Progress in the clinical application of sternal elevation techniques in Nuss procedure for pectus excavatum_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZENG Zhongyi ^1,2,3 , LIN Haonan ^1,2,3 , GUO Hai ^1,2,3 , LI Jian ^1,3 , DU Haotian ^1,3 ,  LIN Feng ^1,2,3

1. Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, 610041, P. R. China;
2. Department of Thoracic Surgery, West China Tianfu Hospital, Sichuan University, Chengdu, 610213, P. R. China;
3. Department of Chest Wall Diseases Center, West China Hospital, Sichuan University, Chengdu, 610041, P. R. China;

Corresponding?author：

LIN Feng, Email: linfeng0220@aliyun.com

Keywords：

Pectus excavatum; chest wall deformity; sternal elevation techniques; Nuss procedure; subxiphoid incision; complications; cost-effectiveness; review

DOI：

10.7507/1007-4848.202511061

Video：

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Abstract Full text Figures/Tables Video References Cited by

Pectus excavatum is the most common chest wall deformity, and the Nuss procedure has become the most widely used surgical treatment owing to its minimally invasive nature and reliable corrective outcomes. However, during the critical step in which the introducer and corrective bar traverse the anterior mediastinum, rare but potentially fatal complications may occur, including injury to the lungs, heart, and great vessels. Although thoracoscopic assistance can reduce the incidence of these events to some extent, it cannot eliminate the risk entirely. To further enhance intraoperative safety, various sternal elevation techniques (SET) have been introduced in recent years and applied in combination with the Nuss procedure for the treatment of pectus excavatum. By temporarily elevating the sternum and anterior chest wall to enlarge the retrosternal space, SET may facilitate safer mediastinal passage and mitigate the risk of cardiopulmonary and major vascular injury. This review summarizes the technical characteristics and recent clinical advances of different SET modalities used in conjunction with the Nuss procedure, analyzes their advantages and limitations, and provides a reference for future research and clinical practice.

