Introduction

Pectus excavatum is a congenital deformity where the chest wall is sunken in, creating a caved - in appearance. It is relatively common and occurs more often in males. In adults, severe cases of pectus excavatum can affect lung capacity, causing fatigue, shortness of breath, chest pain, and a fast heartbeat. When it comes to seeking surgical treatment for adult pectus excavatum in New York City, patients often wonder about the technological capabilities of the hospitals. In this article, we will explore the technology and expertise available in New York City hospitals for adult pectus excavatum surgery.

Understanding Pectus Excavatum

Definition and Causes

Pectus excavatum is a malformation of the chest wall in which several ribs and the sternum (breastbone) grow abnormally, resulting in a sunken appearance. Although its causes are not completely understood, the condition is believed to arise from excessive growth of the cartilage connecting the ribs to the breastbone, which pulls the sternum inward. Approximately 40% of people with pectus excavatum have one or more family members with the defect. It can be present at birth or develop during puberty.

Symptoms and Complications

In mild cases, a person with pectus excavatum may have no symptoms for ordinary everyday activities. However, in severe cases, it can cause significant problems. The proximity of the sternum and the pulmonary artery may cause a heart murmur. During exercise, symptoms such as fatigue, shortness of breath, chest pain, and a fast heartbeat often appear. Lung capacity may be curtailed because the lungs are confined and cannot properly expand. Psychosocial effects are also common, especially in adolescents and adults, who may experience self - consciousness and difficult peer interactions due to their appearance.

Diagnosis

Multiple tools are used to diagnose pectus excavatum and gauge its extent:

• Visual examination of the chest: A simple way to initially detect the condition.
• Auscultation: Analysis of sounds of the heart and chest to detect the condition's effect on heart and lung function.
• Electrocardiogram (ECG or EKG): To check the heart's electrical activity.
• Echocardiogram: A non - invasive test that takes a picture of the heart with sound waves.
• Pulmonary function testing: Involves breathing into a mouthpiece connected to an instrument that measures the amount of air breathed over a period of time.
• Chest X - ray: Gives a basic view of the chest structure.
• CT - scan: Provides more detailed images of the chest. The Haller index, calculated from the CT scan, is used to measure the extent of pectus excavatum. A Haller index of greater than 3.25 is generally considered severe (a normal Haller index is 2.5).

Common Surgical Treatments for Pectus Excavatum

Nuss Procedure

The minimally invasive Nuss procedure is performed under general anesthesia. It uses video - assisted thoracoscopic surgery (VATS). The surgeon creates a horizontal passage underneath the sternum through two small incisions in the side of the chest. A small incision enables the surgeon to view the inside of the chest with a thoracoscopic camera. A convex bar known as the Lorenz pectus bar, specially shaped to fit the individual’s anatomy, is inserted through the passage and then turned to push the sternum outward. The bar must remain in place for a minimum of three years while the chest contour re - forms to its new shape. It is then removed as an outpatient procedure. This procedure was originally developed for children but has also been used successfully in adults.

Modified Ravitch Repair

The modified Ravitch repair is also performed under general anesthesia. It utilizes a horizontal incision and involves removing small pieces of deformed chest cartilage and repositioning the protruding ribs and sternum. To support the repaired chest architecture, titanium bars are secured to the ribs and sternum. Previously, the supports used to keep the sternum in place needed to be removed after several years. However, the bars currently used are secured to the chest wall in such a way that they can remain permanently in place, eliminating the need for a second operation.

New York City Hospitals for Adult Pectus Excavatum Surgery

NewYork - Presbyterian Queens

NewYork - Presbyterian Queens has a highly advanced thoracic surgery program. It has earned a three - star rating from the Society of Thoracic Surgeons (STS) for patient care and outcomes in isolated coronary artery bypass grafting (CABG) procedures, which is a sign of its high - quality surgical care. The hospital's thoracic surgeons, in collaboration with Weill Cornell Medicine, provide the latest in surgical techniques and comprehensive care for patients with diseases of the lung, trachea, esophagus, chest wall, and mediastinum. For pectus excavatum, they offer the minimally invasive Nuss procedure. The program also features a world - class team that is committed to developing and using the most advanced minimally invasive diagnostic and surgical techniques. Patients have access to one of the most sophisticated minimally invasive thoracic surgery programs in the world. The majority of patients are able to have their surgery performed through a minimally invasive approach, which results in less blood loss, less postoperative pain, shorter hospital stays, and a quicker recovery and return to normal activities. The hospital's multidisciplinary team, including thoracic surgeons, medical and radiation oncologists, pulmonologists, gastroenterologists, radiologists, pathologists, neurologists, physician assistants, nurse practitioners, dedicated thoracic intensive care nurses, respiratory therapists, speech therapists, and social workers, collaborates to deliver seamless, high - quality care to patients before, during, and after their hospital stay.

New York - Presbyterian/Columbia University Irving Medical Center

Dr. Lyall Gorenstein, a thoracic surgeon at New York - Presbyterian/Columbia University Irving Medical Center, specializes in minimally invasive thoracic surgery, with a special focus on pectus excavatum. The hospital is part of a top - ranked medical center. It is likely to have access to the latest surgical techniques and technologies. Columbia University's surgical lung & chest care program, associated with the hospital, prides itself on providing the most up - to - date options for all chest conditions, from the extremely common to the most rare and complex. The center is at the forefront of thoracic surgical innovation and can offer patients a wide range of treatment options for pectus excavatum.

