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Endoscopic Assisted Modified Ravitch Procedure
Brian W. Starr, MD, Elizabeth A. Lax, MD, Tony T. Jiang, MD,PhD, Victor Garcia, MD, FACS, FAAP, Ann R. Schwentker, MD
Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
2020-02-02
Presenter: Brian W. Starr, MD
Affidavit:
Ann Schwentker, MD
Director Name: ARS
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: General Reconstruction
PURPOSE: Mark Ravitch pioneered the first surgical pectus repair, open costal cartilage and sternal reshaping, in 1949. Nuss developed a curved metal bar for pectus excavatum in 1998, eliminating the large midline or subcostal scar. Pectus carinatum can be treated with bracing, but mixed disorders are difficult to correct without surgically reshaping the anterior chest wall.
METHODS: A cadaver study was undertaken to demonstrate the feasibility of a minimally invasive approach to the Ravitch procedure. An 11-year-old female presented with worsening upper sternal prominence following pectus bar placement for pectus arcuatum. Informed consent was obtained for a minimally invasive, endoscopic-assisted Ravitch procedure. Transaxillary dissection of the retropectoral space allowed visualization of the ribs with a 30 degree endoscope and an Emory retractor, and the affected costal cartilage was divided with the Sonopet. A small sternal incision allowed a closing wedge sternotomy and repair with wire sutures.
RESULTS: The patient had an uneventful recovery with improved chest contour and symmetry. She was discharged on post-op day 3 and returned to school a few weeks later.
CONCLUSION:Endoscopic assisted modified Ravitch shows promise for the correction of protrusive pectus deformities, and may have the benefit of minimal incisional scars and faster recovery.
