Objective:

To evaluate the safety and efficacy of the thoracoscopy-assisted modified Nuss procedure for the treatment of pectus excavatum in children.

Approach:

• Study Design: A retrospective analysis of patients who underwent surgery for pectus excavatum between January 2023 and June 2025.
• Patient Groups: 199 patients underwent the thoracoscopy-assisted modified Nuss procedure (MP group), while 32 underwent the thoracoscopy-assisted traditional Nuss procedure (TP group).
• Bar Implantation Groups: Patients were further divided into single-bar (SB group) and double-bar (DB group) based on the number of bars implanted.

Key Findings:

• A total of 231 patients were included, with a median age of 12 years (IQR: 10-14 years).
• Postoperative hospital stay ranged from 3 to 18 days, with a median of 6 days (IQR: 5-8 days).
• Surgical complications occurred in 8.65% of cases.
• Significant differences in operation time (MP: 65 min vs. TP: 87.5 min, P < 0.001), postoperative pain score (MP: 6 vs. TP: 6, P < 0.05), and hospital stay (MP: 6 days vs. TP: 9 days, P < 0.001) were noted.
• Significant differences in age (SB: 12 years vs. DB: 4.1 years, P < 0.001), operation time (SB: 65 min vs. DB: 95 min, P < 0.001), and hospitalization (SB: 6 days vs. DB: 7.5 days, P < 0.05) were observed.

Interpretation:

The thoracoscopy-assisted modified Nuss procedure achieved comparable correction of the Haller index.

Limitations:

• Retrospective study design may introduce bias.
• Single-center study limits generalizability of findings.

Conclusion:

The thoracoscopy-assisted modified Nuss procedure may be suitable for pediatric patients with pectus excavatum, providing effective correction with shorter recovery times.