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Ann Thorac Surg 2006;81:1099-1103
© 2006 The Society of Thoracic Surgeons

New technology

New Endoscopic Minimal Access Pectus Carinatum Repair Using Subpectoral Carbon Dioxide

Klaus Schaarschmidt, MD * , Andreas Kolberg-Schwerdt, MD, Michael Lempe, MD, Frank Schlesinger, MD

Helios Center of Pediatric and Adolescent Surgery, Berlin-Buch, Berlin, Germany

Accepted for publication October 31, 2005.

* Address correspondence to Prof Dr Schaarschmidt, Director of Helios Center of Pediatric and Adolescent Surgery, Klinikum Buch, Hobrechtsfelder Chaussee 100, Berlin, D-13125 Germany (Email: kschaarschmidt{at}berlin.helios-kliniken.de).

PURPOSE: This study establishes a minimal access hybrid technique for pectus carinatum repair. Based on 132 conventional repairs (1984–2000) and our own endoscopic technique for correcting prominent costal arches, the conventional carinatum repair was adapted to an endoscopic-assisted technique.

DESCRIPTION: Inserting two submuscular trocars and inflating CO2, the entire ventral thoracic wall was dissected endoscopically detaching pectoral muscles from ribs and sternum. February 2001 to February 2004, we repaired 37 patients (32 male) of 16.8 ± 4.3 years (12 to 36 years). Endoscopic-assisted rib resection and axial reanastomosis, transsternal struts, and sternotomies were performed semi-open from a 2.9 to 4.7 cm incision.

EVALUATION: All were completed minimally invasively, one seroma was managed conservatively. Thirty-three patients rated their result as excellent, 4 as good with a follow-up of 29.1 ± 9.5 months (range, 18 to 55 months). Twenty-one struts were removed with no recurrence.

CONCLUSIONS: Minimal access pectus carinatum repair is safe, effective, and offers high comfort for the patient. The results are at least as good as conventional repairs, but hospital stays could be halved. Encouraging results of this early experience warrant further evaluation by other centers.




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E. H. Austin III
Invited commentary
Ann. Thorac. Surg., March 1, 2006; 81(3): 1103 - 1104.
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