1.	Janssen N, Coorens NA, Fransen A, et al. Pectus excavatum and carinatum: a narrative review of epidemiology, etiopathogenesis, clinical features, and classification. J Thorac Dis, 2024, 16(2): 1687-1701.
2.	Ciriaco P. Surgical treatment of pectus excavatum: the boundary between pathologic and aesthetic need. J Clin Med, 2025, 14(1): 231.
3.	Walsh J, Walsh R, Redmond K. Systematic review of physiological and psychological outcomes of surgery for pectus excavatum supporting commissioning of service in the UK. BMJ Open Respir Res, 2023, 10(1): e001665.
4.	Chu CC, Chang JW, Yang HH, et al. Outcomes of the Nuss procedure in children with pectus excavatum: 14 years of experience. J Chin Med Assoc, 2024, 87(3): 314-319.
5.	Beati F, Frediani S, Pardi V, et al. Case report-Every thoracic surgeon's nightmare: cardiac and lung perforation during placement of Nuss bar for pectus excavatum. Front Pediatr, 2023, 11: 1241273.
6.	Sato K, Miyajima M, Sato T, et al. Two cases of lung injury during the Nuss procedure for pectus excavatum. Cureus, 2025, 17(6): e85952.
7.	Senica SO, Gasparrella P, Soldatenkova K, et al. Cardiac perforation during minimally invasive repair of pectus excavatum: a rare complication. J Surg Case Rep, 2022, 2022(11): rjac538.
8.	Pawlak K, G?siorowski ?, Gabryel P, et al. Video-assisted-thoracoscopic surgery in left-to-right Nuss procedure for pectus excavatum for prevention of serious complications-technical aspects based on 1006 patients. Wideochir Inne Tech Maloinwazyjne, 2018, 13(1): 95-101.
9.	Park HJ, Chung WJ, Lee IS, et al. Mechanism of bar displacement and corresponding bar fixation techniques in minimally invasive repair of pectus excavatum. J Pediatr Surg, 2008, 43(1): 74-78.
10.	Belcher E, Arora S, Samancilar O, et al. Reducing cardiac injury during minimally invasive repair of pectus excavatum. Eur J Cardiothorac Surg, 2008, 33(5): 931-933.
11.	Schier F, Bahr M, Klobe E. The vacuum chest wall lifter: an innovative, nonsurgical addition to the management of pectus excavatum. J Pediatr Surg, 2005, 40(3): 496-500.
12.	Takagi S, Oyama T, Tomokazu N, et al. A new sternum elevator reduces severe complications during minimally invasive repair of the pectus excavatum. Pediatr Surg Int, 2012, 28(6): 623-626.
13.	Park HJ, Rim G, Yoon SK. Crane-powered pectus excavatum repair: the NeoPectus surgery. Front Surg, 2023, 10: 1267009.
14.	Fokin AA, Steuerwald NM, Ahrens WA, et al. Anatomical, histologic, and genetic characteristics of congenital chest wall deformities. Semin Thorac Cardiovasc Surg, 2009, 21(1): 44-57.
15.	Aly MR, Farina JM, Botros MM, et al. Minimally invasive repair of pectus excavatum in adults: a review article of presentation, workup, and surgical treatment. J Thorac Dis, 2023, 15(9): 5150-5173.
16.	Biavati M, Kozlitina J, Alder AC, et al. Prevalence of pectus excavatum in an adult population-based cohort estimated from radiographic indices of chest wall shape. PLoS One, 2020, 15(5): e0232575.
17.	Jaroszewski D, Notrica D, McMahon L, et al. Current management of pectus excavatum: a review and update of therapy and treatment recommendations. J Am Board Fam Med, 2010, 23(2): 230-239.
18.	Sonaglioni A, Bruno A, Polymeropoulos A, et al. Prevalence of mitral valve prolapse among individuals with pectus excavatum: a systematic review and meta-analysis. Diagnostics (Basel), 2024, 14(22): 2488.
