Clinical application and technical advantages of percutaneous suspension technique via sternal elevation device-assisted pectus excavatum correction_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

TIAN Dong ¹ , DENG Zhiqiang ¹ , LIN Haonan ^1,2,3 , ZENG Zhongyi ^1,2,3 , LI Jian ^1,3 , DU Haotian ^1,3 , XIAO Yong ⁴ ,  LIN Feng ^1,2,3

1. Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, 610041, P. R. China;
2. Department of Thoracic Surgery, West China Tianfu Hospital, Sichuan University, Chengdu, 610213, P. R. China;
3. Department of Chest Wall Diseases Center, West China Hospital, Sichuan University, Chengdu, 610041, P. R. China;
4. Department of Thoracic Surgery, Sichuan Science City Hospital, Mianyang, 621900, P. R. China;

Corresponding author：

LIN Feng, Email: linfeng0220@aliyun.com

Keywords：

Balance-shaped sternal elevation device; percutaneous suspension technique; pectus excavatum correction

DOI：

10.7507/1007-4848.202508035

Video：

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Objective To explore the clinical application effect and technical advantages of percutaneous suspension technique via sternal elevation device-assisted pectus excavatum (PE) correction. Methods Patients who underwent percutaneous suspension technique via sternal elevation device-assisted PE correction at West China Hospital of Sichuan University from July to August 2025 were consecutively enrolled, and their clinical data were analyzed. Results A total of 5 PE patients were included in the study, including 4 males and 1 female, aged 14 to 27 years, and the preoperative Haller index ranged from 3.44 to 7.65. Among them, 4 patients underwent PE correction assisted by percutaneous suspension technique via balance-shaped sternal elevation device, and one underwent PE correction assisted by percutaneous suspension technique via single sternal elevation device. All operations were completed successfully, with a significant expansion of the retrosternal space, smooth implantation of the steel plate, and no complications. The operation time ranged from 29 to 48 minutes, and the intraoperative blood loss was 2 to 5 mL. The patients recovered well after surgery, and the satisfaction rate with thoracic wall appearance correction was 100%. Conclusion The percutaneous suspension technique via sternal elevation device-assisted PE correction can safely expand the retrosternal operating space. This crucial expansion reduces surgical risks and optimizes the orthopedic outcome, underscoring its significant clinical value for minimally invasive treatment of PE.

