The Nuss Procedure is the most common form of treatment for Pectus Excavatum. It involves inserting a metal bar (or multiple bars) into the chest. A few years later, the bars are removed.
The Nuss Procedure can vary depending on the surgeon, but the basic steps hold true for most institutions.
Nuss Procedure Steps
- Anesthesia – the patient is put to sleep with general anesthesia with endotracheal intubation
- Prep – the chest is prepped, cleaned, and draped
- Time Out – the surgery team performs a “time out” to confirm who the patient is, what the surgery is, and any further details necessary
- IV Antibiotics – antibiotics are given, a standard of care for surgery to help prevent infection
- Marking the chest – the chest is marked for optimal placement of the bar(s) based on the anatomy of the patient
- Incisions – incision are made on both sides of the chest at the same level usually. Incisions are as deep as the serratus muscle.
- Thoracoscopic incision – An incision for the thoracoscope (about 2mm) is made on the side of the chest as well (left or right)
- Thoracoscope insertion – Small gas insufllation is used and the thorascope is inserted to view the anatomy
- Clamp – sometimes, the sternum is clamped from the outside with two tiny incisions so that it can be lifted up as the bars are inserted across the chest
- Insertion of bars – the bars manually shaped to fit the patient and are then inserted from one incision, pushed through the chest, until they reach the other side of the chest. A guiding rod or string can be used during this process.
- Bar flip – the bar is then flipped, and if necessary, the process is repeated if more bars are needed
- Secure bars – bars are secured using a variety of techniques, such as fiberwire. The sutures go through the underlying ribs around the bar. About four or five sutures are used on each side, for each bar.
- Bar stabilizers – sometimes used, they require a few more sutures
- Irrigation – wounds are cleaned
- Closing – the incisions are closed with sutures
- Dressing – the incisions are covered