# Two Cases of Lung Injury During the Nuss Procedure for Pectus Excavatum

## TL;DR

This paper reports two cases of lung injury during a minimally invasive chest surgery, emphasizing the importance of careful technique to prevent complications.

## Contribution

The paper presents two clinical cases and proposes preventive measures to reduce lung injury risks during the Nuss procedure.

## Key findings

- Lung injuries occurred when the introducer tip penetrated the left lingular segment during the Nuss procedure.
- Thoracoscopic repair of the injuries led to successful postoperative recovery in both patients.
- Improved visualization techniques and surgeon experience are recommended to prevent such complications.

## Abstract

The Nuss procedure is a minimally invasive surgery commonly performed for pectus excavatum. However, it can cause fatal complications during surgery, making it crucial to prevent these complications. Here, we report two cases of lung injury during the procedure and discuss their causes and preventive measures. Two male patients, aged 18 and 19 years, with a Haller index of 5.9 and 3.5, respectively, underwent the Nuss procedure under thoracoscopic guidance. In both cases, the introducer tip penetrated the left lingular segment during passage, with an injury being discovered upon bar insertion. The lung injuries were repaired thoracoscopically using sutures, with uneventful postoperative recovery. Although the Nuss procedure is minimally invasive, it carries risks, including lung injury. Our experience highlights the importance of visualizing the introducer tip during the passage to avoid complications. We recommend a 4-5 cm wide mediastinal pleural incision, thoracoscopic confirmation of introducer placement, and addition of a left thoracic port for improved visualization. Both the surgeon's experience and the age of the patient may contribute to complications. These cases highlight the importance of meticulous technique and vigilant execution during the Nuss procedure.