1.	Karabulut M. Increased incidence of mitral valve prolapse in children with pectus chest wall deformity. Pediatr Int, 2023, 65(1): e15582.
2.	Janssen N, Coorens NA, Franssen A, et al. Pectus excavatum and carinatum: a narrative review of epidemiology, etiopathogenesis, clinical features, and classification. J Thorac Dis, 2024, 16(2): 1687-1701.
3.	Ciriaco P. Surgical treatment of pectus excavatum: the boundary between pathologic and aesthetic need. J Clin Med, 2025, 14(1): 231.
4.	Walsh J, Walsh R, Redmond K, et al. Systematic review of physiological and psychological outcomes of surgery for pectus excavatum supporting commissioning of service in the UK. BMJ Open Respir Res, 2023, 10(1): e001665.
5.	曾忠义, 林浩楠, 孙海鹏, 等. Nuss手术联合简易胸骨提升法治疗重度漏斗胸一例. 中国胸心血管外科临床杂志, 2025.Zeng ZY, Lin HN, Sun HP, et al. Application of the simplified sternal elevation technique in the Nuss procedure for severe pectus excavatum: a case report. Chin J Clin Thorac Cardiovasc Surg, 2025.
6.	Nuss D, Kelly RE Jr, Croitoru DP, et al. A 10-year review of a minimally invasive technique for the correction of pectus excavatum. J Pediatr Surg, 1998, 33(4): 545-552.
7.	Liu S, Wang L, Zhang H, et al. Modified Nuss procedure with a novel steel bar in patients with pectus excavatum post-congenital heart surgery. Interact Cardiovasc Thorac Surg, 2022, 34(3): 424-430.
8.	de Loos ER, Daemen JHT, Coorens NA, et al. Sternal elevation by the crane technique during pectus excavatum repair: a quantitative analysis. JTCVS Tech, 2021, 9: 167-175.
9.	Janssen N, Coorens NA, Daemen JHT, et al. Sternal elevation in pectus excavatum repair: comparison of a unilateral versus bilateral frame crane system. Eur J Cardiothorac Surg, 2024, 66(5): ezae395.
10.	Pawlak K, Gąsiorowski Ł, Gabryel P, et al. Video-assisted-thoracoscopic surgery in left-to-right Nuss procedure for pectus excavatum for prevention of serious complications: technical aspects based on 1006 patients. Wideochir Inne Tech Maloinwazyjne, 2018, 13(1): 95-101.
11.	Haecker FM, Krebs T, Kocher GJ, et al. Sternal elevation techniques during the minimally invasive repair of pectus excavatum. Interact Cardiovasc Thorac Surg, 2019, 29(4): 497-502.
12.	赵金兰, 陈蔚洋, 何春梅, 等. “天平拉钩抬高胸骨法”在经剑突下单孔胸腔镜辅助前纵隔肿物切除术中的应用. 中国胸心血管外科临床杂志, 2025, 32(3): 308-312.Zhao JL, Chen WY, He CM, et al. Application of “balance-shaped sternal elevation device” in the subxiphoid uniportal video-assisted thoracoscopic surgery for anterior mediastinal masses resection. Chin J Clin Thorac Cardiovasc Surg, 2025, 32(3): 308-312.
13.	范江, 陈龙奇, 上海医师协会胸外科分会纵隔学组, 等. 胸骨抬高经剑突下入路前纵隔肿物胸腔镜手术中国专家共识. 中国胸心血管外科临床杂志, 2025, 32(7): 887-896.Fan J, Chen LQ, Mediastinal Group of Thoracic Surgery Branch of Shanghai Medical Association, et al. Chinese expert consensus on subxiphoid video-assisted thoracoscopic surgery with sternal elevation for anterior mediastinal masses. Chin J Thorac Cardiovasc Surg, 2025, 32(7): 887-896.
14.	Daemen JHT, Cortenraad I, Kawczynski MJ, et al. Defining the optimal annual institutional case volume for minimally invasive repair of pectus excavatum through a systematic review of literature and meta-analysis of outcomes. J Thorac Dis, 2024, 16(9): 6081-6093.
15.	Sun H, Huang Y, Han Y, et al. Perioperative outcomes of thoracoscopic versus non-thoracoscopic minimally invasive repair of pectus excavatum: a systematic review and meta-analysis. J Cardiothorac Surg, 2024, 19(1): 603.
16.	Kenney LM, Obermeyer RJ. Pectus repair after prior sternotomy: clinical practice review and practice recommendations based on a 2, 200-patient database. J Thorac Dis, 2023, 15(7): 4114-4119.
17.	Park HJ, Rim G. Development of a screw-crane system for pre-lifting the sternal depression in pectus excavatum repair: a test of mechanical properties for the feasibility of a new concept. J Chest Surg, 2021, 54(3): 186-190.
18.	Wang L, Bi R, Xie X, et al. A modified Nuss procedure for recurrent pectus excavatum of adults. Front Surg, 2022, 8: 814837.
19.	Neves SC, Pinho AC, Fonseca JC, et al. Finite element analysis of pectus carinatum surgical correction via a minimally invasive approach. Comput Methods Biomech Biomed Engin, 2015, 18(7): 711-720.
20.	de Loos ER, Pennings AJ, van Roozendaal LM, et al. Nuss procedure for pectus excavatum: a comparison of complications between young and adult patients. Ann Thorac Surg, 2021, 112(3): 905-911.

