Is Dairy Effluent an Alternative for Maize Crop Fertigation in Semiarid Regions? An Approach to Agronomic and Environmental Effects.

The reuse of effluents from intensive dairy farms combined with localized irrigation techniques (fertigation) has become a promising alternative to increase crop productivity while reducing the environmental impact of waste accumulation and industrial fertilizers production. Currently, the reuse of dairy effluents through fertigation by subsurface drip irrigation (SDI) systems is of vital importance for arid regions but it has been poorly studied. The present study aimed to assess the greenhouse gas (GHG) emissions, soil properties, and crop yield of a maize crop fertigated with either treated dairy effluent or dissolved granulated urea applied through an SDI system at a normalized N application rate of 200 kg N ha-1. Fertilizer application was divided into six fertigation events. GHG fluxes were measured during fertigation (62-day) using static chambers. Soil properties were measured previous to fertilizer applications and at the harvest coinciding with crop yield estimation. A slight increase in soil organic matter was observed in both treatments for the 20-60 cm soil depth. Both treatments also showed similar maize yields, but the dairy effluent increased net GHG emissions more than urea during the fertigation period. Nevertheless, the net GHG emissions from the dairy effluent were lower than the theoretical CO2eq emission that would have been emitted during urea manufacturing or the longer storage of the effluent if it had not been used, showing the need for life-cycle assessments. Local-specific emission factors for N2O were determined (0.07%), which were substantially lower than the default value (0.5%) of IPCC 2019. Thus, the subsurface drip irrigation systems can lead to low GHG emissions, although further studies are needed.

Complex tracheal resection in children: Myths, reality and lessons learned.

Tracheal resection is an uncommon procedure in children. It was described many years ago and many surgeons still rely on historical reports when performing the procedure, despite the technological and clinical advancements achieved during the last decades. We consider complex tracheal resections those resections of 30 to 50% of tracheal length, corresponding to at least 6-7 rings. With proper intra and post-operative management, this surgery is safe in children. In this review, we focused on the experience with this procedure of 3 reference centers, with 49 patients operated. We present a management algorithm for these patients, describing pre-operative evaluations, decision on surgical approach, need of tracheotomy, type of intra-operative oxygenation, surgical steps, and post-operative care.

Congenital airway anomalies.

Congenital airway anomalies (CAA) include a variety of conditions that cause respiratory distress in neonates and infants. These malformations occur at various anatomic levels and manifest in a wide spectrum of airway symptoms, with presentation significantly influenced by the level at which obstruction occurs as well as by the severity of obstruction. The prevalence of congenital airway malformations has been estimated to range between 0.2 and 1 in 10,000 live births. The most frequent CAA are laryngomalacia, bilateral vocal cord paralysis, subglottic stenosis, laryngeal webs, subglottic hemangioma, tracheomalacia, congenital tracheal stenosis, laryngotracheal cleft, and tracheal agenesis.

Management of the Disrupted Airway in Children.

OBJECTIVE: Our objective was to gather data that would enable us to suggest more specific guidelines for the management of children with airway disruption. STUDY DESIGN: Retrospective case series with data from five tertiary medical centers. METHODS: Children younger than 18 years of age with a disrupted airway were enrolled in this series. Data pertaining to age, sex, etiology and location of the disruption, type of injury, previous surgery, presence of air extravasation, management, and outcome were obtained and summarized. RESULTS: Twenty children with a mean age of 4.4 years (range 1 day-14.75 years) were included in the study. All were evaluated by flexible endoscopy and/or microlaryngoscopy in the operating room. Twelve (60%) children had tracheal involvement; seven had bronchial involvement; and one had involvement of the cricoid cartilage. Nine children had air extravasation, and all these children required surgical repair. Of the 11 who did not have air extravasation, only one underwent surgical repair. Complete healing of the disrupted airway was seen in all cases. CONCLUSION: This series suggests that if there is no continuous air extravasation demonstrated on imaging studies or clinical examination, nonoperative management may allow for spontaneous healing without sequelae. However, surgical repair may be considered in those patients with continuous air extravasation unless a cuffed tube can be placed distal to the site of injury. For children in whom airway injury occurs in a previously operated area, the risk of extravasation is reduced. This risk is also diminished if positive pressure ventilation can be avoided or minimized. LEVEL OF EVIDENCE: 4 Laryngoscope, 131:921-924, 2021.

