Description

The Nuss Procedure, also known as MIRPE (Minimally Invasive Repair of Pectus Excavatum), is a widely used minimally invasive surgical technique for correcting pectus excavatum, the most common congenital chest wall deformity where the sternum is sunken in. 🩺 Indications Moderate to severe pectus excavatum (e.g., Haller index > 3.2) Symptomatic patients (dyspnea, chest pain, reduced exercise tolerance) Psychosocial distress due to cosmetic appearance Sometimes combined with cardiac or pulmonary compression findings on imaging 🔧 Surgical Technique (Nuss / MIRPE) Preoperative Evaluation Chest CT for Haller index Cardiac and pulmonary function tests Sometimes 3D planning or MRI Procedure Steps General anesthesia with single-lumen intubation Thoracoscopy (usually right side) to visualize the pleural cavity and guide bar placement Small lateral incisions on each side of the chest wall (typically at the mid-axillary line) Substernal tunnel creation using a clamp or introducer behind the sternum Insertion of a curved metal bar (titanium or stainless steel) through the tunnel Bar rotation: Once in position, the bar is flipped to push the sternum outward, correcting the deformity Bar fixation using stabilizers and/or sutures to prevent rotation or displacement Closure: Incisions are closed, and chest drains are rarely needed 🕒 Postoperative Care Hospital stay: 3–5 days Pain management: Epidural or PCA pump initially, followed by oral meds Activity restrictions: Avoid sports and heavy lifting for ~3 months No twisting or bending for the first few weeks Bar removal: Typically 2–4 years later under general anesthesia ✅ Advantages of the Nuss Procedure Minimally invasive with small incisions Excellent cosmetic results Shorter operation time compared to open procedures Less disruption of musculoskeletal structures ⚠️ Complications Bar displacement Pneumothorax or hemothorax Pericardial or cardiac injury (rare but serious) Infection Allergic reaction to metal (rare) Pain: Common in early recovery but typically improves Overcorrection/undercorrection