Endoscopically assisted pectus excavatum repair

We present an endoscopic approach for the reconstruction of pectus excavatu m with a custom silicone implant. The procedure incorporates endoscopic tec hniques to facilitate dissection of an extensive subcutaneous pocket throug h a 6-cm Chevron skin incision 8 cm below the level of the xiphoid. The inc ision is designed based on the size, shape, and flexibility of the custom i mplant and the configuration of the chest wall deformity. A superiorly base d rectus abdominis anterior fascial sheath flap then is elevated up to the caudal-most margin of the implant, creating a sling below the implant, thus stabilizing its position and preventing direct communication with the over lying skin incision. In our patient, the endoscope permitted insertion of t he custom implant while minimizing the length of incision. The cosmetic res ult using a minimally invasive approach to assist with the dissection was a cceptable, and the morbidity and scarring were minimized.