Minimally Invasive Surgical Techniques for Chest Wall Deformities

Chest wall deformities such as pectus excavatum and pectus carinatum affect both form and function of the thorax, with potential cardiopulmonary and psychosocial consequences. Over recent decades, the management of these conditions has shifted from extensive open procedures to less traumatic, minimally invasive approaches. Central to this advance is the Nuss procedure, which employs a pre-bent metal bar inserted beneath the sternum via small lateral incisions under thoracoscopic guidance. This technique reduces operative time, blood loss and postoperative pain while accelerating recovery and improving cosmetic results. Complementary innovations include computer-aided biomechanical simulations for surgical planning, enhanced imaging modalities for precise defect characterisation and refined perioperative strategies—such as optimised analgesia, careful bar removal protocols and patient-specific instrumentation. Collectively, these developments have broadened the applicability of minimally invasive repair across paediatric and adult populations worldwide and have paved the way for personalised treatment pathways.

Research from Nature Portfolio

A recent investigation has characterised a subset of patients exhibiting elevated thoracic indices on cardiac magnetic resonance imaging despite lacking visible chest wall depression. This “internal” pectus excavatum cohort displayed a reduced right ventricular ejection fraction, subtle alterations in right heart geometry and a higher incidence of rhythm disturbances and associated findings such as pericardial effusion and mitral valve prolapse. The study highlights the value of advanced imaging in uncovering concealed deformities, emphasises the mechanical impact of thoracic constriction on cardiac function and suggests that minimally invasive realignment may benefit individuals who would otherwise escape diagnosis.

Minimally Invasive Surgical Techniques for Chest Wall Deformities publication trend

The graph below shows the total number of articles in minimally invasive surgical techniques for chest wall deformities across all publications each year (not limited to Nature Index journals).

Technical terms

Pectus excavatum: A congenital depression of the anterior chest wall, most commonly centred on the sternum.

Nuss procedure: A minimally invasive repair involving insertion of a curved metal bar under the sternum via small incisions and thoracoscopic guidance to elevate the chest wall.

Thoracoscopy: Endoscopic visualisation of the pleural cavity using a small camera introduced through intercostal ports.

Haller index: A ratio obtained from transverse and anterior–posterior chest dimensions, used to quantify the severity of pectus excavatum.

References

1. Biomechanical validation of novel Nuss procedure simulations for patients with various morphological types of pectus excavatum. Frontiers in Bioengineering and Biotechnology (2023).
2. Description of a new clinical syndrome: thoracic constriction without evidence of the typical funnel-shaped depression—the "invisible" pectus excavatum. Scientific Reports (2023).
3. The Nuss procedure for pectus excavatum: An effective and safe approach using bilateral thoracoscopy and a selective approach to use multiple bars in 296 adolescent and adult patients. PLOS ONE (2020).
4. Minimization of the complications associated with bar removal after the Nuss procedure in adults. Journal of Cardiothoracic Surgery (2020).
5. New Methods for Imaging Evaluation of Chest Wall Deformities. Frontiers in Pediatrics (2017).
6. Assessment of psychosocial functioning and its risk factors in children with pectus excavatum. Health and Quality of Life Outcomes (2011).
7. Systematic review of surgical treatment techniques for adult and pediatric patients with pectus excavatum. Journal of Cardiothoracic Surgery (2014).