19.	Rachwan RJ, Purpura AK, Kahwash BM. Sudden cardiac arrest in a young patient with severe pectus excavatum. Am J Med Sci, 2018, 356(6): 570-573.
20.	Nuss D, Kelly RE, Jr., Croitoru DP, et al. A 10-year review of a minimally invasive technique for the correction of pectus excavatum. J Pediatr Surg, 1998, 33(4): 545-552.
21.	李星, 梁驍, 姜濤, 等. 漏斗胸手術治療的爭議點探討. 中國胸心血管外科臨床雜志, 2025, 32(10): 1376-1383.Li X, Liang X, Jiang T, et al. Discussion on controversial points of surgical treatment of pectus excavatum. Chin J Clin Thorac Cardiovasc Surg, 2025, 32(10): 1376-1383.
22.	Hebra A, Kelly RE, Ferro MM, et al. Life-threatening complications and mortality of minimally invasive pectus surgery. J Pediatr Surg, 2018, 53(4): 728-732.
23.	Garzi A, Prestipino M, Rubino MS, et al. Complications of the "Nuss Procedure" in pectus excavatum. Transl Med UniSa, 2020, 22: 24-27.
24.	Castellani C, Schalamon J, Saxena AK, et al. Early complications of the Nuss procedure for pectus excavatum: a prospective study. Pediatr Surg Int, 2008, 24(6): 659-666.
25.	Zhang Y, Chen Q, Luo Y, et al. Wire fracture in postoperative Nuss procedure: a problem that cannot be ignored. Transl Pediatr, 2021, 10(3): 569-578.
26.	Kelly RE, Jr., Obermeyer RJ, Goretsky MJ, et al. Recent modifications of the Nuss procedure: the pursuit of safety during the minimally invasive repair of pectus excavatum. Ann Surg, 2022, 275(2): e496-e502.
27.	Cuji?o-álvarez IF, Torres-Salazar D, Velásquez-Galvis M. Cardiorespiratory arrest during and after Nuss procedure: case report. J Cardiothorac Surg, 2023, 18(1): 166.
28.	Kim DY, Jeong JY. Penetrating lung injury during Nuss procedure for pectus excavatum. J Cardiothorac Surg, 2020, 15(1): 184.
29.	Uemura S, Nakagawa Y, Yoshida A, et al. Experience in 100 cases with the Nuss procedure using a technique for stabilization of the pectus bar. Pediatr Surg Int, 2003, 19(3): 186-189.
30.	Park HJ, Kim KS, Lee S, et al. A next-generation pectus excavatum repair technique: new devices make a difference. Ann Thorac Surg, 2015, 99(2): 455-461.
31.	Park HJ, Kim KS, Moon YK, et al. The bridge technique for pectus bar fixation: a method to make the bar un-rotatable. J Pediatr Surg, 2015, 50(8): 1320-1322.
32.	Park HJ, Rim G, Yoon SK. Recent advancements in pectus surgery: crane lifting, multiple-bar approach, bridge stabilization, and sandwich technique. J Pediatr Surg, 2024, 59(4): 640-647.
33.	Sun H, Huang Y, Han Y, et al. Perioperative outcomes of thoracoscopic versus non-thoracoscopic minimally invasive repair of pectus excavatum: a systematic review and meta-analysis. J Cardiothorac Surg, 2024, 19(1): 603.
34.	Johnson WR, Fedor D, Singhal S. A novel approach to eliminate cardiac perforation in the Nuss procedure. Ann Thorac Surg, 2013, 95(3): 1109-1111.
35.	Haecker FM, Sesia SB. Intraoperative use of the vacuum bell for elevating the sternum during the Nuss procedure. J Laparoendosc Adv Surg Tech A, 2012, 22(9): 934-936.
36.	Ciopiński M, Marciniak M, Bogucki K, et al. Safety enhancement in Nuss procedure: sternal elevation and thoracoscopic dissection. Pol Przegl Chir, 2024, 97(2): 1-5.
37.	Tedde ML, de Campos JR, Wihlm JM, et al. The Nuss procedure made safer: an effective and simple sternal elevation manoeuvre. Eur J Cardiothorac Surg, 2012, 42(5): 890-891.
38.	Rygl M, Vyhnanek M, Kucera A, et al. Technical innovation in minimally invasive repair of pectus excavatum. Pediatr Surg Int, 2014, 30(1): 113-117.
