Patient Position Supine 2 arms abducted –Allows access to both axillas Primary access usually on...
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Transcript of Patient Position Supine 2 arms abducted –Allows access to both axillas Primary access usually on...
Patient PositionPatient Position
• Supine
• 2 arms abducted– Allows access to both
axillas
• Primary access usually on the right– Left for special situation
(heart)
• Monitor on the left
Find the appropriate Find the appropriate landmarkslandmarks
– Deepest bony pointDeepest bony point– Appropriate inter-Appropriate inter-
costal spacecostal space– Apex of deformityApex of deformity– Level of the bar in Level of the bar in
the mid axillary linethe mid axillary line
ThoracoscopyThoracoscopy
• 5 mm trocar; 0° telescope
• 2 ICS below the intended position of the bar
• 4 mmHg CO2 pneumothorax
TunnelingTunneling
• Mid-axillary line transverse incisions– 2-3 cm on the right
and on the left (stabilizer)
• Bilateral subcutaneous/sub-pectoral tunnel – To the apical
landmark
Prepare The BarPrepare The Bar
• Use a malleable Template:
– Check the length– Mold the contour of
the corrected chest– Choose the
appropriate Pectus Bar
• Using the template as a guide
• Remain symmetrical
• Final adjustments after insertion
INSERT THE PECTUS BARINSERT THE PECTUS BAR
• Under direct vision from one side at least.
• Minimize the manipulation
Flipping the Bar !!!Flipping the Bar !!!
• Exsufflate the pneumothorax– Keep the trocar in place– Connect its insufflations tubing to a water seal– Inflate the lung till no more air leak– Remove the trocar
Post-OPPost-OP
• No chest tube• Bed rest till
comfortable (2 to 4 days)
• Chest PT• Discharge 4 to 8
days• No sports for 3
months
PitfallPitfall
• Introducer- should be done under direct vision
• Attention in case of- resistance: it has to pass smoothly to
contralateral side- ECG should be hearable
• Bar- in older adolecents/adults: consider two
bars and cartligge release on one or two side
• Stabiliser- at least on one side with wire cerclage
ComplicationComplication
Remove the bar in about 2 yearsRemove the bar in about 2 years
Question?Question?
Thank You