Initial experience with a 3D printed model for preoperative simulation of the Nuss procedure for pectus excavatum

Abstract

The incidence of pectus excavatum has been estimated to be between 0.1% and 0.8% though a large autopsy series reports. After publication of the Nuss procedure for pectus excavatum, it became widely accepted. However, there are still some complications, such as over-correction and recurrence. To reduce differences in the procedure due to surgeons' experience level, preoperative simulation may be useful. Thus, we performed simulated surgery using a specific patient's three-dimensional (3D) chest wall model made by a 3D printer before operation. A 13-year-old male patient with a severe deformity of the chest underwent the Nuss procedure. As in the simulation, bars were inserted into the 5^th and 7^th intercostal spaces (ICS), leading to improvement of the chest wall. This simulation can increase surgeons' confidence to improve the deformity by determination of the number and insertion sites of bars.

Keywords: Three-dimensional (3D) printed model; pectus excavatum; pediatric.

Figure 1

Steps in making the 3D model. 3D, three-dimensional.

Figure 2

Simulation to insert one bar into the 6^th ICS. The bar is inserted into the 6^th ICS and rotated in the chest cavity (8). ICS, intercostal spaces. Available online: http://asvidett.amegroups.com/article/view/22889

Figure 3

Simulation to insert two bars into the 5^th and 7^th ICSs. Two bars are inserted into the 5^th and 7^th ICSs and rotated in the chest cavity (9). ICS, intercostal spaces. Available online: http://asvidett.amegroups.com/article/view/22890

Figure 4

Simulation of the Nuss procedure using a 3D printed model. (A) Top perspective view of chest wall before bar insertion; (B) perspective view of the chest wall from the caudal side before bar insertion; (C) top perspective view after bar insertion into the 6^th ICS; (D) top perspective view after bar insertion into the 5^th and 7^th ICSs; (E) perspective view from the caudal side after bar insertion into the 6^th ICS; (F) perspective view from the caudal side after bar insertion into the 5^th and 7^th ICSs; (G) perspective view from the cranial side after bar insertion into the 6^th ICS; (H) perspective view from the cranial side after bar insertion into the 5^th and 7^th ICSs; (I) perspective view from the caudal side after bar insertion into the 6^th ICS; (J) perspective view from the caudal side after bar insertion into the 5^th and 7^th ICSs. 3D, three-dimensional; ICS, intercostal spaces.

Figure 5

Improvement of the chest wall after the Nuss procedure. (A) Chest wall before the operation; (B,C) chest X-ray after the operation; (D) chest wall before the Nuss procedure; (E) chest wall after the Nuss procedure.