39.	St Peter SD, Sharp SW, Ostlie DJ, et al. Use of a subxiphoid incision for pectus bar placement in the repair of pectus excavatum. J Pediatr Surg, 2010, 45(6): 1361-1364.
40.	Gould JL, Sharp RJ, Peter SD, et al. The minimally invasive repair of pectus excavatum using a subxiphoid incision. Eur J Pediatr Surg, 2017, 27(1): 2-6.
41.	曾忠義, 林浩楠, 孫海鵬, 等. Nuss手術聯合簡易胸骨提升法治療重度漏斗胸一例. 中國胸心血管外科臨床雜志, 2025. [Epub ahead of print].Zeng ZY, Lin HN, Sun HP, et al. Application of the simplified sternal elevation technique in the Nuss procedure for severe pectus excavatum: a case report. Chin J Clin Thorac Cardiovasc Surg, 2025. [Epub ahead of print].
42.	Haecker FM, Sesia S. Vacuum bell therapy. Ann Cardiothorac Surg, 2016, 5(5): 440-449.
43.	Haecker FM, Krebs T, Kocher GJ, et al. Sternal elevation techniques during the minimally invasive repair of pectus excavatum. Interact Cardiovasc Thorac Surg, 2019, 29(4): 497-502.
44.	Obermeyer RJ, Goretsky MJ, Kelly RE, Jr., et al. Selective use of sternal elevation before substernal dissection in more than 2 000 Nuss repairs at a single institution. J Pediatr Surg, 2021, 56(4): 649-654.
45.	Elsayed H. Crane technique with the vacuum bell device for improving access in the Nuss procedure. J Thorac Cardiovasc Surg, 2015, 150(5): 1372-1373.
46.	Park HJ, Lee SY, Lee CS. Complications associated with the Nuss procedure: analysis of risk factors and suggested measures for prevention of complications. J Pediatr Surg, 2004, 39(3): 391-395.
47.	Park HJ, Rim G. Development of a screw-crane system for pre-lifting the sternal depression in pectus excavatum repair: a test of mechanical properties for the feasibility of a new concept. J Chest Surg, 2021, 54(3): 186-190.
48.	Kim D, Idowu O, Palmer B, et al. Anterior chest wall elevation using a T-fastener suture technique during a Nuss procedure. Ann Thorac Surg, 2014, 98(2): 734-736.
49.	Takahashi T, Okazaki T, Yamataka A, et al. Usefulness of Kent retractor and lifting hook for Nuss procedure. Pediatr Surg Int, 2015, 31(11): 1103-1105.
50.	Jaroszewski DE, Johnson K, McMahon L, et al. Sternal elevation before passing bars: a technique for improving visualization and facilitating minimally invasive pectus excavatum repair in adult patients. J Thorac Cardiovasc Surg, 2014, 147(3): 1093-1095.
51.	Jaroszewski DE. Forced mechanical sternal elevation for Nuss repair. Ann Thorac Surg, 2013, 96(5): 1914.
52.	Velazco CS, Arsanjani R, Jaroszewski DE. Nuss procedure in the adult population for correction of pectus excavatum. Semin Pediatr Surg, 2018, 27(3): 161-169.
53.	Arredondo Montero J, Hernández-Martín S, Martín-Calvo N, et al. Development and clinical application of a new sternal zenithal traction system in video-assisted percutaneous thoracoplasty. Cir Esp (Engl Ed), 2023, 101(5): 319-324.
54.	De Loos ER, Daemen JHT, Coorens NA, et al. Sternal elevation by the crane technique during pectus excavatum repair: a quantitative analysis. JTCVS Tech, 2021, 9: 167-175.
55.	Janssen N, Coorens NA, Daemen JHT, et al. Sternal elevation in pectus excavatum repair: comparison of a unilateral versus bilateral frame crane system. Eur J Cardiothorac Surg, 2024, 66(5): ezae395.
56.	田東, 鄧志強, 林浩楠, 等. 經皮懸吊拉鉤輔助漏斗胸矯治術的臨床應用及技術優勢. 中國胸心血管外科臨床雜志, 2025. [Epub ahead of print].Tian D, Deng ZQ, Lin HN, et al. Clinical application and technical advantages of percutaneous suspension technique via sternal elevation device-assisted pectus excavatum correction. Chin J Clin Thorac Cardiovasc Surg, 2025. [Epub ahead of print].

