casamassima MG, Goldstein SD, Gause CD, et al. Minimally invasive repair of pectus excavatum: Analyzing contemporary practice in 50 ACS NSQIP-pediatric institutions. Pediatr Surg Int. 2015;31(5):493-499. EDN: BHGMYU doi: 10.1007/s00383-015-3694-z

[16] Sacco-Casamassima M.G., Goldstein S.D., Gause C.D., et al. Minimally invasive repair of pectus excavatum: Analyzing contemporary practice in 50 ACS NSQIP-pediatric institutions // Pediatr Surg Int. 2015. Vol. 31, N 5. Р. 493-499. EDN: BHGMYU doi: 10.1007/s00383-015-3694-z

[17] Haecker FM, Krebs T, Kocher GJ, et al. Sternal elevation techniques during the minimally invasive repair of pectus excavatum. Interact CardioVasc Thorac Surg. 2019;29(4):497-502. doi: 10.1093/icvts/ivz142

[18] Haecker F.M., Krebs T., Kocher G.J., et al. Sternal elevation techniques during the minimally invasive repair of pectus excavatum // Interact CardioVascThorac Surg. 2019. Vol. 29, N 4. Р. 497-502. doi: 10.1093/icvts/ivz142

[19] Yoon YS, Kim HK, Choi YS, et al. A modified Nuss procedure for late adolescent and adult pectus excavatum. World J Surg. 2010;34(7):1475-1480. doi: 10.1007/s00268-010-0465-9

[20] Yoon Y.S., Kim H.K., Choi Y.S., et al. A modified Nuss procedure for late adolescent and adult pectus excavatum // World J Surg. 2010. Vol. 34, N 7. Р. 1475-1480. doi: 10.1007/s00268-010-0465-9

[21] Peter SD, Sharp SW, Ostlie DJ, et al. Use of subxiphoid incision for pectus bar placement in the repair of pectus excavatum. J Pediatr Surg. 2010;45(6):1361-1364. doi: 10.1016/j.jpedsurg.2010.02.115

[22] St Peter S.D., Sharp S.W., Ostlie D.J., et al. Use of subxiphoid incision for pectus bar placement in the repair of pectus excavatum // J Pediatr Surg. 2010. Vol. 45, N 6. Р. 1361-1364. doi: 10.1016/j.jpedsurg.2010.02.115

[23] Park HJ, Jeong JY, Jo WM, et al. Minimally invasive repair of pectus excavatum: A novel morphology-tailored, patient-specific approach. J Thorac Cadriovasc Surg. 2010;139(2):379-386. doi: 10.1016/j.jtcvs.2009.09.003

[24] Park H.J., Jeong J.Y., Jo W.M., et al. Minimally invasive repair of pectus excavatum: A novel morphology-tailored, patient-specific approach // J Thorac Cadriovasc Surg. 2010. Vol. 139, N 2. Р. 379-386. doi: 10.1016/j.jtcvs.2009.09.003

[25] Park HJ, Chung WJ, Lee IS, Kim KT. Mechanism of bar displacement and corresponding bar fixation techniques in minimally invasive repair of pectus excavatum. J Pediatr Surg. 2008;43(1):74-78. doi: 10.1016/j.jpedsurg.2007.09.022

[26] Park H.J., Chung W.J., Lee I.S., Kim K.T. Mechanism of bar displacement and corresponding bar fixation techniques in minimally invasive repair of pectus excavatum // J Pediatr Surg. 2008. Vol. 43, N 1. Р. 74-78. doi: 10.1016/j.jpedsurg.2007.09.022

[27] Takagi S, Oyama T, Tomokazu N, et al. A new sternum elevator reduces severe complications during minimally invasive repair of pectus excavatum. Pediatr Surg Int. 2012;28(6):623-626. doi: 10.1007/s00383-012-3087-5

[28] Takagi S., Oyama T., Tomokazu N., et al. A new sternum elevator reduces severe complications during minimally invasive repair of pectus excavatum // PediatrSurg Int. 2012. Vol. 28, N 6. Р. 623-626. doi: 10.1007/s00383-012-3087-5