Apendicitis aguda perforada con diagnóstico prequirúrgico y hernia inguinal bilateral en recién nacido de pretérmino / Acute perforated appendicitis with pre-surgical diagnosis and bilateral inguinal hernia in preterm infants

INTRODUCCIÓN: La apendicitis aguda neonatal es una patología de muy baja frecuencia, con escasos reportes en los últimos 30 años. La clínica e imágenes son inespecíficas, diagnosticándose la mayoría de las veces durante el procedimiento quirúrgico. OBJETIVO: Presentar un caso de apendicitis aguda perfora da en paciente prematura, con diagnóstico prequirúrgico y resolución laparoscópica, asociada a aparición posterior de hernia inguinal. CASO CLÍNICO: Recién nacido femenino de 34 semanas que a los 17 días de vida presentó fiebre, irritabilidad y aumento del residuo lácteo. Al examen físico destacaba distensión y sensibilidad del abdomen y tanto la radiografía como ecografía abdominales eran compatibles con apendicitis aguda perforada, por lo cual ingresó a pabellón para laparoscopía. Confirmado el diagnóstico, se realizó apendicectomía. Dos semanas después en consulta ambulatoria, se evidenció y confirmó con ecografía una hernia inguinal bilateral que se corrigió quirúrgicamente. CONCLUSIÓN: La apendicitis aguda debe considerarse dentro de los diagnósticos diferenciales en neonatos con clínica de abdomen agudo, principalmente en prematuros. En este caso, la ecografía permitió realizar el diagnóstico pre-operatorio. La posible asociación con hernia inguinal, debiera motivar a examinar siempre conductos inguinales durante la evaluación con imá genes y en el procedimiento quirúrgico.

INTRODUCTION: Acute neonatal appendicitis is a rare pathology, with few reports in the last 30 years. Since its clinical presentation and imaging studies are non-specific, most cases are diagnosed during a surgical pro cedure. OBJECTIVE: To describe a neonatal case of acute perforated appendicitis associated with later appearance of inguinal hernia, with pre-surgical diagnosis and treated through laparoscopy. CLINICAL CASE: A 17-day-old preterm female newborn presented with fever, irritability, and increased milk intolerance. Physical examination showed abdominal distention, tenderness and both, abdominal X- ray and ultrasound showed compatible images with acute perforated appendicitis. Once the diagnosis was confirmed, we performed an appendicectomy through laparoscopy. Two weeks later, during an outpatient visit, we observed a bilateral inguinal hernia which was confirmed by ultrasound, and then it was surgically corrected. CONCLUSION: Acute appendicitis should be considered within the differential diagnosis in neonates with acute abdominal symptoms, mainly in premature infants. In this case, ultrasound scan allowed us to make the pre-operative diagnosis. The possible association with inguinal hernias should motivate to examine inguinal ducts during imaging assessment and surgical procedure.

[Acute perforated appendicitis with pre-surgical diagnosis and bilateral inguinal hernia in preterm infants]. / Apendicitis aguda perforada con diagnóstico prequirúrgico y hernia inguinal bilateral en recién nacido de pretérmino.

INTRODUCTION: Acute neonatal appendicitis is a rare pathology, with few reports in the last 30 years. Since its clinical presentation and imaging studies are non-specific, most cases are diagnosed during a surgical pro cedure. OBJECTIVE: To describe a neonatal case of acute perforated appendicitis associated with later appearance of inguinal hernia, with pre-surgical diagnosis and treated through laparoscopy. CLINICAL CASE: A 17-day-old preterm female newborn presented with fever, irritability, and increased milk intolerance. Physical examination showed abdominal distention, tenderness and both, abdominal X- ray and ultrasound showed compatible images with acute perforated appendicitis. Once the diagnosis was confirmed, we performed an appendicectomy through laparoscopy. Two weeks later, during an outpatient visit, we observed a bilateral inguinal hernia which was confirmed by ultrasound, and then it was surgically corrected. CONCLUSION: Acute appendicitis should be considered within the differential diagnosis in neonates with acute abdominal symptoms, mainly in premature infants. In this case, ultrasound scan allowed us to make the pre-operative diagnosis. The possible association with inguinal hernias should motivate to examine inguinal ducts during imaging assessment and surgical procedure.

Pediatric airway tumors: A report from the International Network of Pediatric Airway Teams (INPAT).

