Safe retroesternal dissection with harmonic scalpel and indocyanine green during Nuss surgery

Introduction: Mediastinal dissection in the Nuss technique can result in cardiac injury. The Lorenz bar introducer only allows a limited mediastinal dissection with poorly controlled movements. To make a wide dissection, the harmonic scalpel simultaneously dissects, cuts, and coagulates, generating a wide retrosternal space without bleeding. The use of indocyanine green facilitates the identification of vascular structures, avoiding damage to them. The present work aims to show the usefulness of the harmonic scalpel and indocyanine green in combination to facilitate wide and safe mediastinal dissection. Method: Prospective study, case series. Patients aged 10 to 20 years, Haller index greater than 3.2. Surgical technique: through the right lateral incision the harmonic scalpel was introduced, indocyanine green was administered intravenously, retrosternal dissection was started until reaching the left hemithorax, the window was enlarged through which two bars were placed. Haller’s index, surgical time, bleeding, residual pneumothorax, hospital stay, and patient satisfaction were analyzed. Descriptive statistics were used. Results: Eighteen patients were treated, average age 15.05, average Haller index 4.9, treated with the surgical technique described. Average operative time 78.59 minutes. Average bleeding 14.41 ml. Discharged on the fourth day; esthetic result was satisfactory. Discussion: The use of the harmonic scalpel and indocyanine green together allows a wide mediastinal dissection, without bleeding, which facilitates the passage of the dissector and the Nuss bars in a safe and uncomplicated manner.