1. Janssen N, Coorens NA, Fransen A, et al. Pectus excavatum and carinatum: a narrative review of epidemiology, etiopathogenesis, clinical features, and classification. J Thorac Dis, 2024, 16(2): 1687-1701.
2. Ciriaco P. Surgical treatment of pectus excavatum: the boundary between pathologic and aesthetic need. J Clin Med, 2025, 14(1): 231.
3. Walsh J, Walsh R, Redmond K. Systematic review of physiological and psychological outcomes of surgery for pectus excavatum supporting commissioning of service in the UK. BMJ Open Respir Res, 2023, 10(1): e001665.
4. Chu CC, Chang JW, Yang HH, et al. Outcomes of the Nuss procedure in children with pectus excavatum: 14 years of experience. J Chin Med Assoc, 2024, 87(3): 314-319.
5. Beati F, Frediani S, Pardi V, et al. Case report-Every thoracic surgeon's nightmare: cardiac and lung perforation during placement of Nuss bar for pectus excavatum. Front Pediatr, 2023, 11: 1241273.
6. Sato K, Miyajima M, Sato T, et al. Two cases of lung injury during the Nuss procedure for pectus excavatum. Cureus, 2025, 17(6): e85952.
7. Senica SO, Gasparrella P, Soldatenkova K, et al. Cardiac perforation during minimally invasive repair of pectus excavatum: a rare complication. J Surg Case Rep, 2022, 2022(11): rjac538.
8. Pawlak K, G?siorowski ?, Gabryel P, et al. Video-assisted-thoracoscopic surgery in left-to-right Nuss procedure for pectus excavatum for prevention of serious complications-technical aspects based on 1006 patients. Wideochir Inne Tech Maloinwazyjne, 2018, 13(1): 95-101.
9. Park HJ, Chung WJ, Lee IS, et al. Mechanism of bar displacement and corresponding bar fixation techniques in minimally invasive repair of pectus excavatum. J Pediatr Surg, 2008, 43(1): 74-78.
10. Belcher E, Arora S, Samancilar O, et al. Reducing cardiac injury during minimally invasive repair of pectus excavatum. Eur J Cardiothorac Surg, 2008, 33(5): 931-933.
11. Schier F, Bahr M, Klobe E. The vacuum chest wall lifter: an innovative, nonsurgical addition to the management of pectus excavatum. J Pediatr Surg, 2005, 40(3): 496-500.
12. Takagi S, Oyama T, Tomokazu N, et al. A new sternum elevator reduces severe complications during minimally invasive repair of the pectus excavatum. Pediatr Surg Int, 2012, 28(6): 623-626.
13. Park HJ, Rim G, Yoon SK. Crane-powered pectus excavatum repair: the NeoPectus surgery. Front Surg, 2023, 10: 1267009.
14. Fokin AA, Steuerwald NM, Ahrens WA, et al. Anatomical, histologic, and genetic characteristics of congenital chest wall deformities. Semin Thorac Cardiovasc Surg, 2009, 21(1): 44-57.
15. Aly MR, Farina JM, Botros MM, et al. Minimally invasive repair of pectus excavatum in adults: a review article of presentation, workup, and surgical treatment. J Thorac Dis, 2023, 15(9): 5150-5173.
16. Biavati M, Kozlitina J, Alder AC, et al. Prevalence of pectus excavatum in an adult population-based cohort estimated from radiographic indices of chest wall shape. PLoS One, 2020, 15(5): e0232575.
17. Jaroszewski D, Notrica D, McMahon L, et al. Current management of pectus excavatum: a review and update of therapy and treatment recommendations. J Am Board Fam Med, 2010, 23(2): 230-239.
18. Sonaglioni A, Bruno A, Polymeropoulos A, et al. Prevalence of mitral valve prolapse among individuals with pectus excavatum: a systematic review and meta-analysis. Diagnostics (Basel), 2024, 14(22): 2488.
19. Rachwan RJ, Purpura AK, Kahwash BM. Sudden cardiac arrest in a young patient with severe pectus excavatum. Am J Med Sci, 2018, 356(6): 570-573.