OBJECTIVE: Primary tracheobronchial tumors (PTTs) are rare heterogeneous lesions arising from any part of the tracheobronchial tree. Nonspecific symptoms may lead to delayed diagnosis that requires more aggressive surgical treatment. An analysis of cases collected by the International Network of Pediatric Airway Team was undertaken to ensure proper insight into the behavior and management of PTTs. METHODS: Patients <18 years of age with a histological confirmation of PTT diagnosed from 2000 to 2015 were included in this multicenter international retrospective study. Medical records, treatment modalities, and outcomes were analyzed. The patient presentation, tumor management, and clinical course were compared between malignant and benign histotypes. Clinical and surgical variables that might influence event-free survival were considered. RESULTS: Among the 78 children identified, PTTs were more likely to be malignant than benign; bronchial carcinoid tumor (n = 31; 40%) was the most common histological subtype, followed by inflammatory myofibroblastic tumor (n = 19; 25%) and mucoepidermoid carcinoma (n = 15; 19%). Regarding symptoms at presentation, wheezing (P = 0.001) and dyspnea (P = 0.03) were more often associated with benign growth, whereas hemoptysis was more frequently associated with malignancy (P = 0.042). Factors that significantly worsened event-free survival were age at diagnosis earlier than 112 months (P = 0.0035) and duration of symptoms lasting more than 2 months (P = 0.0029). CONCLUSION: The results of this international study provide important information regarding the clinical presentation, diagnostic workup, and treatment of PTTs in children, casting new light on the biological behavior of PTTs to ensure appropriate treatments. LEVEL OF EVIDENCE: NA Laryngoscope, 130:E243-E251, 2020.

Outcome measures for pediatric laryngotracheal reconstruction: International consensus statement.

OBJECTIVES: Develop multidisciplinary and international consensus on patient, disease, procedural, and perioperative factors, as well as key outcome measures and complications, to be reported for pediatric airway reconstruction studies. METHODS: Standard Delphi methods were applied. Participants proposed items in three categories: 1) patient/disease characteristics, 2) procedural/intraoperative/perioperative factors, and 3) outcome measures and complications. Both general and anatomic site-specific measures were elicited. Participants also suggested specific operations to be encompassed by this project. We then used iterative ranking and review to develop consensus lists via a priori Delphi consensus criteria. RESULTS: Thirty-three pediatric airway experts from eight countries in North and South America, Europe, and Australia participated, representing otolaryngology (including International Pediatric Otolaryngology Group members), pulmonology, general surgery, and cardiothoracic surgery. Consensus led to inclusion of 19 operations comprising open expansion, resection, and slide procedures of the larynx, trachea, and bronchi as well as three endoscopic procedures. Consensus was achieved on multiple patient/comorbidity (10), disease/stenosis (7), perioperative-/intraoperative-/procedure-related (16) factors. Consensus was reached on multiple outcome and complication measures, both general and site-specific (8 general, 13 supraglottic, 15 glottic, 17 subglottic, 8 cervical tracheal, 12 thoracic tracheal). The group was able to clarify how each outcome should be measured, with specific instruments defined where applicable. CONCLUSION: This consensus statement provides a framework to communicate results consistently and reproducibly, facilitating meta-analyses, quality improvement, transfer of information, and surgeon self-assessment. It also clarifies expert opinion on which patient, disease, procedural, and outcome measures may be important to consider in any pediatric airway reconstruction patient. LEVEL OF EVIDENCE: 5 Laryngoscope, 129:244-255, 2019.

Congenital tracheal malformations.

Congenital malformations of the trachea include a variety of conditions that cause respiratory distress in neonates and infants. A number of anomalies are self-limiting while others are life-threatening and require immediate therapy. The prevalence of congenital airway malformations has been estimated to range between 0.2 and 1 in 10,000 live births. The most frequent congenital tracheal malformations are: tracheomalacia, congenital tracheal stenosis, laryngotracheal cleft and tracheal agenesis. The management of congenital tracheal malformations is complex and requires an individualized approach delivered by a multidiscipilinary team within centralized units with the necessary expertise.

Primary tracheobronchial tumors in children.

