Optimizing the Nuss Technique: Modified Approaches to Pediatric Pectus Excavatum

<b>Introduction:</b> Pectus excavatum is the most common congenital chest wall deformity, characterized by posterior displacement of the sternum and adjacent costal cartilages. In severe cases, it can impair cardiopulmonary function and negatively affect the quality of life due to physical limitations and psychosocial distress.<b>Aim:</b> To present current modifications of the Nuss procedure and assess their impact on the safety, postoperative outcomes, and patient comfort of surgical treatment for pectus excavatum.<b>Methods:</b> A narrative review based on a comprehensive analysis of relevant literature was conducted, focusing on advancements and technical modifications of the original Nuss technique.<b>Results:</b> Since its introduction in 1998, the Nuss procedure has become the standard minimally invasive approach for correcting pectus excavatum. Various modifications - such as changes in bar design, stabilization methods, use of thoracoscopy, and postoperative pain management protocols - have improved surgical outcomes and reduced complication rates. These advancements have increased the procedure's safety and patient comfort, while maintaining high correction efficacy.<b>Conclusions:</b> The evolution of the Nuss procedure has significantly enhanced the surgical management of pectus excavatum. Ongoing refinements continue to optimize patient outcomes, making the technique safer, more comfortable, and more widely applicable across age groups.