Safety enhancement in Nuss procedure: sternal elevation and thoracoscopic dissection

<b>Introduction:</b> <i>Pectus excavatum</i> (PE) is the most common chest wall deformity. Minimally invasive repair techniques based on the Nuss procedure are a mainstay of treatment. However, intraoperative cardiac injury, though rare, can be a devastating complication.<b>Aim:</b> This study aimed to evaluate a modification of the Nuss procedure designed to minimize the risk of serious complications.<b>Material and methods:</b> A retrospective analysis of medical records for 38 patients treated with a modified Nuss procedure forPE was conducted. The specific modifications to the surgical technique were described.<b>Results:</b> No intraoperative complications were observed in the analyzed patients. In 3 patients (7.9%), early complicationsafter surgery occurred, with none relating to the modification of the surgical technique.<b>Discussion:</b> Minimally invasive PE repair carries a risk of serious complications, prompting the development of variousmodifications. These modifications often involve techniques of sternal elevation and retrosternal dissection to achieve clearview throughout the procedure.<b>Conclusions:</b> The Nuss procedure with sternal elevation and thoracoscopic retrosternal dissection offers a simple andpotentially safer approach to PE repair.