Primary tracheobronchial tumors are rare lesions that can be benign or malignant, with different location along the airway tree. Symptoms may include wheezing, chronic pneumonia, asthma, chest pain, recurrent cough, atelectasis, haemoptysis, and weight loss. Due to the heterogeneity of symptoms, diagnosis can be difficult and the airway involvement can lead progressively to a bronchial or tracheal obstruction. Due to the rarity of primary tracheobronchial tumors in children, there are not any oncological guidelines on pre-operative work-up, treatment, and follow-up. Only few reports and multicentric studies are reported. In most cases, surgical resection seems to be the treatment of choice. Brachytherapy, endoscopic treatment, and chemotherapy are rarely described. In this article we present an overview on these rare tumors, including pathological aspects, clinical presentation, imaging assessment, and endoscopic or open surgical treatments. We discuss different surgical approaches, according with tumor location.

Tracheal and bronchial tumors.

Although primary tracheobronchial tumors are extremely rare in children, recurrent respiratory symptoms resistant to conventional therapy require further investigations to exclude possible malignant obstructive causes. As the matter of fact, early diagnosis may allow minimally invasive surgeries, improving the standard of living and the globally survival rate. The aim of this article is to provide an overview of diagnosis and management of tracheobronchial tumors in the early age, since only few reports are reported in the worldwide literature.

Chemocauterization with trichloroacetic acid in congenital and recurrent tracheoesophageal fistula: a minimally invasive treatment.

OBJECTIVE: Recurrent tracheoesophageal fistula (RTEF) is a serious complication after primary repair of esophageal atresia and tracheoesophageal fistula (EA/TEF). Treatment of RTEF involved an open surgery by thoracotomy. Technically it is a challenge with a high morbidity and mortality. Congenital tracheoesophageal fistula (CTEF) traditionally involved an open surgery by thoracotomy or cervicotomy. Many endoscopic techniques have been developed since the past decades: thoracoscopic or bronchoscopic approach for the treatment of RTEF and CTEF; nevertheless, optimal treatment is not still determined because of few numbers of patients, short-term follow-up, and different procedures. We report our experience and evaluated the efficacy in the chemocauterization of CTEF and RTEF, with the use of 50% trichloroacetic acid (TCA) as a technique minimally invasive. MATERIALS AND METHODS: From 2010 to 2014, fourteen patients with TEF (twelve RTEF and two CTEF) were selected for endoscopic management in two centers. Twelve patients had RTEF after primary repair of EA/TEF by thoracotomy approach, and two patients had CTEF in the upper pouch, diagnosed after EA/TEF (Type B) long gap, treated by thoracotomy and thoracoscopy, respectively. In all cases the diagnosis was confirmed by esophagram, bronchoscopy, and clinical evaluation. Under general anesthesia, a rigid pediatric bronchoscope with a 0° rod lens telescope and tele-monitoring was used to localize the TEF. Cotton soaked with 50% TCA was applied on the TEF during 30 s, and the procedure was repeated 3 times. The endoscopic treatment was performed monthly until TEF closure was achieved. RESULTS: RTEF and CTEF were closed in all patients. The mean number of procedure in each patient was 1.8. Closure of TEF was confirmed by esophagram, bronchoscopy, and clinical evaluation. There were a bacterial pneumonia and bronchospasm as postoperative complications. Median follow-up was 41 months (8-72). All of these TEF remain completely obliterated, and all patients are asymptomatic. CONCLUSION: Endoscopic management of congenital and recurrent TEF with the use of 50% TCA is as a minimally invasive, effective, simple and safe technique in these patients and avoids the morbidity of open surgery.

Agenesia Traqueal. Anomalía congénita rara con alta mortalidad / Tracheal Agenesis. a Rare Congenital Anomaly with High-Mortality

Introducción: La agenesia traqueal es una malformación congénita muy rara, incompatible con la vida, el defecto consiste en una ausencia parcial o total de la tráquea debajo de la laringe permitiendo que el tracto respiratorio inferior se conecte con el tracto gastrointestinal por medio de una fístula traqueó-esofágica distal. Caso Clínico: Se presenta el caso clínico de un recién nacido, con antecedente materno de polihidramnios, nace con dificultad respiratoria, ausencia de llanto y dificultad para la intubación orotraqueal, Apgar 4/8, pasa a Unidad de Cuidados Intensivo neonatales (UCIN) y es conectado a Asistencia Respiratoria Mecánica (ARM) a las 6hs de vida se extuba en forma accidental, con imposibilidad para la reintubación, se realizan Tomografía de cuello y tórax donde se constata agenesia traqueal con fistula traqueoesofágica distal, sin otras malformaciones congénitas asociadas, se realizan varias cirugías paliativas. A pesar de todos los esfuerzos médicos, el paciente fallece a los 6 días de vida, ante colapso de vías aéreas. Discusión: Se presenta este caso por ser la agenesia traqueal una malformación extremadamente rara, y con muy pocos casos descriptos en la literatura. Es el primer caso en nuestro hospital, se presenta como un caso clínico complejo, de manejo multidisciplinario, sometido a varias cirugías paliativas, el paciente fallece, la evolución es generalmente fatal y de mal pronóstico debido a que aún no se han desarrollado técnicas adecuadas de reemplazo traqueal .

