Pectus excavatum correction

In the supine position, the left arm is extended, and the right arm is fixed at 90° flexion at the elbow joint on the support. The right shoulder and back are padded for stabilization.

Preoperatively, the inframammary fold was marked while standing. Now, the nipple/medioclavicular lines are added. Subsequently, the xiphoid process is palpated and also marked. This is followed by identifying the planned entry points for the pectus bar laterally, at the level of the highest point of the deformity. These are marked on the inframammary lines.

Through a small skin incision on the mid-axillary line at the level of the axilla, the optical trocar is inserted into the right thorax under apnea. After blocking the trocar to prevent dislocation, CO2 insufflation is connected and the camera with 30° optics is introduced. Explorative thoracoscopy.

First, an incision is made at the previously determined sites using a scalpel. Then, preparation is carried out using monopolar and scissors down to the outer thoracic fascia. Around the incision, a pocket is bluntly and digitally created for the later fixation of the pectus bar. This should occur on the mentioned fascia and under the pectoral muscles.

Smaller bleedings are controlled by coagulation with the bipolar.

Under constant thoracoscopic control, the intercostal muscles and parietal pleura are perforated on the right with the sword. After further advancement into the thorax, the pleura is again penetrated retrosternally with the sword tip, and the opposite pleura is also opened. The perforation of the left pleura and intercostal muscles then occurs, so that the sword tip protrudes beyond the previously made skin incision.

To avoid unwanted injuries, the sword should always remain in contact with the sternum.