Nuss Procedure Steps

By | June 9, 2016
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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

  1. Anesthesia – the patient is put to sleep with general anesthesia with endotracheal intubation
  2. Prep – the chest is prepped, cleaned, and draped
  3. Time Out – the surgery team performs a “time out” to confirm who the patient is, what the surgery is, and any further details necessary
  4. IV Antibiotics – antibiotics are given, a standard of care for surgery to help prevent infection
  5. Marking the chest – the chest is marked for optimal placement of the bar(s) based on the anatomy of the patient
  6. Incisions – incision are made on both sides of the chest at the same level usually. Incisions are as deep as the serratus muscle.
  7. Thoracoscopic incision – An incision for the thoracoscope (about 2mm) is made on the side of the chest as well (left or right)
  8. Thoracoscope insertion – Small gas insufllation is used and the thorascope is inserted to view the anatomy
  9. 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
  10. 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.
  11. Bar flip – the bar is then flipped, and if necessary, the process is repeated if more bars are needed
  12. 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.
  13. Bar stabilizers – sometimes used, they require a few more sutures
  14. Irrigation – wounds are cleaned
  15. Closing – the incisions are closed with sutures
  16. Dressing – the incisions are covered