Choosing a surgeon for the Nuss Procedure
Who is the best surgeon for doing your child’s Nuss Procedure?
When choosing a surgeon to repair a pectus excavatum, it is important to choose a surgeon with experience in the Nuss Procedure. Consider asking these questions:
- How did you learn how to do the procedure? Dr Nuss published the original technique in 1999, so many surgeons did not learn it in their training.
- How many Nuss Procedures have you done? While there is not a minimum number of procedures that is required, it is important that you are confident that the surgeon has the experience to do a good job for you or your child.
- What are you doing to decrease the risk of heart injury? In mild cases of pectus, simply placing a camera (thoracoscopy) may be enough. For severe cases, sternal elevation through any of the many described techniques may decrease the risk of cardiac injury
- How do you keep the bars from flipping? Fixation of the bar to the adjacent rib is now used by most active pectus surgeons. While some centers may choose one suture type over another, the main thing is that they are not simply attaching it to the adjactent muscle (as originally described by Dr Nuss). Some centers continue to use the stabilizer bars (struts), those these alone do not prevent bar migration. We found no benefit in our patients after adopting rib fixation, so they are no longer used at our center.