20. Nuss D, Kelly RE, Jr., Croitoru DP, et al. A 10-year review of a minimally invasive technique for the correction of pectus excavatum. J Pediatr Surg, 1998, 33(4): 545-552.
21. 李星, 梁驍, 姜濤, 等. 漏斗胸手術治療的爭議點探討. 中國胸心血管外科臨床雜志, 2025, 32(10): 1376-1383.Li X, Liang X, Jiang T, et al. Discussion on controversial points of surgical treatment of pectus excavatum. Chin J Clin Thorac Cardiovasc Surg, 2025, 32(10): 1376-1383.
22. Hebra A, Kelly RE, Ferro MM, et al. Life-threatening complications and mortality of minimally invasive pectus surgery. J Pediatr Surg, 2018, 53(4): 728-732.
23. Garzi A, Prestipino M, Rubino MS, et al. Complications of the "Nuss Procedure" in pectus excavatum. Transl Med UniSa, 2020, 22: 24-27.
24. Castellani C, Schalamon J, Saxena AK, et al. Early complications of the Nuss procedure for pectus excavatum: a prospective study. Pediatr Surg Int, 2008, 24(6): 659-666.
25. Zhang Y, Chen Q, Luo Y, et al. Wire fracture in postoperative Nuss procedure: a problem that cannot be ignored. Transl Pediatr, 2021, 10(3): 569-578.
26. Kelly RE, Jr., Obermeyer RJ, Goretsky MJ, et al. Recent modifications of the Nuss procedure: the pursuit of safety during the minimally invasive repair of pectus excavatum. Ann Surg, 2022, 275(2): e496-e502.
27. Cuji?o-álvarez IF, Torres-Salazar D, Velásquez-Galvis M. Cardiorespiratory arrest during and after Nuss procedure: case report. J Cardiothorac Surg, 2023, 18(1): 166.
28. Kim DY, Jeong JY. Penetrating lung injury during Nuss procedure for pectus excavatum. J Cardiothorac Surg, 2020, 15(1): 184.
29. Uemura S, Nakagawa Y, Yoshida A, et al. Experience in 100 cases with the Nuss procedure using a technique for stabilization of the pectus bar. Pediatr Surg Int, 2003, 19(3): 186-189.
30. Park HJ, Kim KS, Lee S, et al. A next-generation pectus excavatum repair technique: new devices make a difference. Ann Thorac Surg, 2015, 99(2): 455-461.
31. Park HJ, Kim KS, Moon YK, et al. The bridge technique for pectus bar fixation: a method to make the bar un-rotatable. J Pediatr Surg, 2015, 50(8): 1320-1322.
32. Park HJ, Rim G, Yoon SK. Recent advancements in pectus surgery: crane lifting, multiple-bar approach, bridge stabilization, and sandwich technique. J Pediatr Surg, 2024, 59(4): 640-647.
33. Sun H, Huang Y, Han Y, et al. Perioperative outcomes of thoracoscopic versus non-thoracoscopic minimally invasive repair of pectus excavatum: a systematic review and meta-analysis. J Cardiothorac Surg, 2024, 19(1): 603.
34. Johnson WR, Fedor D, Singhal S. A novel approach to eliminate cardiac perforation in the Nuss procedure. Ann Thorac Surg, 2013, 95(3): 1109-1111.
35. Haecker FM, Sesia SB. Intraoperative use of the vacuum bell for elevating the sternum during the Nuss procedure. J Laparoendosc Adv Surg Tech A, 2012, 22(9): 934-936.
36. Ciopiński M, Marciniak M, Bogucki K, et al. Safety enhancement in Nuss procedure: sternal elevation and thoracoscopic dissection. Pol Przegl Chir, 2024, 97(2): 1-5.
37. Tedde ML, de Campos JR, Wihlm JM, et al. The Nuss procedure made safer: an effective and simple sternal elevation manoeuvre. Eur J Cardiothorac Surg, 2012, 42(5): 890-891.
38. Rygl M, Vyhnanek M, Kucera A, et al. Technical innovation in minimally invasive repair of pectus excavatum. Pediatr Surg Int, 2014, 30(1): 113-117.
39. St Peter SD, Sharp SW, Ostlie DJ, et al. Use of a subxiphoid incision for pectus bar placement in the repair of pectus excavatum. J Pediatr Surg, 2010, 45(6): 1361-1364.
