THE NUSS PROCEDURE USING LEFT-SIDED THORACOSCOPY FOR PECTUS EXCAVATUM. ANALYSIS OF 100 CASES. maciek.preinl@gmail.com

493-03

THE NUSS PROCEDURE USING LEFT-SIDED THORACOSCOPY FOR PECTUS EXCAVATUM. ANALYSIS OF 100 CASES.

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Poland

Oral or Poster

Dr. Donald Nuss introduced a minimally invasive procedure for pectus excavatum in 1997. Modifications, including right-sided thoracoscopy, have improved safety and efficacy. We present a further modification—left-sided thoracoscopy—to allow continuous visualization of the heart and pericardium.

We retrospectively reviewed 100 children treated with a modified Nuss procedure at the University Children’s Hospital of Cracow between 2016 and 2024. Data collected included demographics, surgery duration, hospital stay, and outcomes. The technique used three incisions: two for the introducer (anterior to the heart and lungs, posterior to ribs and sternum) and one for the thoracoscope. In our modification, the thoracoscope was placed on the left side to optimize cardiac visualization. The bar was removed after 2–4 years.

Of the 100 patients, 92 were male. All underwent left-sided thoracoscopy. Mean hospital stay was 9 days (range 5–21). Recurrence appeared in two patients. Surgical complications were observed in 5 patients; early postoperative complications in 12. No significant correlation was found between age and complications, recurrence, or reoperation. Higher weight was significantly associated with fewer intraoperative complications (rho = –0.46). Weak but significant correlations were found between shorter surgery duration and longer hospitalization (rho = –0.33), and between longer surgery duration and increased reoperation risk (rho = 0.35).

The Nuss procedure remains an effective, low-risk treatment for pectus excavatum. Left-sided thoracoscopy may improve safety by reducing cardiac injury risk. Higher patient weight may indicate a lower risk of intraoperative complications.