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How is the Nuss procedure for pectus excavatum performed?

The Nuss procedure is a minimally invasive procedure used to correct pectus excavatum, a congenital deformity known as “sunken chest” or “funnel chest."

The Nuss procedure uses three small incisions; one under each arm and the third for a thin scope that gives the surgeon an inside view of the chest. During the procedure, a curved stainless steel bar is placed behind the sternum. It sits on top of the ribs on either side of the sternum; the chest wall is used as a base of support. The bar, which sits entirely under the skin and soft tissues, pushes the sternum to its proper position. It's left in place for three years. During this time the chest remodels itself to the normal contour. Removing the bar only requires an out-patient procedure.

Patients will experience improvements in breathing, comfort and stamina soon after surgery. Typically they can return to school or work in one to two weeks. Competitive sports and other strenuous activities can be resumed in about eight weeks.

The minimally invasive Nuss procedure for pectus excavatum is performed with general anesthesia, as well as placement of an epidural catheter for pain management after the operation. Performed using video-assisted thoracoscopic surgery or VATS, The Nuss procedure involves creation of a horizontal passage underneath the sternum through two small incisions in the side of the patient's chest. A separate, small incision enables the surgeon to view the inside of the chest with the thoracoscopic camera. A convex steel bar known as the Lorenz pectus bar is specially shaped to fit the patient's anatomy, inserted through the passage and then turned to push the sternum outward. A metal plate and sutures secure the bar and prevent it from moving ("wandering") while the chest tissue re-forms. The bar must remain in place for a minimum of two years while the chest heals and re-forms to its new shape. The bar is removed as an outpatient procedure.

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