Media Contact: Sandra VanTelephone: 1-800-880-2397E-mail: [email protected]
LOS ANGELES (March 14, 2002) -- Children who have Pectus Excavatum -- a congenital chest wall deformity in which the sternum sinks inward to create a concave, funnel-shaped chest -- may now avoid the open surgical procedure that required a long incision, removal of deformed cartilage, and often significant blood loss.
Pediatric surgeon Steve C. Chen, M.D., and his colleagues at Cedars-Sinai Medical Center offer a correction procedure called Minimally Invasive Repair of Pectus Excavatum (MIRPE) or the Nuss Technique, named after the pediatric surgeon, Donald Nuss, who developed it.
The concave anterior chest wall in Pectus Excavatum can cause constriction and compression of vital internal organs such as the lungs and heart. But Dr. Chen says many children and their parents choose to have the deformity corrected for social and psychological reasons as well as anatomic and physiologic reasons.
"When I came back to Los Angeles after training in Houston, I performed the procedure on a kid who had never taken his shirt off around his friends. He avoided going to the beach or the swimming pool. But two weeks after the operation, he went to the beach for the first time in many years," says Dr. Chen, who serves as associate director of pediatric general surgery and director of pediatric trauma at Cedars-Sinai.
After earning his medical degree at the University of Southern California School of Medicine, Dr. Chen completed a research fellowship and residencies in general surgery and surgical critical care at Cedars-Sinai. He then completed a pediatric surgery residency at Baylor College of Medicine in Houston.
Danielle Schwebel, age 7, is one of Dr. Chen's Pectus Excavatum repair patients. Her parents, Mark and Susan, discovered that she had the condition when she was about 2 years of age. Because her health was not in danger, her pediatrician suggested the family postpone a decision on surgery until she was older.
Mark and Susan heard about the Nuss Technique a couple of years ago. They thought it might be a good option for Danielle because they did not want her to go through life feeling self-conscious. "She always knew that there was something different. Her brother didn't look that way. Nobody else looked that way," says Susan.
"My husband and I talked about it and we talked to Danielle about it. She wanted to get it fixed, and that was that," Susan recalls. "We didn't want to have it done the old way because that's pretty serious. We were going to leave it alone if this new procedure wasn't out."
Although Danielle was having no physical symptoms, they later discovered that her heart had shifted slightly due to the constriction of the chest cavity. The operation was performed last November and Danielle went home after a four-day hospital stay. According to Susan, "She's perfectly fine now."
Neither the old nor the new procedure is pleasant for a child. In both operations, a metal bar is placed in the chest to push the sternum forward into its proper position.
"I try not to let the parents and the child have a false expectation that this is a cinch," Dr. Chen says. "I tell parents that from the outside it looks minimally invasive but it is still a major operation in the chest. Kids normally describe a heavy pressure sensation in the anterior chest because this procedure is somewhat like putting on braces for teeth. But in orthodontics, the braces are tightened gradually. In this operation, the correction occurs instantly. The child goes to sleep under anesthesia and wakes up with this bar in place. It may take a couple of weeks to get accustomed to the bar under the sternum. "
In the traditional approach, an incision is made across the chest, from nipple to nipple. The surgeon cuts through cartilage, ribs and the sternum to insert a bar that remains in place for about six months. Patients sometimes need blood transfusions to replace the blood lost during the operation. The traditional operation, known as the modified Ravitch procedure, may take four to six hours to complete, depending on the amount of cartilage to be removed. Although the cartilage grows back, in some instances it does not keep pace with normal growth and the child's upper chest may be smaller or more rigid than normal.
The new technique reduces operating time to about a third of the previous time, estimates Dr. Chen, and there is no blood loss, no need for transfusions and no need for a drainage tube to evacuate blood for a few days after surgery.
Instead of opening the front of the chest cavity, Dr. Chen works through small incisions on the sides of the patient's chest. On the patient's right side, he makes a quarter-inch incision and inserts a thoracoscope -- a fiber-optic telescope with a camera attached. Sharp, precise real-time images of the surgical site are displayed on monitors, enabling the surgical team to manipulate instruments and the bar through the chest cavity. The bar is inserted through a 1-inch incision that is also in the patient's right side.
The bar -- which is pre-measured and shaped to fit the dimensions of each child -- emerges through another 1-inch incision on the patient's left side. When surgery is finished, the bar extends through the chest cavity on both sides, but the ends are buried in a pocket under the skin.
"We should all recuperate like 10-year-old boys," says Randi Berger whose son, Max, underwent the Nuss Technique last summer. He experienced pain for a few days, as expected, but it improved noticeably each day.
Their pediatrician explained Pectus Excavatum to Randi and her husband, Steve, when Max was 1 or 2 years old and they could see that his chest wasn't formed properly. The pediatrician suggested they wait and watch. When Max was 5, Steve and Randi consulted two surgeons who described the traditional open surgical procedure and suggested they wait a few more years to decide.
"We were advised to wait until he was 9 or 10 and see just how important it was to him, but we were not going to let him go through all that," recalls Randi. In the spring of 2001, they were referred to Dr. Chen to find out about the new procedure.
"The surgery was on July 19, 2001. It went -- I can't tell you -- it was awesome. It was incredible. We were thrilled," she says. "He came out of recovery saying, 'Is my chest straight?' It wasn't even bandaged up. Only the incisions were. So we could see. It was remarkable. It was immediate and remarkable."
After two years, the bar will be removed. That will be accomplished under general anesthesia as an outpatient procedure. In the meantime, Max can lead a normal life.
"Most of the kids find the first week after surgery to be rough," says Dr. Chen. "They have to get used to it. By the second week, they're generally not taking much medication for pain and they're doing most of their daily activities without a problem. If they're involved in sports activities -- particularly competitive sports -- they probably will have a harder time because it is a bit sore when they move in repetitive motions. Usually by about four to six weeks, they're back to whatever they were doing before."
Randi says she and Steve were impressed with Dr. Chen's surgical skill but also by the way he made Max feel as comfortable as possible.
"Dr. Chen walked him in, holding his hand into surgery," she recalls. "Two minutes later he came out and said, 'Can I have Max's blanket?' He went in with him, he put the blanket around Max, and he held Max in his arms until Max was out. This is an incredible doctor. Not only is he a genius with his stitching and his work, he is an incredible man. I can't say enough about the man, as a doctor, as a person."
Cedars-Sinai Medical Center is one of the largest non-profit academic medical centers in the Western United States. For the fifth straight two-year period, Cedars-Sinai has been named Southern California's gold standard in health care in an independent survey. Cedars-Sinai is internationally renowned for its diagnostic and treatment capabilities and its broad spectrum of programs and services, as well as breakthrough in biomedical research and superlative medical education. Named one of the 100 "Most Wired" hospitals in health care in 2001, the Medical Center ranks among the top 10 non-university hospitals in the nation for its research activities.
# # #
For media information and to arrange an interview, please contact Sandra Van via e-mail at [email protected] or call 1-800-880-2397. Please note that this information is intended for members of the news media. If you have received this news release in error and do not wish to receive future advisories, or if they should be directed to someone else in your organization, please let us know so we can update our records. Also if you have a preference for receiving future advisories (e-mail vs. fax), please so advise.
RSS