Minimally invasive treatment of funnel chest is widely used in clinical practice for its advantages of being less invasive. Indications for minimally invasive funnel chest surgery
In view of the fact that minimally invasive surgery for funnel chest is still traumatic for children, it is currently considered appropriate to operate at the age of 3-12 years, with 6-12 years being the best. Most scholars consider the indications for minimally invasive surgery as.
1.Age >3 years old, and the best age is 6-12 years old.
2. Moderate to severe symmetrical funnel chest deformity with Haller index >3.2 on CT.
3, pulmonary function tests suggest restrictive or obstructive airway pathology, susceptibility to upper respiratory tract infections, reduced tolerance to strenuous activity, shortness of breath when running or climbing stairs.
4.The heart is displaced by pressure and the electrocardiogram shows myocardial damage.
5.People who have failed other surgical methods.
6.Adolescents who have serious psychological burden and require correction of appearance.
Contraindications to minimally invasive funnel chest surgery
1.Age <2 years old.
2.Haller index less than 3.0 , mild funnel chest deformity without symptoms.
3.Severe asymmetric funnel chest and very heavy funnel chest with limited depression.
Pleural access minimally invasive surgery
Preoperative preparation for minimally invasive pleural approach surgery
Chest X-ray and CT scan to understand the degree of deformity pulmonary function, electrocardiogram and echocardiogram to understand cardiopulmonary function and control respiratory tract infection. Intraoperative supine position with chest padded and both upper limbs abducted at 90° Routine disinfection and towel laying.
Select a plate of appropriate length
Mark the lowest point of the thoracic depression and make a horizontal line, and select the appropriate rib gap position at the funnel crest. The distance between the mid-axillary line on both sides via the lowest point of the thoracic depression minus 1-2 cm is the alternative brace length, and the plate is adjusted so that the curvature is consistent with the preset lifting height. The position of the fixator should be as close as possible to the position of the plate into the chest. For asymmetric funnel chest, obliquely placed plates or irregular plates can be used for support.
Pleural access minimally invasive surgical incision
A transverse or longitudinal incision between the bilateral anterior axillary line and the mid-axillary line, 2-2.5 cm long, is made to cut the subcutaneous skin, free the muscle flap to the edge of the ipsilateral depression (pre-selected plate entry and exit points), and a 5 mm trocar is stabbed into the thoracic cavity between the ribs at the right side of the incision to establish an artificial pneumothorax (5-6 mm Hg) and place the thoracoscope. Intraoperatively, 0 degree or 30 degree lumpectomy is used. Generally, the right side of the thoracic cavity has more space, and the trocar is placed on the right side; attention is paid to avoid Trocar damage to the diaphragm and liver. Some foreign scholars recommend placing the Trocar in the intercostal space above the plate insertion point.
Creation of a tunnel behind the sternum
Under thoracoscopic surveillance, a Lorenz penetrator is passed through the chest wall at the preselected rib space, and the posterior sternal septum is carefully passed to the contralateral chest wall penetration point, reaching the contralateral incision. The penetrator is withdrawn and a thick band is introduced. Take care not to damage the pericardium.
Plates placement for minimally invasive pleural access surgery
Introduce the plate: Fix the thick band firmly with the supporting plate, pull the thick band, and under the surveillance of the thoracoscope, the supporting plate is bowed backward through the tunnel.
Adjustment of the plate: Adjust the plate so that it is perfectly aligned with the curvature of the chest wall. The flipper rotates the support plate 180° so that it is bowed up and supported behind the sternum, and the plate is fixed on one or both ends of the fixator.
Fixation of the plate: The anesthesiologist assisted in puffing the lung (PEEP 4-6 cmH2O), removing the gas from the chest cavity, and seeing the lung fully inflated under direct vision; the Trocar poke hole was sutured closed; the plate and the fixator were tied and fixed with nylon thread or wire thread, and then the ends of the plate and the fixator were fixed with chest wall muscle and fascia wrapped and sutured. To prevent displacement, some scholars use stainless steel wire to bind the plate to the ribs or use the 3-point fixation method.
Closure of the incision
The subcutaneous tissue was sutured and the skin was sutured intradermally.