Decreased risk of complications with bilateral thoracoscopy and left-to-right mediastinal dissection during minimally invasive repair of pectus excavatum

Introduction: The repair of pectus excavatum using minimally invasive surgery is widely gaining acceptance as an equal if not superior technique to the traditional open approach. A number of modifications to the original Nuss procedure have been proposed to avoid complications. Purpose of the Study: The aim of the study was to confirm the efficacy and safety of left-to-right mediastinal dissection during a Nuss procedure. Methods: A retrospective review of modified thoracoscopic Nuss repairs of pectus excavatum done at the Children's Hospital Oakland over approximately a 5-year period with subsequent data analysis was performed. Results: Thirty-two patients between the ages of 3 and 19 underwent a modified Nuss procedure using bilateral thoracoscopy and left-to-right mediastinal dissection. No intra- or postoperative complications were noted in any of the patients, which included but were not limited to mediastinal injury, bleeding, or chest tube insertion for pneumothorax. Conclusions: Bilateral thoracoscopic repair of pectus excavatum with left-to-right mediastinal dissection is a safe alternative to the traditional approach, as it allows a more complete visualization of the mediastinum and eliminates the need for additional safety measures such as subxiphoid dissection and elevation.