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Uni-Portal Nuss Procedure: Where Do We Place the Camera?

Ivan Schewitz

Waterfall City Hospital, Gauteng, South Africa


Introduction: Every surgeon has his own preferences. In observing the Nuss procedure performed in different centers I have seen the camera placed in line with the bar, superiorly and inferiorly but always through a separate incision. The patient is placed at the edge of the operating table allowing the camera to be angled in the direction of the sternum without being obstructed by the table.  Gonzalez has popularized Uniportal thoracic surgery. If a lobectomy can be performed with one incision for the camara and instruments, why not the Nuss procedure?

Procedure: The patient is placed in the center of the operating table as in most supine procedures with the arms at right angles. A 0 degree 5mm camera is used. The initial study was with 12 cases. The camera was inserted in the same incision as the bars. The incisions made on both sides as usual.

Result: In all cases vision was as good as with the alternate approaches. Both sides can be visualized without any extra incisions. There is no obstruction to the camera when pointing at the sternum.  No complications have been experienced.

Conclusion: This has become my preferred camera position. I am offering an alternative view, which I believe gives advantages.

Keywords: Nuss procedure, pectus excavatum, uniportal