40. Gould JL, Sharp RJ, Peter SD, et al. The minimally invasive repair of pectus excavatum using a subxiphoid incision. Eur J Pediatr Surg, 2017, 27(1): 2-6.
41. 曾忠義, 林浩楠, 孫海鵬, 等. Nuss手術聯合簡易胸骨提升法治療重度漏斗胸一例. 中國胸心血管外科臨床雜志, 2025. [Epub ahead of print].Zeng ZY, Lin HN, Sun HP, et al. Application of the simplified sternal elevation technique in the Nuss procedure for severe pectus excavatum: a case report. Chin J Clin Thorac Cardiovasc Surg, 2025. [Epub ahead of print].
42. Haecker FM, Sesia S. Vacuum bell therapy. Ann Cardiothorac Surg, 2016, 5(5): 440-449.
43. Haecker FM, Krebs T, Kocher GJ, et al. Sternal elevation techniques during the minimally invasive repair of pectus excavatum. Interact Cardiovasc Thorac Surg, 2019, 29(4): 497-502.
44. Obermeyer RJ, Goretsky MJ, Kelly RE, Jr., et al. Selective use of sternal elevation before substernal dissection in more than 2 000 Nuss repairs at a single institution. J Pediatr Surg, 2021, 56(4): 649-654.
45. Elsayed H. Crane technique with the vacuum bell device for improving access in the Nuss procedure. J Thorac Cardiovasc Surg, 2015, 150(5): 1372-1373.
46. Park HJ, Lee SY, Lee CS. Complications associated with the Nuss procedure: analysis of risk factors and suggested measures for prevention of complications. J Pediatr Surg, 2004, 39(3): 391-395.
47. Park HJ, Rim G. Development of a screw-crane system for pre-lifting the sternal depression in pectus excavatum repair: a test of mechanical properties for the feasibility of a new concept. J Chest Surg, 2021, 54(3): 186-190.
48. Kim D, Idowu O, Palmer B, et al. Anterior chest wall elevation using a T-fastener suture technique during a Nuss procedure. Ann Thorac Surg, 2014, 98(2): 734-736.
49. Takahashi T, Okazaki T, Yamataka A, et al. Usefulness of Kent retractor and lifting hook for Nuss procedure. Pediatr Surg Int, 2015, 31(11): 1103-1105.
50. Jaroszewski DE, Johnson K, McMahon L, et al. Sternal elevation before passing bars: a technique for improving visualization and facilitating minimally invasive pectus excavatum repair in adult patients. J Thorac Cardiovasc Surg, 2014, 147(3): 1093-1095.
51. Jaroszewski DE. Forced mechanical sternal elevation for Nuss repair. Ann Thorac Surg, 2013, 96(5): 1914.
52. Velazco CS, Arsanjani R, Jaroszewski DE. Nuss procedure in the adult population for correction of pectus excavatum. Semin Pediatr Surg, 2018, 27(3): 161-169.
53. Arredondo Montero J, Hernández-Martín S, Martín-Calvo N, et al. Development and clinical application of a new sternal zenithal traction system in video-assisted percutaneous thoracoplasty. Cir Esp (Engl Ed), 2023, 101(5): 319-324.
54. De Loos ER, Daemen JHT, Coorens NA, et al. Sternal elevation by the crane technique during pectus excavatum repair: a quantitative analysis. JTCVS Tech, 2021, 9: 167-175.
55. Janssen N, Coorens NA, Daemen JHT, et al. Sternal elevation in pectus excavatum repair: comparison of a unilateral versus bilateral frame crane system. Eur J Cardiothorac Surg, 2024, 66(5): ezae395.
56. 田東, 鄧志強, 林浩楠, 等. 經皮懸吊拉鉤輔助漏斗胸矯治術的臨床應用及技術優勢. 中國胸心血管外科臨床雜志, 2025. [Epub ahead of print].Tian D, Deng ZQ, Lin HN, et al. Clinical application and technical advantages of percutaneous suspension technique via sternal elevation device-assisted pectus excavatum correction. Chin J Clin Thorac Cardiovasc Surg, 2025. [Epub ahead of print].

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