[29] Tedde ML, Milanez de Campos JR, Wihlm JM, Jatene FB. The Nuss procedure made safer: An effective and simple sternal elevation manoeuvre. Eur J Cardiothorac Surg. 2012;42(5):890-891. doi: 10.1093/ejcts/ezs442

[30] Tedde M.L., de Campos J.R., WihlmJ.M., JateneF.B. The Nuss procedure made safer: An effective and simple sternal elevation manoeuvre // Eur J Cardiothorac Surg. 2012. Vol. 42, N 5. Р. 890-891. doi: 10.1093/ejcts/ezs442

[31] Dzielicki J, Korlacki W, Janicka I, Dzielicka E. Difficulties and limitations in minimally invasive repair of pectus excavatum: 6 years experiences with Nuss technique. Eur J Cardiothorac Surg. 2006;30(5):801-804. doi: 10.1016/j.ejcts.2006.08.004

[32] Dzielicki J., Korlacki W., Janicka I., Dzielicka E. Difficulties and limitations in minimally invasive repair of pectus excavatum: 6 years experiences with Nuss technique // Eur J Cardiothorac Surg. 2006. Vol. 30, N 5. Р. 801-804. doi: 10.1016/j.ejcts.2006.08.004

[33] Kim DH, Hwang JJ, Lee MK, et al. Analysis of the Nuss procedure for pectus excavatum in different age groups. Ann Thorac Surg. 2005;80(3):1073-1077. doi: 10.1016/j.athoracsur.2005.03.070

[34] Kim D.H., Hwang J.J., Lee M.K., et al. Analysis of the Nuss procedure for pectus excavatum in different age groups // Ann Thorac Surg. 2005. Vol. 80, N 3. Р. 1073-1077. doi: 10.1016/j.athoracsur.2005.03.070

[35] Haecker FM, Sesia S. Intraoperative use of the vacuum bell for elevating the sternum during the Nuss procedure. J Laparoendosc Adv Surg Tech A. 2012;22(9):934-936. doi: 10.1089/lap.2012.0030

[36] Haecker F.M., Sesia S. Intraoperative use of the vacuum bell for elevating the sternum during the Nuss procedure // J Laparoendosc Adv Surg Tech A. 2012. Vol. 22, N 9. Р. 934-936. doi: 10.1089/lap.2012.0030

[37] Sesia S, Hradetzky D, Haecker FM. Monitoring the effectiveness of the vacuum bell during pectus excavatum treatment: Technical innovation. J Pediatr Surg. 2018;53(3):411-417. doi: 10.1016/j.jpedsurg.2017.05.023

[38] Sesia S., Hradetzky D., Haecker F.M. Monitoring the effectiveness of the vacuum bell during pectus excavatum treatment: Technical innovation // J Pediatr Surg. 2018. Vol. 53, N 3. Р. 411-417. doi: 10.1016/j.jpedsurg.2017.05.023

[39] Haecker FM, Krebs T, Kocher GJ, et al. Sternal elevation techniques during the minimally invasive repair of pectus excavatum. Interact CardioVasc Thorac Surg. 2019;29(4):497-502. doi: 10.1093/icvts/ivz142

[40] Haecker F.M, Krebs T., Kocher G.J., et al. Sternal elevation techniques during the minimally invasive repair of pectus excavatum // Interact CardioVascThorac Surg. 2019. Vol. 29, N 4. Р. 497-502. doi: 10.1093/icvts/ivz142

[41] Elsayed H. Crane technique with the vacuum bell device for improving access in the Nuss procedure. J Thorac Cardiovasc Surg. 2015;150(5):1372-1373 doi: 10.1016/j.jtcvs.2015.03.064

[42] Elsayed H. Crane technique with the vacuum bell device for improving access in the Nuss procedure // J Thorac Cardiovasc Surg. 2015. Vol. 150, N 5. Р. 1372-1373. doi: 10.1016/j.jtcvs.2015.03.064

RIGHTS & PERMISSIONS

Eco-Vector