Efficacy and Safety of Taulinoplasty Compared with the Minimally Invasive Repair of Pectus Excavatum Approach to Correct Pectus Excavatum

Background: Minimally invasive repair of pectus excavatum (MIRPE) technique is the current most used surgical method for pectus excavatum (PE) correction. To avoid MIRPE-required invasion of the mediastinum or pleural cavity, we developed taulinoplasty approach as an alternative option for the reduction of the sunken chest. Materials and Methods: This is a single-center unblind nonrandomized prospective pilot study, involving 26 MIRPE and 23 taulinoplasty patients. The primary safety endpoint was the presence of surgical complications, and the primary efficacy endpoint was Haller index measured postoperatively in taulinoplasty patients. Secondary endpoints were intensive care unit (ICU) and hospital length of stay (LOS), duration of surgical procedure, and postoperative pain management. Chi-square, Mann-Whitney, or Student "t" tests were used for comparison as appropriate. Results: There were no difference in median age (14.5 and 14 years), Haller index (4.63 and 4.17), or comorbidities. MIRPE and taulinoplasty procedures showed no difference regarding major or minor surgical complications. The efficacy endpoint of taulinoplasty was measured 5.5 (1.5-12) months after the procedure, exhibiting a significant reduction in the Haller index [4.17 (3.7-4.7) at baseline and 3.7 (2.9-4.1) postoperatively, P = .03]. Taulinoplasty required less surgical time (60.4 ± 15.5 versus 70.7 ± 15.9 minutes, P < .01); shorter ICU and hospital LOS (P < .01, respectively); and required fewer days of peridural, intravenous, and oral analgesia (P < .01, respectively). Conclusions: In this pilot study, taulinoplasty technique was as safe as the MIRPE approach and effective for the correction of PE, reducing surgical time, ICU and hospital LOS, and achieving better postoperative pain control.

Initial experience with 3D printing in the use of customized Nuss bars in pectus excavatum surgery

INTRODUCTION

Pectus excavatum (PE) surgical repair according to Nuss procedure is based on the intrathoracic insertion of one (or more) metallic bars for anatomical defect repair. Number of bars, bar length, bar shape, and thoracic insertion site are established during surgery, according to patient morphology, CT-scan, and especially the surgeon's experience.

OBJECTIVE

To assess the usefulness of the design, simulation, and 3D printing of customized Nuss bars for each patient.

MATERIAL AND METHODS

A prospective descriptive study of all patients undergoing PE surgery under 3D printing from June to December 2019 was carried out. Curvature, bar length, and optimal intercostal space were designed based on diagnostic CT-scan, and they were 3D printed full size. The resulting model was reproduced preoperatively on the usual prosthetic material, sterilized, and kept until surgery.

RESULTS

The study cohort consisted of 6 patients. Median age was 15 years old (interquartile range: 14.25-15.25), median Haller index was 4.05 (interquartile range: 3.5-4.49), and repair index was 36.98% (interquartile range: 33.86-38.48%). A Nuss bar was introduced in all cases, without requiring removal or re-insertion. Median operating time was 79.5 minutes (interquartile range: 72.5-103). No postoperative complications were noted during follow-up (12 months).

CONCLUSIONS

The preoperative design of Nuss bars with customized shape and size facilitates surgical planning. It also allows for the most optimal and accurate morphological repair possible, according to patient anatomy, thus reducing the risk of requiring removal and/or re-insertion, and therefore, of surgical complications.

Applicability of Clavien-Dindo classification in Nuss procedure surgical complications

OBJECTIVES

Nuss procedure is a safe surgery but not exempt from complications. Clavien-Dindo classification (1992) allows complications of any surgery to be recorded. Our objective was to prove its applicability in the study of Nuss procedure complications.

MATERIAL AND METHODS

We present a retrospective series of PE patients undergoing surgery from January 2010 to January 2018. Nuss procedure associated morbidity prior to bar removal was studied. Complications were stratified according to Clavien-Dindo classification.

RESULTS

A total of 31 patients were included. Mean age was 14.67 years (4-27 years), with a mean Haller index of 6.06 (3.35-14.14) and a mean correction index of 41.2% (16-87%). Clavien-Dindo classification I-IIIb mild complications were recorded in 35.48% of patients. Seroma was found in 4 patients (12%), of whom 1 had superinfection and 1 had wound dehiscence. In 6 patients, bar and/or stabilizer mobilization was noted, and in 1 patient, postoperative acute pulmonary edema (3%) was observed. Of the 11 patients with complications, only 6 required re-intervention -5 as a result of prosthesis mobilization, and 1 as a result of infection not resolved with intravenous antibiotic therapy.

CONCLUSIONS

Clavien-Dindo classification is being increasingly used as a way of unifying surgical complication criteria by comparing results. Our study demonstrated that such classification is a feasible and reproducible method when it comes to reflecting Nuss procedure morbidity and comparing it with other groups.