Research Paves Ways For Minimally Invasive Correction Method For Rib Cage Deformation
The Instituto do Coração (Incor) of the Hospital das Clínicas of the Faculdade de Medicina of the USP, together with the Hospital Alemão Oswaldo Cruz, participated in the development of a new material for the surgical correction of cases of deformation of the rib cage, the so-called pectus excavatum . The prevalence of this deformation in the population is 1.2%.
The deformation of the thoracic cage is what they call excavated chest: between each rib and a sternum bone, there are cartilages. It is a congenital deformity, which causes malformation in the abnormal growth of the cartilages of the thorax, which ends up pushing the rib cage, thus causing the deformation. This sinking can compress the heart and lungs of those affected. “When you look at the patient, you have the feeling that there is a depression in the chest wall”, explains Miguel Tedde, a thoracic surgeon at InCor and Hospital Alemão Oswaldo Cruz and coordinator of the research project .
In addition to the obvious physical problems, Tedde points out that a consequence of the deformity is the profound impact it has on patients’ self-esteem, well-being and quality of life. He points out that the appearance of this is often during the personality formation phase, which drastically affects the physical and psychological perception of the patient. “There is work showing that they followed patients, half of whom were operated on and [the other] half were not. They were young, evidently, and what we saw is that the school performance of the operated ones was much better than the part that was not treated, showing how much this impacts on the psychological aspect, quality of life and self-esteem of these”, says Tedde .
minimally invasive surgery
There are attempts at non-invasive treatment of pectus excavatum, but “the problem with non-invasive treatment is that there is no scientific evidence to support these treatments”, says the surgeon. The treatment has to be by surgical means. Previously, open surgeries were performed, with drying of the cartilages and support of the sternum with a mesh or some other method. This, however, does not work properly: there is a possibility that the problem will return and the scar will become very apparent, which worsens the psychological situation of the patients.
Tedde says that, until last year, the only metallic prosthesis they had was imported, but this one had a rotation problem, which presents a serious risk for the patient. It is not even suitable for when more than one metal bar is needed. What was done, based on research by Incor and Hospital Oswaldo Cruz, was the development of a bar, stabilizers and safer bridges. The clamping system eliminates the chance for the bar to rotate.
“The minimally invasive treatment of pectus excavatum , which is now the standard of care, has become much safer and more effective for correction. From an aesthetic point of view, it has improved a lot”, says Tedde. “We have observed that patients have been discharged earlier, they have returned to activity earlier and the aesthetic result has been much better”, says the doctor. “I have the impression that there is no going back; the results we have seen with it [the material] have been much better”, he adds.
A comparative work was not done, but practical results indicate that the material is better than the one used before. The interesting thing about this research is that, in addition to an improvement in the results and reliability of patients, industry and national research can work to replace the material that was previously imported and is now manufactured here in the country.
Tedde says the feeling is that many patients avoided the previous surgery – the open-chest surgery – because of the complications. With the reduction of complications and less invasive surgery , through video-assisted thoracoscopy , more patients will seek effective treatment.
The search
This new material has already been successfully implemented in 50 surgeries performed at Incor and has already been approved by Anvisa for use anywhere, regardless of whether it is a research or not.
“Nowadays we no longer talk about research, as it is in current use. Today, Brazilian thoracic surgeons have at their disposal, and I have no hesitation in saying this, the most complete material to operate on patients”, he says. According to the surgeon, different techniques for using the metal bars are possible, which the surgeon chooses according to the patient. “If they need that treatment today, they have better treatment than they had in the recent past,” he concludes.