Robert Fleck Video Submission.mp4 (256.59 MB)

First Minimally Invasive Pectus UP Intervention for Pectus Excavatum in the UK and Ireland

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posted on 07.10.2020 by Robert Fleck, Alan Keyes, Shyam Kolvekar, Manuel Lopez Paredes, Karen Redmond

The Pectus UP Implant is a minimally invasive extrathoracic surgical treatment for pectus excavatum. Surgery is customized for each patient according to information obtained from a CT scan. The patient was a 17-year-old boy with a symmetrical pectus excavatum (haller index 2.4). He had no other significant past medical history.

Preparation

There are 12 implant sizes. Size selection is based on the distance between costal cusps measured on the CT scan. Of these 12 sizes, 3 implants are preselected for the patient and will be available in theater. Once the right implant is chosen, preoperative skin markings are made:

  1. The superior/inferior margins of the sternum
  2. The midline of the lower sternum/central point of the implant where the incision will be made.
  3. Implant length. The distance between both ends of the implant denotes the subpectoral pocket required to introduce the implant.

This patient required a 154 mm implant.

Procedure

A 4-5 cm incision was made horizontally over the lower 1/3 of the sternum. A subpectoral pocket was created bilaterally large enough to accommodate the chosen implant. The left pocket was larger than the right to allow introduction of the implant. Once the implant was in place, the central point of the sternum was marked with diathermy to identify the lifting point. The implant was then removed.

Four wires were placed trans-sternally without crossing the second cortex on four sides of the central point (superior/inferior/left/right). The central/lifting point of the sternum was prepared using a #6 followed by a #8 drill bit. The drill limiter was preset using sternal depth measurements from the CT and prevents penetration of the second cortex by the drill bit. The implant was reintroduced and the sternal wires were secured on four sides of the implant along the dedicated wire grooves of the implant. The lifting system was composed of an anchor plug and an expandable screw and was introduced to the prepared drill hole. The anchor plug was fixated to the sternum by turning the expandable screw 5 to 6 turns counterclockwise.

The sternum was then elevated. The screw and power thread were assembled and connected to the threaded end that protrudes from the expanding screw of the anchor plug. With the tubular key, the power screw was held in position while the thread was turned with the purple flat wrench. Each full turn of the power thread equals 2 mm of lift. The number of turns are predetermined from CT scan measurements.

Lifting of the sternum was achieved by alternating between screw turns and sternal wire tightening. Once the implant was in contact with the sternum, it was further secured by x4 fixation screws. These fixation screws and sternal wires ensure correct fixation of the implant. The lifting system/anchor plug was then removed. The remaining hole was filled with bone wax. A redivac drain was inserted and the incision was closed in a standard fashion.

Disclosure

Staff from Ventura Medical Technologies, who produce the Pectus UP Implant, assisted in the making/formatting of this video.

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