Mount Sinai - New York

Mount Sinai - New York offers both open and closed (minimally invasive) surgeries for pectus excavatum repair. The open surgery involves making a cut across the front part of the chest, removing the deformed cartilage, repositioning the breastbone, and using a metal strut to hold it in place until it heals. The minimally invasive surgery, mainly used for children but also applicable to some adults, makes two small incisions on each side of the chest, inserts a thoraco scope to view inside the chest, and places a curved steel bar under the breastbone to lift it. The hospital has a well - established protocol for pre - operative evaluation, including electrocardiogram, pulmonary function tests, and CT scan or MRI of the chest. They also provide comprehensive post - operative care, including pain management and guidance on recovery activities.

Technology and Expertise in New York City Hospitals

Minimally Invasive Techniques

New York City hospitals are at the forefront of using minimally invasive techniques for pectus excavatum surgery. The Nuss procedure, which uses video - assisted thoracoscopic surgery (VATS), is widely available. VATS allows surgeons to perform the procedure through small incisions, reducing trauma to the patient's body. This results in less blood loss, less pain, and a shorter recovery time compared to traditional open surgeries. The hospitals have experienced surgeons who are well - trained in these advanced techniques and can adapt them to the specific needs of adult patients.

Robotic Surgery

Although not specifically for pectus excavatum, New York - Presbyterian LeFrak Center for Robotic Surgery, in conjunction with Weill Cornell Medicine, is home to the most technologically - advanced surgical robots available in New York City. While the application of robotic surgery to pectus excavatum may still be in the early stages, the presence of such advanced robotic technology in the city's hospitals indicates a high level of technological readiness. Robotic surgery can offer greater precision and control during complex surgical procedures, which could potentially benefit patients in the future for pectus excavatum surgery as well.

Multidisciplinary Approach

All the major hospitals in New York City take a multidisciplinary approach to patient care. For pectus excavatum surgery, a team of different specialists, such as thoracic surgeons, cardiologists, pulmonologists, and anesthesiologists, work together. This ensures that all aspects of the patient's health are considered, from the diagnosis and pre - operative evaluation to the surgical procedure and post - operative recovery. The coordination between these specialists leads to better treatment outcomes and a more comprehensive approach to patient care.

Research and Innovation

New York City hospitals are also involved in research and innovation related to pectus excavatum. They keep up with the latest medical literature and are likely to participate in clinical trials. For example, although not directly related to surgical technology, there has been research on alternative treatments like the use of magnets and an external brace for pectus excavatum in children. The hospitals' connection to top - tier medical institutions in the city means that they are in a position to adopt new and improved treatment methods as they become available.

Benefits of Having Good Technology for Adult Pectus Excavatum Surgery

Improved Surgical Outcomes

Advanced technology, such as minimally invasive techniques, allows for more precise surgical procedures. This can lead to better correction of the pectus excavatum deformity, improving the appearance of the chest. In terms of functional outcomes, it can also result in better lung and heart function, reducing symptoms such as shortness of breath and chest pain.

Faster Recovery

Minimally invasive surgeries cause less trauma to the body. Patients who undergo these procedures typically have shorter hospital stays and can return to their normal activities more quickly. This is especially important for adults who may have work and family commitments.

Reduced Complications

The use of advanced diagnostic tools and surgical techniques can help in accurately assessing the patient's condition and performing the surgery with greater precision. This reduces the risk of complications such as injury to the heart, lung collapse, and infection, which are potential risks associated with pectus excavatum surgery.

Patient Considerations

Choosing a Hospital

When choosing a hospital for adult pectus excavatum surgery in New York City, patients should consider several factors. The hospital's reputation, the experience of the surgical team, the availability of advanced technology, and the success rates of previous surgeries are all important. It is also advisable to talk to other patients who have undergone the surgery at the hospital to get an idea of their experiences.

Pre - operative Preparation

Patients need to undergo a thorough pre - operative evaluation, including a complete medical exam, electrocardiogram, pulmonary function tests, and CT scan or MRI of the chest. They should also inform the surgeon about any medications they are taking, including over - the - counter drugs, herbs, and supplements, as well as any allergies they may have. In the days before the surgery, they may be asked to stop taking certain blood - thinning drugs.

Post - operative Care

After the surgery, patients will need to stay in the hospital for a few days for monitoring. Pain management is an important part of post - operative care, and patients may receive pain medication through an IV or an epidural initially and then switch to oral medications. They will also need to follow a specific activity restriction plan, gradually increasing their activities as they recover. Physical therapy may be recommended to help with the recovery process.

Conclusion

In conclusion, the hospitals in New York City for adult pectus excavatum surgery generally have good technology. They offer a range of advanced surgical techniques, such as the minimally invasive Nuss procedure, and take a multidisciplinary approach to patient care. The availability of advanced diagnostic tools and the experience of the surgical teams contribute to better treatment outcomes. The use of minimally invasive techniques also offers benefits such as faster recovery and reduced complications. However, patients should carefully consider their options and choose a hospital that best suits their needs.

If you or someone you know is considering adult pectus excavatum surgery in New York City, take the time to research the hospitals and surgeons available. You can reach out to the hospitals directly, read patient reviews, and schedule consultations to discuss your specific situation. Share this article with others who may benefit from the information, and continue to explore related topics on pectus excavatum treatment and recovery to make an informed decision.