Anesthetic and Perioperative Considerations in Minimally Invasive Repair of Pectus Excavatum – Nuss Procedure: Our Initial Experience

Abstract Pectus excavatum, also known as funnel chest or trichterbrust, is a congenital concave depression as well as torsion of the sternum and the ribs. Surgical correction can be performed through a minimally invasive technique of internally bracing the sternum forward – the Nuss procedure. Alternatively, the sternum can be dismantled and reset as is done in the modified Ravitch procedure. The Nuss procedure is challenging in terms of preoperative counseling, psychological evaluation, one lung anesthesia, risk of intraoperative hemodynamic instability, arrhythmia, and major blood loss, especially during mediastinal dissection and bar manipulation. We performed a retrospective analysis of patient data and medical records from five patients who underwent video-assisted thoracoscopic Nuss procedures at our institute between November 2023 and July 2025. Given its rarity, this retrospective analysis highlights our experience with five patients who underwent the Nuss procedure.