Introduction: Tracheal a genesis is a very rare congenital malformation that is incompatible with life.The anomaly consists of the partial or total absence of the trache a below the larynx that allows connection of the lower respiratory...

Vía aérea en pediatría: cirugía de laringe y tráquea / Pediatric airway: larynx and tracheal surgery

Major congenital malformations affecting the larynx and trachea are laryngomalacia, vocal cord paralysis, subglottic hemangioma, congenital laryngeal web, laryngotracheal cleft, congenital tracheal stenoses, tracheal and bronchomalacia. The most frequent acquired diseases are stenotic lesions, mainly subglottic stenosis. In this chapter the main anomalies affecting the airway of children and adolescents are described, emphasizing the importance of early and accurate diagnosis as well as defining the modern treatment options.

Las principales malformaciones congénitas que afectan la laringe y tráquea son la laringomalacia, parálisis de cuerdas vocales, hemangioma subglótico, web laríngeo, hendidura laringotraqueal, estenosis traqueal congénita, traqueo y broncomalacia. Las lesiones adquiridas que con mayor frecuencia debemos diagnosticar y tratar son las lesiones post intubación, principalmente la estenosis subglótica. En este capítulo se describen estas afecciones de la vía aérea del niño, haciendo énfasis en la importancia de un diagnóstico precoz y preciso además de definir las alternativas modernas de tratamiento.

Dismorfología de las deformidades de la pared torácica: distribución de frecuencias de los subtipos de pectus excavatum típico y subtipos poco comunes / Dysmorphology of Chest Wall Deformities: Frequency Distribution of Subtypes of Typical Pectus Excavatum and Rare Subtypes

Antecedentes/Objetivo: Más del 40% de los pacientes con pectus excavatum tienen antecedentes familiares de una deformidad torácica. Sin embargo, no se han publicado estudios de la frecuencia de los diferentes fenotipos de pectus excavatum. Métodos: Se estudió una muestra aleatoria de 300 pacientes con pectus excavatum no sindrómico de la clínica de deformidades de la pared torácica del Children's Hospital of the King's Daughters de Norfolk (Virginia, Estados Unidos) y se clasificó a los pacientes según un sistema descrito con anterioridad. Se utilizaron para ello fotografías e imágenes de tomografía computarizada (TC). Resultados: Pectus excavatum típico. Datos fotográficos: se observó una deformidad con depresión profunda localizada (forma de taza) en el 67% de los casos, difusa (en forma de platillo) en el 21%, de tipo trinchera (en forma de surco) en el 10%, y de tipo Currarino-Silverman (deformidad mixta de pectus excavatum/pectus carinatum condromanubrial) en el 1%. El punto más profundo se encontraba a la derecha de la línea media en el 80% de los casos, a la izquierda en el 10% y en el centro en el 10%. En las fotografías, el punto más profundo se encontraba en la parte inferior del esternón en el 75% de los casos. Cuando había asimetría, el punto más profundo de la deformidad estaba a la derecha de la línea media en el 90% de los casos. Datos de TC: la media del índice de Haller fue de 4,9. La torsión esternal intensa (>30 grados) se asoció a un índice de Haller más alto (6,3) que el observado en la torsión leve (4,5). El punto más profundo de la depresión se encontraba en la parte media o baja del esternón en más del 99% de los casos. Resultó imposible estimar la anchura o la longitud de la depresión, ya que los límites estaban mal definidos (AU)

Conclusiones: El pectus excavatum típico tiene forma de copa en el 67% de los casos, se encuentra a la derecha de la línea media en el 80% y afecta a la parte media o baja del esternón en el 99%. Sin embargo, otros fenotipos, como el de forma de platillo y el de trinchera larga, constituyeron una tercera parte del total. La definición de la deformidad es más fiable mediante la TC (AU)

