While sorting through the messages exchanged with the patient, I accidentally found the following message from the mother of the child. I should have responded very carefully at the time. Due to the overwhelming number of messages from patients, I cannot remember the exact content of the response. From her message, I can see that this is a very great mother. She asked a lot of questions and was very attentive, covering almost a lot of topics of concern to mothers, so it was necessary to answer them all. Here is her message: ? Thank you, Director Wang, for responding to my questions early in the morning. I’m sorry I didn’t reply in time when I was getting the kids in the morning. Since last night, I’ve been reading the articles in Director Wang’s WeChat, and many of the problems are already clearly explained in the articles. When my child was first found to have an exostosis and then a funnel chest, I was really anxious to have a way to control and solve the current problem. However, as I learned more about rickets and funnel chest, I gradually clarified my thinking that rickets needs to be diagnosed and staged as early as possible so that the child’s skeletal changes can be controlled as soon as possible, and that funnel chest, whether it is early or late as stated on the internet, is not necessary to rush into surgery until I have more adequate information, and there is still enough time for me to learn about the relevant aspects. As you have mentioned in your article about the trust between doctors and patients and the fact that many doctors do not analyze patients individually, people all over the country are looking for a good doctor, but is this fame good or not? Director Wang’s current non-thoracoscopic surgical approach, which can be discharged in three days, is the shortest time in the information I’ve learned so far, and I have to admire Director Wang’s great skill! I also have a few questions to ask you in this technique. Standard nuss surgery post-operative pain is a focus of post-operative treatment, because the damage to the body during surgery is actually relatively large, light pain relief will take two or three days, your surgery because the degree of damage to the body is small, so less pain, so how long does this pain relief take? After reading one of your articles, for an extra pleural surgery, there may be problems such as bleeding that are not easily detected when entering the other side of the chest cavity from outside the pleura, and you are also taking an extra pleural surgery, does this problem exist as well? Are you still using the foreign nuss plate in your current surgery? According to your article, does your surgery require an opening in the chest, a guide tube or some other tool to introduce the plate into the lateral rib, then the chest is corrected and then comes out of the other rib? Forgive my unprofessionalism, that’s the only way I can phrase it. And is there any movement during the post-operative recovery process? Is the post-op recovery care different from standard nuss surgery? I also read that you have several procedures in the area of funnel chest, such as modified nuss surgery, ultra-minimally invasive surgery, thoracoscope-free surgery, etc. Are these procedures an upgrade of the original technique or are they chosen according to different situations? As an ordinary patient, there is no way to know the answer to questions like the above. But I can see from your article your compassion, your responsibility, and your views and thoughts on many things, which makes me think you are a trustworthy doctor, a good doctor! As my understanding of funnel chest gradually increased, my mood went from anxious at the beginning to calm now. I am now fully prepared for the fact that my child’s depression will deepen, and I am fully prepared for the need for surgery in the future, and now it’s a matter of finding the right treatment plan with my child. I agree with Director Wang’s article on the reasons for surgery after the child is 5 years old. Another question I would like to ask is, after 5 years old, although the chest support is stronger, but the child’s development will not stop, the chest circumference will still increase, and the plate will not grow, so how to choose the plate? With the growth of the child’s ribs, the force at the ends of the plates will cause compression on the ribs, so will this compression cause new deformities on the ribs in three years’ time, such as two concave ribs? Some experts on the internet say that the plate should be placed for 2 years if done at the age of 5, how many years should the plate be placed for your surgery? I read your article in 2009 that the cost was about 10,000, currently it is about 30,000, in another 5 years, it will not go up to 90,000, right? But I also believe that with the development of technology, 5 years later, you may create a safer and better program! 3 months to make a section appear a radical change, this is not anyone can do ah! Thank you very much, and good luck with your work! By the way, do you also perform plate reversal for this type of surgery for my daughter? Here is a brief answer to her question: First, about the doctor’s reputation. This is a major concern for parents of patients when they seek medical care. Generally speaking, there is a connection that a doctor with a high reputation should also have better skills. However, in a particular social environment, fame is not necessarily proportional to skill. This is perhaps a special phenomenon in the era of commodity economy. In essence, there is not much difference between doing surgery and shaving and pedicure. There is a good saying that the masters are among the people. What is the concept of folk? It is where no one pays attention. A folk master is not very famous, but is often a true master. Doing surgery is actually similar to this, it’s just that. There are a lot of strange things in this circle of medicine that I don’t want to start discussing here. As a surgeon I just want to give patients a piece of advice, do not blindly believe in those so-called famous doctors, especially those names hanging in the first Baidu search. You should know that old Chinese doctors who see sexually transmitted diseases often make themselves famous that way. Do you think that kind of person is reliable? Secondly, about the time of discharge from the hospital. For post-operative patients, if special treatment is needed, the operation time can be extended as needed. But why stay in the hospital if neither medication treatment nor even stitches need to be removed? Is it to