Minimally invasive procedure helps patients with chest deformity

December 13, 2002

A new minimally invasive procedure offers patients suffering from pectus excavatum--commonly known as funnel chest--better results than conventional surgery. In the Chicago area, the procedure is being performed at the University of Chicago Children's Hospital (UCCH).

Pectus excavatum is a congenital malformation of the chest cavity. Thousands of children suffer from it. Patients with this deformity experience shortness of breath, the result of compressed lungs.

Conventional surgery for pectus excavatum required the breastbone to be broken and repositioned. A short bar was then wired to the ribs. Patients were left with a large chest scar. It took weeks to recover from the surgery. Postoperative complications, such as a stiff chest, were common.

Now, UCCH offers a new approach based on a technique known as the Nuss procedure. This minimally invasive surgery (MIS) requires only a one-inch incision made on each side of the chest. A thoracoscope and a surgical steel U-shaped bar are threaded underneath the rib cage. The bar is then rotated 180 degrees to move the chest into the normal position. Patients are released from the hospital within a few days with only small scars on their chest.

Donald Liu, MD, chief of pediatric surgery at UCCH, performed the first Nuss procedures at UCCH last summer. Liu will perform the procedure on two more patients on Friday, Dec. 13, 2002.

The procedure is one of a number of minimally invasive surgeries preformed at UCCH. Minimally invasive surgery can often cure their disease with little scarring, less pain, and a quicker recovery.

"Due to the nature of MIS and improved cosmetics, I believe pediatricians will be more willing to consider and recommend surgical intervention," says Liu. "Likewise, patients and their parents will seek the procedure at an earlier age."

Liu believes the concept of avoiding large incisions to perform invasive surgery and causing less post-operative pain are the basis for the current surge of minimally invasive surgery in children.

Although many types of MIS have been offered to adults since 1989, it has become available to children only in the last few years. Liu believes several factors are responsible for the slow shift to MIS in children.

"Many physicians and surgeons underappreciated postoperative pain and surgical stress in children," he says. Children require smaller incisions, Liu adds, but when the incision length is compared to body size, pediatric incisions for open procedures are proportional to adult incisions." Another barrier has been that few pediatric surgeons have the skills to perform MIS. Liu is considered a leader among a growing number of pediatric surgeons nationwide specializing in minimally invasive surgeries.

MIS procedures are the "future of surgery," says Liu. He is now investigating the use of robotics in performing minimally invasive surgery.

Liu also performs MIS for:

  • Pyloric stenosis--a disease in which the muscle between the stomach and small bowel becomes enlarged, causing vomiting and dehydration
  • Gastroesophageal reflux disease (better known as GERD)
  • Inflammatory bowel disease--such as Crohn's disease and ulcerative colitis
  • Tumor resection
  • Lung biopsies
  • Myasthenia gravis--muscle weakness due to an autoimmune attack
  • Pulmonary infections

Liu states an ever-increasing number of pediatric patients can now have MIS versus conventional surgery. "Soon all surgery will be done this way," predicts Liu.

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