Background/Purpose: More than forty percent of patients with pectus excavatum have a family history of chest deformity. However, no studies of the frequency of the different phenotypes of pectus excavatum have been published. Methods: A random sample of 300 non-syndromic pectus excavatum patients, from the chest wall deformities clinic at Children's Hospital of The King's Daughters in Norfolk, VA, was studied and classified according to a previously described classification system. Photographs and computed tomography (CT) scans were utilized. Results: Typical pectus excavatum. Photo data: localized deep depression (cup-shaped) deformity occurred in 67%; diffuse (saucer-shaped) 21%, trench-like (furrow-shaped) 10%, and Currarino-Silverman (mixed pectus excavatum/chondromanubrial carinatum) 1%. The deepest point was to the right of midline in 80%, left in 10% and central in 10%. As per the photograph, the deepest point was in the lower sternum in 75%. When asymmetric, the deepest point of the deformity was to the right of midline in 90%. CT data: the average Haller index was 4.9. Severe sternal torsion (>30°) was associated with greater Haller index (6.3) than mild torsion (4.5). The deepest point of the depression was at the mid- or lower sternum in more than 99%. It proved impossible to estimate width or length of the depression because of poorly defined borders. Conclusions: Typical PE is cup-shaped in 67% of cases, to the right of the midline in 80%, and involving the mid-to-lower sternum in 99%. However, other phenotypes, like the saucer and long trench, comprised one-third. Definition of the deformity is more reliable by CT scan (AU)

Dysmorphology of chest wall deformities: frequency distribution of subtypes of typical pectus excavatum and rare subtypes.

BACKGROUND/PURPOSE: More than forty percent of patients with pectus excavatum have a family history of chest deformity. However, no studies of the frequency of the different phenotypes of pectus excavatum have been published. METHODS: A random sample of 300 non-syndromic pectus excavatum patients, from the chest wall deformities clinic at Children's Hospital of The King's Daughters in Norfolk, Va., was studied and classified according to a previously described classification system. Photographs and computed tomography (CT) scans were utilized. RESULTS: Typical pectus excavatum. Photo data: localized deep depression (cup-shaped) deformity occurred in 67%; diffuse (saucer-shaped) 21%, trench-like (furrow-shaped) 10%, and Currarino-Silverman (mixed pectus excavatum/chondromanubrial carinatum) 1%. The deepest point was to the right of midline in 80%, left in 10% and central in 10%. By photo, the deepest point was in the lower sternum in 75%. When asymmetric, the deepest point of the deformity was to the right of midline in 90%. CT data: the average Haller index was 4.9. Severe sternal torsion (>30 degrees) was associated with greater Haller index (6.3) than mild torsion (4.5). The deepest point of the depression was at the mid- or lower sternum in more than 99%. It proved impossible to estimate width or length of the depression because of poorly defined borders. CONCLUSIONS: Typical PE is cup-shaped in 67% of cases, to the right of the midline in 80%, and involving the mid-to-lower sternum in 99%. However, other phenotypes, like the saucer and long trench, comprised one-third. Definition of the deformity is more reliable by CT scan.

Thoracoscopic cartilage resection with partial perichondrium preservation in unilateral pectus carinatum: preliminary results.

BACKGROUND/PURPOSE: Although minimally invasive repair of pectus excavatum has gained worldwide acceptance, treatment of pectus carinatum is mostly performed with open procedures. Different minimally invasive alternatives have been proposed in the last few years, including subpectoral CO(2) dissection and intrathoracic compression (Abramson technique), or conservative procedures, as dynamic compression system. Recently, another surgical technique has been proposed for the treatment of unilateral pectus carinatum, consisting of a thoracoscopic approach and multiple cartilage incisions. The aim of this work is to present our modification to this approach. METHODS: We have modified this technique by introducing complete cartilage resection of all anomalous costal cartilages, performed thoracoscopically. Three thoracoscopic ports were used. Cartilage is removed progressively using a rongeur and preserving the anterior perichondrium. RESULTS: We have performed this technique in 4 patients during the last year. Follow-up ranged from 6 to 14 months. No intraoperative or postoperative complications were observed. The results, assessed by the patients themselves, were good in 2 cases, quite good in one, and fair in the first patient of our series, who was reoperated using a classical open approach. Pain was well controlled without the need of an epidural catheter. CONCLUSION: Thoracoscopic cartilage resection with perichondrium preservation can be considered as feasible alternative for the treatment of unilateral pectus carinatum.