1. Karabulut M. Increased incidence of mitral valve prolapse in children with pectus chest wall deformity. Pediatr Int, 2023, 65(1): e15582.
2. Janssen N, Coorens NA, Franssen A, et al. Pectus excavatum and carinatum: a narrative review of epidemiology, etiopathogenesis, clinical features, and classification. J Thorac Dis, 2024, 16(2): 1687-1701.
3. Ciriaco P. Surgical treatment of pectus excavatum: the boundary between pathologic and aesthetic need. J Clin Med, 2025, 14(1): 231.
4. Walsh J, Walsh R, Redmond K, et al. Systematic review of physiological and psychological outcomes of surgery for pectus excavatum supporting commissioning of service in the UK. BMJ Open Respir Res, 2023, 10(1): e001665.
5. 曾忠义, 林浩楠, 孙海鹏, 等. Nuss手术联合简易胸骨提升法治疗重度漏斗胸一例. 中国胸心血管外科临床杂志, 2025.Zeng ZY, Lin HN, Sun HP, et al. Application of the simplified sternal elevation technique in the Nuss procedure for severe pectus excavatum: a case report. Chin J Clin Thorac Cardiovasc Surg, 2025.
6. Nuss D, Kelly RE Jr, Croitoru DP, et al. A 10-year review of a minimally invasive technique for the correction of pectus excavatum. J Pediatr Surg, 1998, 33(4): 545-552.
7. Liu S, Wang L, Zhang H, et al. Modified Nuss procedure with a novel steel bar in patients with pectus excavatum post-congenital heart surgery. Interact Cardiovasc Thorac Surg, 2022, 34(3): 424-430.
8. de Loos ER, Daemen JHT, Coorens NA, et al. Sternal elevation by the crane technique during pectus excavatum repair: a quantitative analysis. JTCVS Tech, 2021, 9: 167-175.
9. Janssen N, Coorens NA, Daemen JHT, et al. Sternal elevation in pectus excavatum repair: comparison of a unilateral versus bilateral frame crane system. Eur J Cardiothorac Surg, 2024, 66(5): ezae395.
10. Pawlak K, Gąsiorowski Ł, Gabryel P, et al. Video-assisted-thoracoscopic surgery in left-to-right Nuss procedure for pectus excavatum for prevention of serious complications: technical aspects based on 1006 patients. Wideochir Inne Tech Maloinwazyjne, 2018, 13(1): 95-101.
11. Haecker FM, Krebs T, Kocher GJ, et al. Sternal elevation techniques during the minimally invasive repair of pectus excavatum. Interact Cardiovasc Thorac Surg, 2019, 29(4): 497-502.
12. 赵金兰, 陈蔚洋, 何春梅, 等. “天平拉钩抬高胸骨法”在经剑突下单孔胸腔镜辅助前纵隔肿物切除术中的应用. 中国胸心血管外科临床杂志, 2025, 32(3): 308-312.Zhao JL, Chen WY, He CM, et al. Application of “balance-shaped sternal elevation device” in the subxiphoid uniportal video-assisted thoracoscopic surgery for anterior mediastinal masses resection. Chin J Clin Thorac Cardiovasc Surg, 2025, 32(3): 308-312.
13. 范江, 陈龙奇, 上海医师协会胸外科分会纵隔学组, 等. 胸骨抬高经剑突下入路前纵隔肿物胸腔镜手术中国专家共识. 中国胸心血管外科临床杂志, 2025, 32(7): 887-896.Fan J, Chen LQ, Mediastinal Group of Thoracic Surgery Branch of Shanghai Medical Association, et al. Chinese expert consensus on subxiphoid video-assisted thoracoscopic surgery with sternal elevation for anterior mediastinal masses. Chin J Thorac Cardiovasc Surg, 2025, 32(7): 887-896.
14. Daemen JHT, Cortenraad I, Kawczynski MJ, et al. Defining the optimal annual institutional case volume for minimally invasive repair of pectus excavatum through a systematic review of literature and meta-analysis of outcomes. J Thorac Dis, 2024, 16(9): 6081-6093.
15. Sun H, Huang Y, Han Y, et al. Perioperative outcomes of thoracoscopic versus non-thoracoscopic minimally invasive repair of pectus excavatum: a systematic review and meta-analysis. J Cardiothorac Surg, 2024, 19(1): 603.
16. Kenney LM, Obermeyer RJ. Pectus repair after prior sternotomy: clinical practice review and practice recommendations based on a 2, 200-patient database. J Thorac Dis, 2023, 15(7): 4114-4119.
17. Park HJ, Rim G. Development of a screw-crane system for pre-lifting the sternal depression in pectus excavatum repair: a test of mechanical properties for the feasibility of a new concept. J Chest Surg, 2021, 54(3): 186-190.
18. Wang L, Bi R, Xie X, et al. A modified Nuss procedure for recurrent pectus excavatum of adults. Front Surg, 2022, 8: 814837.
19. Neves SC, Pinho AC, Fonseca JC, et al. Finite element analysis of pectus carinatum surgical correction via a minimally invasive approach. Comput Methods Biomech Biomed Engin, 2015, 18(7): 711-720.
20. de Loos ER, Pennings AJ, van Roozendaal LM, et al. Nuss procedure for pectus excavatum: a comparison of complications between young and adult patients. Ann Thorac Surg, 2021, 112(3): 905-911.

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