|Nuss expert’s Edinburgh masterclass|
|Thursday, 24 November 2011|
The Department of Thoracic Surgery at Edinburgh Royal Infirmary, supported by the RCSEd, has hosted a Masterclass on Nuss correction of pectus excavatum
This Masterclass, held on 27-28 September, utilised a more traditional approach than the didactic lecture room-based programme with edited video material. The format adopted was, therefore, to provide an immersive operating theatre experience for the attending surgeons. This was intended to provide a complete understanding of the procedure and of all the set-up and surgical manoeuvres which might not be evident from edited video material or formal presentations.
Although this necessarily limited numbers to eight participants from Scotland and the North of England, the advantage was that all elements of the procedures were constantly under view and subject to straightforward, relaxed discussion between the demonstrating surgeon and delegates. Videoscopic elements of the procedures were displayed on large wall monitors.
“The event was intended to provide a complete understanding of the procedure and of all the set-up and surgical manoeuvres which might not be evident from edited video material or formal presentations”
The technique involves the insertion of one or two hoop-shaped bars utilising minimally invasive access in order to evert the pectus deformity and hold it in a corrected position. A stabiliser is applied to one or both ends of the bar(s) in order to prevent rotation of the bar through 180 degrees and hence both recurrence of the deformity and possible cardiac compromise. Although originally described by Nuss (J Paediatr Surg, 1998; 33: p545-52) as a paediatric procedure, this technique is becoming widely used in older patients.
The demonstration procedures were performed by Professor Hans Pilegaard from Aarhus University Hospital, Skejby, Denmark who has the largest western experience of Nuss bar endoscopic correction applied in late adolescence and adult patients (World J Surg 2002, 26: p1217-21), with over 1000 cases recently reported at the European Association of Cardiothoracic Surgery in Lisbon.
Five procedures were performed over two days. On the afternoon of the first day an MDT was held in order to discuss possible patients as an experience in case selection and was followed by a formal lecture given by Professor Pilegaard, who presented his experience summarising various technical aspects and providing operative tips.
All those attending found the format helpful due to the informal atmosphere, ease of communication with the surgeon and the opportunity to view the entire procedure. This format is greatly supported by the extensive use of in-theatre video displays and, with suitable camera facilities, should be extendable to more conventional open surgeries as well as minimally invasive procedures. Further similar Thoracic Surgery Masterclasses are planned at RIE to cover a variety of new Thoracic Surgery procedures. There is no substitute for being there on the day!
William Walker, Consultant Cardiothoracic Surgeon, Edinburgh Royal Infirmary