The Operation

The Nuss Procedure is a minimally-invasive approach to correcting pectus excavatum by using a metal bar, surgically inserted 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 Nuss procedure begins with the patient receiving general anesthesia and the placement of an intravenous catheter for pain management after the procedure.

Next, the surgeon bends the Lorenz pectus bar to the correct shape based on precise measurements of the patient’s chest.

The surgeon will make two small lateral incisions, one on each side of the chest, where the bar will enter the chest and be guided through to the other side. A separate, small incision is made for the thoracoscope (a tiny camera to monitor the procedure), and the camera is positioned in the chest.

The pectus 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” is used to guide the bar. Then the surgeon uses a custom device called a “bar flipper” to rotate the bar 180 degrees. 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 of the patient’s chest to confirm the correct position of the bar.