[show abstract][hide abstract] ABSTRACT: Although minimally invasive repair of pectus excavatum has gained worldwide acceptance, treatment of pectus carinatum is mostly performed with open procedures. Different minimally invasive alternatives have been proposed in the last few years, including subpectoral CO(2) dissection and intrathoracic compression (Abramson technique), or conservative procedures, as dynamic compression system. Recently, another surgical technique has been proposed for the treatment of unilateral pectus carinatum, consisting of a thoracoscopic approach and multiple cartilage incisions. The aim of this work is to present our modification to this approach.
We have modified this technique by introducing complete cartilage resection of all anomalous costal cartilages, performed thoracoscopically. Three thoracoscopic ports were used. Cartilage is removed progressively using a rongeur and preserving the anterior perichondrium.
We have performed this technique in 4 patients during the last year. Follow-up ranged from 6 to 14 months. No intraoperative or postoperative complications were observed. The results, assessed by the patients themselves, were good in 2 cases, quite good in one, and fair in the first patient of our series, who was reoperated using a classical open approach. Pain was well controlled without the need of an epidural catheter.
Thoracoscopic cartilage resection with perichondrium preservation can be considered as feasible alternative for the treatment of unilateral pectus carinatum.
Journal of Pediatric Surgery 01/2011; 46(1):263-6. · 1.38 Impact Factor
[show abstract][hide abstract] ABSTRACT: Pediatric airway tumors are uncommon. A 4-year-old girl with history of stridor since the first year of life underwent rigid laryngotracheal endoscopy revealing a left posterolateral subglottic mass occluding 80% of lumen. Complete tumor resection by open approach was undertaken. Histopathologic and immunohistochemical studies revealed granular cells tumor. The similarity of the clinical and endoscopic presentation of this tumor to the much more frequent subglottic hemangioma that usually requires a different therapeutic approach was of interest. Granular cell tumor must be considered in the differential diagnosis of upper airway obstructive symptoms in infancy and childhood.
Journal of Pediatric Surgery 12/2010; 45(12):e9-11. · 1.38 Impact Factor
[show abstract][hide abstract] ABSTRACT: Lipoblastoma and lipoblastomatosis are rare tumors of infancy. They originate from embryonic fat and localize in soft tissues. We present the case of a lipoblastoma of the neck with localization in tracheal and esophageal walls that required an extended laryngotracheal and esophageal resection. To our knowledge, this is the first report of such localization of this tumor.
Journal of Pediatric Surgery 10/2010; 45(10):e21-3. · 1.38 Impact Factor
[show abstract][hide abstract] ABSTRACT: The removal of the substernal bar after the Nuss operation is not always an easy and fast maneuver. Only a few different technical solutions have been described. In the original Nuss technique, the patient was lying on dorsal decubitus and rotated on the side during the procedure. The Noguchi technique avoids the rotation of the patient, but requires two incisions and straightening of the bar before pulling it out the thorax. Recently, another technique was proposed, avoiding the need of straightening the bar, but it is feasible only if two operative beds in a large operative room are available. We propose another approach for the removal of the bar: The patient is lying on the lateral decubitus, only one incision is performed, and the bar is pulled out along the thoracic wall. Twenty-one bars were removed by using the present approach without any complications. The advantages of our approach on the previous techniques are the single incision, no need of rotating the patient, straightening the bar, or having two operative beds. Our approach is not feasible when metallic stabilizers have been used on both sides, but in our experience, this was not necessary in order to stabilize the bar.
[show abstract][hide abstract] ABSTRACT: Mini-invasive repair of pectus excavatum with Nuss technique is the preferred technique in most centers. One of the most important technical points for the final result is the stabilization of the bar, usually obtained by one or more stabilizers and few stitches fixing the bar to some ribs. Our aim is to show how to get the bar more stable by passing bilaterally some stitches around the bar and the ribs close to it. By a right thoracoscopy and a 30-degree optic, we are able to pass the stitches bilaterally by using an Endoclose needle (Covidien Ltd., Hamilton HM, Bermuda). The left hemithorax is visualized from the right side, pushing the optic through the mediastinum following the bar and staying just below it.
We have operated on 230 patients in two centers. We have used only one stabilizer in more than 90% of the patients. In all patients, we have passed four absorbable stitches on the right side, using an Endoclose needle. In the last 45 cases, we have adopted bilateral fixation of the bar by the Endoclose needle.
The maneuver takes only around 10 minutes. We did not have complications related to that maneuver. We did not observe destabilization of the bar in those cases. The overall destabilization rate was 1.3%.
We suggest this technique to give the bar more stability on both sides. We think the use of a bilateral stabilizer can be avoided.
[show abstract][hide abstract] ABSTRACT: The minimally invasive repair of pectus excavatum has become the preferred technique in most centres. One of the most important technical points for the final result is stabilisation of the bar, usually obtained by one or two metal stabilisers. Recently, long-term absorbable stabilisers have become available (LactoSorb, Biomet, Jacksonville, FL, USA). Made of poly-L-lactic and polyglycolic acid, they have been introduced with the aim of reducing local discomfort and making removal of the bar easier. Their efficacy for the stabilisation of the bar has not been proved yet. In this paper we compare the surgical outcome in two groups of patients, one treated with metallic and the other with absorbable stabilisers.
A total of 280 patients underwent pectus excavatum repair using a Nuss technique in two centres. In 194 patients (group 1), operated on since 2001, the metallic stabiliser was used. In 86 patients (group 2), operated on since February 2007, the LactoSorb stabiliser was preferred. We compared both groups in terms of surgical details, local symptoms or complications, and bar instability rate.
The surgical technique for the stabilisation of the bar was identical in both groups, but in group 1 the stabiliser was fastened to the bar with a steel wire, while in group 2 polyglycolic sutures were used. No differences in local discomfort or postoperative pain were observed between the groups. The LactoSorb stabiliser was palpable for at least 6-9 months, and progressively disappeared at 9-12 months. In group 1 we observed 6 local complications. In particular, two patients presented with infection, one of them associated with a skin lesion and opening over the metallic stabiliser (revision of the wound was performed). Another patient developed a thoracic wall haematoma after suffering a trauma over the metallic stabiliser, 13 months after operation. Three patients developed a seroma. In group 2 we observed 3 subcutaneous swellings at the site of the LactoSorb stabiliser at 6, 8 and 9 months after the operation. We did not observe either skin lesions or infections. In the group with metallic stabiliser, 3 patients (1.5 %) had bar dislocation, while we did not observe bar instability in the group with LactoSorb stabiliser.
LactoSorb stabiliser is safe and effective for stabilising the bar in pectus surgery. We suggest its routine use as it appears to be less traumatic and could make bar removal easier.
European Journal of Pediatric Surgery 01/2009; 18(6):407-9. · 0.84 Impact Factor