Rachel L. Medbery, MD, a double-board-certified thoracic surgeon at Emory Healthcare, has pioneered a new technique that eliminates the guesswork in pectus excavatum (PE) surgery. Here, she discusses how 3D computer modeling improves cosmetic outcomes, operating room efficiency and patient satisfaction.
Dr. Medbery: In pectus excavatum surgery, I do the modified Ravitch procedure to permanently expand the chest cavity and reposition the sternum. I start by removing all excess rib cartilage, and then I reshape the sternum with a wedge osteotomy and secure it with a lightweight, titanium plate.
Dr. Medbery: Pectus excavatum surgery is essentially a math problem—you’re trying to correct the depth-to-width ratio that makes up the Haller index. Our computer model utilizes CT images of the patient’s sternum to calculate the optimal location to cut the sternum, the angle at which to cut and the size of the wedge.
Additionally, the system generates data to 3D-print two physical models of the sternum. One model is for the Zimmer BioMet rep, who uses it to select the correct titanium plate and bend the plate before surgery (Figure 1). The other is a pre-op model that shows the wedge (Figure 2).
I take that model into the OR with me and place it next to the sternum after opening the patient. Using a ruler and marking pen, I transcribe what’s on the model to the patient’s sternum. The model also shows me the depth of the bone and guides screw size selection.
Dr. Medbery: The surgery is for adults with severe, symptomatic pectus excavatum deformities. Symptoms include:
Pectus excavatum symptoms can worsen as adults get older. I operate on a lot of college-age patients as well as people in their 50s and 60s.
Dr. Medbery: I tell all my patients that this is a major surgery that will disrupt their lives for several months. Patients spend five to seven days in the hospital, and I discharge them with three months of strict sternal precautions that include restrictions such as no driving. They need to wear a custom brace for that long or longer.
However, after recovery, patients typically experience significant and long-lasting symptom relief, including improvements in pain, breathing capacity and cardiac function. Some patients with severe palpitations before surgery were able to discontinue their anti-arrhythmic medications.
Dr. Medbery: At Emory Saint Joseph’s Hospital, we’re already using it to create custom plates for chest wall trauma surgeries. I anticipate that we will soon use it for complex chest wall tumor resections. Surgeons are problem solvers, and if there is a way to make procedures more precise, we’ll do it.
Dr. Medbery: I encourage referrals when patients are experiencing severe symptoms with pectus excavatum. I’m happy to evaluate anyone who is considering surgery. About half of the people I evaluate for PE surgery decide not to do it right away. They can always come back if their symptoms worsen. There’s no time limit.
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