Sternal elevation techniques during the minimally invasive repair of pectus excavatum.

Autor:	Haecker FM; Pediatric Surgery, Surgical Clinic, American Hospital Dubai, Dubai, United Arab Emirates.; Department of Pediatric Surgery, Children's Hospital of Eastern Switzerland, St. Gallen, Switzerland.; Faculty of Medicine, University of Basel, Basel, Switzerland., Krebs T; Department of Pediatric Surgery, Children's Hospital of Eastern Switzerland, St. Gallen, Switzerland., Kocher GJ; Division of General Thoracic Surgery, Bern University Hospital/Inselspital, Bern, Switzerland., Schmid RA; Division of General Thoracic Surgery, Bern University Hospital/Inselspital, Bern, Switzerland., Sesia SB; Division of General Thoracic Surgery, Bern University Hospital/Inselspital, Bern, Switzerland.
Jazyk:	angličtina
Zdroj:	Interactive cardiovascular and thoracic surgery [Interact Cardiovasc Thorac Surg] 2019 Oct 01; Vol. 29 (4), pp. 497-502.
DOI:	10.1093/icvts/ivz142
Abstrakt:	The aim of the review was to evaluate the routine use of sternal elevation techniques (SETs) during minimally invasive repair of pectus excavatum (MIRPE, the Nuss procedure). We performed a review of the literature between January 1998 and September 2018 with focus on different methods of SET during MIRPE. Reported effects and side effects were evaluated and compared with our own experience concerning the routine use of the vacuum bell for sternal elevation during MIRPE during the last 13 years. SET is more often used in adult patients than in adolescents. SET improves visualization and safety of MIRPE. Advancement of the pectus introducer, retrosternal dissection and placement of the pectus bar are easier. The risk of cardial and/or pericardial lesion is reduced significantly. Different types of retractors, a crane combined with a wire and/or customized hooks are reported to be used as SET. Furthermore, routine use of a subxiphoid incision is reported. However, more technical equipment, and in some SETs additional incisions are necessary. In contrast, no additional skin incision is necessary for the vacuum bell. The routine intraoperative use of the vacuum bell was safe and effective in 131 patients. It facilitates the retrosternal dissection and the insertion of the pectus bar like other SETs. Besides a temporary mild hematoma, no relevant side effect was observed. In conclusion, an increasing number of authors report on the routine use of SET during MIRPE to improve safety of the procedure. We recommend the routine intraoperative use of the vacuum bell during MIRPE. (© The Author(s) 2019. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.)
Databáze:	MEDLINE
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