The Nuss procedure is a minimally invasive surgical technique primarily designed to correct pectus excavatum, a condition characterized by a sunken chest due to an abnormality in the development of the rib cage and sternum. This condition can lead to both aesthetic concerns and functional issues, including impaired cardiopulmonary function. The procedure involves the insertion of a convex metal bar beneath the sternum, which is positioned through small incisions in the chest wall. This bar serves as a support structure, pushing the sternum outward and restoring a more normal chest shape. Typically performed on adolescents or young adults, the Nuss procedure is favored for its reduced recovery time and lower complication rate compared to traditional open surgical methods like the Ravitch procedure. Prior to the surgery, patients undergo various imaging studies, such as CT scans, to assess the severity of the pectus excavatum and to plan for the optimal placement of the bar. During the operation, the patient is placed under general anesthesia, and the surgeon makes two small incisions on either side of the chest. A camera is often utilized for visualization and guidance. The surgeon then carefully inserts the metal bar using an apparatus called a thoracoscope, maneuvering it into the correct position under the sternum. Once in place, the bar is flipped over so that the convex side pushes against the chest wall, lifting the sternum into a more normal alignment. After ensuring the bar is secured, the incisions are closed with sutures. The procedure usually takes about one to two hours and is often performed on an outpatient basis, allowing patients to return home the same day or the following morning. Postoperative care is critical, as patients may experience discomfort, and pain management with medications is typically required. Physical activity is generally limited for several weeks to promote healing, and patients are advised to avoid strenuous exercise during this period. The metal bar remains in place for approximately three years to provide sufficient support for the sternum as it remodels into its new position. After this time, a second procedure is performed to remove the bar, typically with a similar minimally invasive approach. The Nuss procedure has gained popularity due to its effectiveness in addressing both the physical and psychological impacts associated with pectus excavatum, leading to significant improvements in self-esteem and quality of life for many patients. Overall, the Nuss procedure represents a significant advancement in the surgical management of chest wall deformities, providing a less invasive alternative that promotes quicker recovery and better outcomes for individuals suffering from this condition.