spoil the money? And even for pain relief, it is perfectly possible to go back home for that, so why stay in the hospital for pain relief? We discharge patients for three days for the purpose of allowing them to return home for better rest and better nutrition, and for the most important purpose of saving money for the patient. Of course, if the patient and family really do not want to be discharged for three days, we certainly will not force them out. The issue of three-day discharge only shows the advancement of our approach. This advancement is reflected firstly in the tiny damage, and secondly in our certainty that no additional treatment is needed after the surgery, including of course the advantage that the incision does not require stitch removal. This mother has a misconception about post-operative pain relief, thinking that she must have two or three days dedicated to pain relief, which is due to a lack of understanding of pain management. Pain relief actually varies from person to person. Clinical experience has shown that postoperative pain is mostly determined by mental factors. Special pain relief is often not needed if the surgeon can encourage the patient to overcome his or her fear of pain. The vast majority of our patients do not require additional medication for pain relief after surgery. For such a patient, why would we tell him that he needs to be hospitalized for special pain relief? That might scare the patient into real pain. Third, on the issue of the risks of extrapleural surgery. In order to eliminate all the inconveniences of transthoracic surgery, some authors now use extrapleural techniques. There are two specific methods: one is to use instruments directly through the posterior sternal space, and the other is to pass a guide through the posterior sternal space under the surveillance of a thoracoscope. For the former, since it is neither visible nor palpable, it is difficult to ensure that the apparatus is not inserted into the heart or damage important vessels, such as the internal thoracic artery. As for the second type, which is extrapleural surgery under thoracoscopic surveillance. I don’t see any merit in such a procedure, except to say that it is superfluous and I don’t bother to comment on it. There is no denying that the extrapleural technique has unique advantages that are not matched by thoracoscopic surgery. However, its potential risk is again its greatest drawback. To avoid such drawbacks, we have invented an ingenious technique that makes the operation over the posterior sternal space both visible and palpable, and therefore very safe. This is the biggest advantage of our procedure. So we don’t have to worry about damaging the heart and blood vessels. Fourth, about the choice of surgical plate. The plates we are using are imported from abroad. The quality is undoubtedly much better than the domestic plates. Such a plate requires special operation. If they are not handled properly, the plates may move or shift. However, we have experienced the application of these plates, and our patients have not experienced any postoperative movement or displacement. Fifthly, there is a question about the concept of surgery. Almost all of the funnel chest surgeries currently used in clinical practice are NUSS surgeries, which are referred to as modified NUSS surgeries because they differ somewhat from standard NUSS surgeries, which is the collective term for all such surgeries. Such a procedure is more appropriate for older children and is risky if used in those younger than 5 years of age. For younger children, we advocate a different procedure, which becomes a very different procedure from the NUSS procedure. This procedure cannot be called a modified NUSS procedure. Many procedures are currently labeled as minimally invasive surgery. This is actually a misinterpretation of minimally invasive surgery. To draw a line in the sand with this confusing call, we refer to some of our special techniques as ultra-minimally invasive surgery because our techniques do have very minimal trauma. This is something that many other techniques do not have the ability to match. Regarding thoracoscope-free surgery, it’s easy to understand. We do not restrain ourselves with a thoracoscope like other surgeons, so of course we can justifiably call our surgery thoracoscope-free. In the clinic, we never mechanically use one approach for all patients. The patient’s condition varies greatly, and our operation will be flexible and change accordingly. This is a prerequisite to ensure a good surgical outcome. Therefore, regarding the name of the procedure, we will do different names for different procedures. This is mainly to highlight the characteristics of the surgery. Sixth, about the timing of the surgery. We always do not advocate surgery before the age of 5, mainly because of all the disadvantages before the age of 5. I have made it very clear on many occasions about such disadvantages. If NUSS is performed after the age of 5, the limitations of the plate on the thoracic development will still exist, but the effects will be much less than before the age of 5. This is mainly related to the rate of thoracic development. Of course, if one wants to completely eliminate such effects, one can wait until after puberty to have the surgery, which is obviously more than worth the cost, for reasons I don’t need to explain. However, the current NUSS procedure is clearly not able to fulfill this wish for parents. What can be done? We have now found an excellent solution that is completely different from the NUSS procedure and has the opposite age limit, the younger the child, the better the results. However, we still do not recommend the surgery at too young an age. Seventh, about the cost of the surgery. The fees in public hospitals are charged by the hospitals according to the regulations of the health administration. But the general trend is definitely the same, and the fees are now inevitably higher than they were a few years ago. Prices are rising, paper money is depreciating, and society is taking great strides forward, so it’s impossible for surgical fees to stay put. As a doctor, I am very eager to reduce the cost of surgery as much as possible. But hospitals are publicly owned and there are many people who depend on them for their livelihood. There is no such thing as free surgery. The eighth question is about steel flipping. Any kind of surgery that uses the principles of NUSS surgery must be flipped. Unless, of course, a technique we have invented is used, i.e., non-NUSS surgery, then there is no need for flipping.