Mark Slidell, MD, MPH, Assistant Professor of Surgery, discusses his topic in Advances in Minimally Invasive Pectus Repair
[MUSIC PLAYING] MARK SLIDELL: Hi, I'm Dr. Mark Slidell. I'm here to speak to you today about advances in minimally invasive pectus repair. I'm a pediatric surgeon here at Comer Children's Hospital at the University of Chicago Medicine. Over the past decade, our surgeons have performed hundreds of minimally invasive pectus repairs. We have a multi-disciplinary group of surgeons, anesthesia and pain management specialists, as well as advanced practice nurses who will all work together to make sure your child has the best possible outcomes. What is pectus? Pectus excavatum is also known as sunken chest or funnel chest. There's another type of pectus deformity called a pectus carinatum or pigeon chest. Pectus excavatum is where the chest is sunken in and pectus carinatum, the chest is protruding out in an unnatural fashion. It is normal to feel uncomfortable if your chest has these deformities. And there are things we can do to correct it and fix it. And some people actually have symptoms from these deformities. And there's no reason that anybody needs to live with these symptoms. So what are some of the symptoms? People will complain of fatigued, diminished exercise tolerance. Some patients have chest pains, heart problems. And it could take a psychological toll. And this sometimes can progress and worsen throughout adolescence. So what do we do to evaluate you when you come to see us for pectus? The first thing we do is we listen carefully to your story. We take a detailed history, and we perform a detailed physical exam. And then we will obtain a few tests. So the things we need to obtain before we can proceed include a CAT scan of the chest. And this helps us measure something called the Haller index. Now the Haller index gives us an indication of how severe your pectus is and whether it will respond well to repair. The other thing we need to obtain is pulmonary function tests. And this tells us how well the lungs are working and whether they're inhibited or impaired by your pectus deformity. The next thing we need is an echocardiogram or an EKG. And this also gives us some clue about how your heart is functioning and whether there's any impairment of your heart from this deformity. So there are two main approaches to fixing a pectus repair. Historically, the first operation done was a Ravitch repair, but there have been a lot of advances since then. And currently, the most common operation done is a Nuss repair. There are advantages and disadvantages to each. And we will go over them with you and help you choose which operation is the best for your particular situation. Not everybody should be having a Nuss procedure, and not everybody should get a Ravitch repair. And we will customize the treatment for you specifically. So when you have your personalized evaluation with us, we will go over all of these studies. We will discuss with you the options. And we'll choose a plan that is best for you. Currently, our recommendation is that the ideal age to have this performed is 14 to 15 or 16 years of age. There are patients younger than that and patients older than that who are also candidates. So what are the key steps involved in performing this operation? We make two small incisions under your armpit, one on either side. And we also put small telescopic cameras in, so then we can better visualize the anatomy and ensure your safety during the operation. We then place a custom molded bar under your ribcage and sternum. And we use this bar to lift the sunken chest bone up into a more normal position. That bar will be secured in place underneath the skin. And most patients don't notice the bar after they've recovered from the operation itself. The bar needs to remain in place for two to three years, depending on your situation. And what this does is it allows the sternum to remodel itself, reshape, and reform the cartilage ribs and the sternum of your chest in a way that allows that deformity to be more normal. We've also developed ways to reduce the risks associated with this procedure by using multiple cameras to perform this in a minimally invasive fashion and ensure your safety and the best possible outcome. When the bar is removed, your chest will then remain in this new position that has been formed for your chest wall. It's much like wearing braces, where after a period of years, the bar comes out, and the new chest should stay in the same position that we've now reshaped it too. The big concern people have is pain control. And that is why we have the anesthesiology and pain services team involved from the start. And they will customize a pain treatment plan for you. It will depend on your needs. And we will either have an epidural catheter or a patient-controlled pain pump that will help you control your pain following the operation. After a few days in the hospital, typically four to six days, you'll go home on oral pain meds. And usually, patients require these for about two weeks, sometimes a little longer. The length of stay in the hospital as I said is approximately four to six days. So while you're here in the hospital, on the first day, postoperatively, we'll encourage you to get up out of bed, move around, and start working with physical therapy to begin your recovery. Typically, after you go home, you're going to stay out of school for two to three weeks. And we'll encourage you to begin an exercise program of walking for about six weeks. And we will ask you to refrain from returning to competitive sports for about three months. As mentioned previously, the bar will come out after about two to three years. And most patients have excellent results. So what do people say after they've had the surgery? Most patients say they feel like they have improved breathing and endurance after the operation, less chest pain-- if that was one of their symptoms-- better blood circulation sometimes, and importantly to them, better body image and self esteem. This concludes our discussion today about advances in minimally invasive pectus surgery.