Thoracoscopic Treatment of Pectus Excavatum: The Nuss Procedure

Pectus excavatum is the most common chest wall deformity affecting up to 1 % of the population. Traditional management required an open procedure that included an anterior chest incision, resection of the affected cartilages, and sternal osteotomy. In 1997, Donald Nuss proposed a minimally invasive approach that utilized small, laterally oriented incisions and placement of a rigid bar to push the sternum up into the appropriate position. Over time this support allows the chest wall to remodel resulting in reversal of the defect, all without cartilage resection or osteotomy. Since its inception, it has experienced widespread application in many centers worldwide with good results. In this chapter we present the workup, selection of patients, and procedure for the minimally invasive repair of pectus excavatum. There is extensive literature on many aspects of this condition and procedure. The emphasis of this chapter is to present the technical logistics of the minimally invasive approach.