Abstract
BACKGROUND: The minimally invasive Nuss procedure has emerged as the standard of care for correction of pectus excavatum. The site of chest wall insertion and bar shape are currently contoured on the basis of the surgeon's judgment. To optimize and individualize Nuss bar configuration, we aimed to create a virtual surgical planning workflow and 3-dimensional (3D) printed Nuss bar molds customized to each patient's defect. METHODS: Standard thin-section chest computed tomography images were imported into the planning software, and segmentation was used to extract anatomically relevant features including ribs, cartilage, sternum, and skin surface. Curves representing the ideal Nuss bar contour are splined on axial imaging. Molds designed from the Nuss bars are created within medical computer-aided design software and then 3D printed with a biocompatible sterilizable photosensitive resin, labeled with the correct orientation. RESULTS: Virtual surgical planning and 3D reconstruction were used to create patient-specific sterilizable Nuss bar molds in 9 patients presenting with pectus excavatum. The Nuss bar was bent in the operating room to the optimized curve and fitted to the mold. Six male patients with a median age of 26 years underwent customized Nuss bar placement with no intraoperative complications and a procedural time of 126 minutes. The median length of stay was 4 days. No early postoperative revisions were required. CONCLUSIONS: Although further prospective studies are warranted, this initial pilot demonstrates a replicable technique for virtual surgical planning workflows and patient-specific customizable Nuss bar molds for patients with pectus excavatum.