Objective To investigate the efficacy and safety of an ultra-minimally invasive incision technique in the Nuss procedure for the correction of pectus excavatum. Methods We retrospectively analyzed the clinical data of patients with pectus excavatum who underwent the Nuss procedure at Tangdu Hospital, Air Force Medical University, from September 2019 to September 2024. Patients were divided into two cohorts: an ultra-minimally invasive incision group and a conventional incision group. Baseline characteristics, efficacy outcomes (e.g., postoperative Haller index), and safety outcomes (e.g., operative time, intraoperative blood loss, postoperative length of stay, and complications) were collected and compared between the two groups. Results A total of 125 patients were included. The ultra-minimally invasive incision group consisted of 49 patients (43 male, 6 female) with a median age of 14 (12.5, 16) years, while the conventional incision group included 76 patients (64 male, 12 female) with a median age of 14 (12, 16) years. Compared to the conventional group, the ultra-minimally invasive incision group had significantly less intraoperative blood loss [10 (5, 20) mL vs. 20 (10, 30) mL, P=0.012], a shorter postoperative length of stay [4 (3, 4) d vs. 4 (3, 5) d, P=0.014], a lower incidence of postoperative incision complications [2.04% (1/49) vs. 14.47% (11/76), P=0.027], and a lower visual analogue scale (VAS) score on postoperative day 1 [(3.68±0.62) points vs. (5.37±0.89) points, P<0.001]. There were no statistically significant differences between the two groups in operative time, postoperative Haller index, or the incidence of other complications such as pleural effusion and pneumothorax (all P>0.05). Conclusion The ultra-minimally invasive incision technique can significantly reduce the incidence of incision-related complications and alleviate early postoperative pain in patients undergoing the Nuss procedure. It is a safe and feasible surgical approach for the correction of pectus excavatum.
