Understanding the Nuss Procedure

Understanding the Surgery

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Pediatric surgeons at CHKD are the pioneers of the Nuss Procedure and have trained extensively under Dr. Donald Nuss, the originator of the Nuss Procedure, a minimally invasive approach to correcting pectus excavatum.

The Nuss Procedure involves surgeons inserting a metal bar (Lorenz pectus bar) under the ribs and sternum to reshape the chest wall. This technique does not require removal of the ribs and has significantly less blood loss and a shorter recovery time than the Ravitch procedure. 

The surgeon then bends the Lorenz pectus bar to the correct shape based on precise measurements of your child's chest. They will make two small incisions, one on each side of the chest, where the bar will enter and be guided through to the other side. A small, separate incision is made for the thoracoscope (a tiny camera to monitor the procedure), and the camera is positioned in the chest.

The bar is inserted through the right-side incision and advanced across the chest under the sternum to the left incision. Surgical tape and a tool called an "introducer" are used to guide the bar. A custom device, the "bar flipper" is used to rotate the bar 180o. This pushes the sternum out, correcting the pectus deformity.

Once the bar is positioned and the chest has taken the correct shape, a stabilizer bar is sutured to either end of the bar and to the ribs to prevent the bar from slipping. The opposite end of the bar is also sutured to the ribs. Finally, the incisions are dressed and X-rays are taken to confirm the correct position of the bar. 

Nuss Procedure Surgery Location

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The Nuss Procedure

Diving Dynamo

Drs. Donald Nuss and Ann Kuhn performed the Nuss Procedure on Emily Padgett, helping her get back to what she loves to do: competitive diving. Emily tells her story in her own words.

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