Surgical adjuncts in minimally invasive repair of pectus excavatum and carinatum deformities: techniques for internal visualization, sternal elevation, and depression.

Over the past two decades, the repair of pectus excavatum (PE) and pectus carinatum (PC) has evolved significantly, driven by innovations in surgical adjuncts and device development. Originally limited by high risks due to blind mediastinal dissection and force-based correction, pectus repair techniques now prioritize safety, precision, and minimal invasiveness. This paper introduces a series of adjunctive techniques and custom-designed tools that address major limitations in PE and PC surgery. The pectoscope, with its curved shaft and touch-view functionality, allows safe internal visualization during substernal dissection and simplifies guide placement without the need for separate introducers. The Easy Crane system enables controlled, pre-elevation of the sternum in PE patients, facilitating safe passage of the bar and ensuring accurate correction without relying on the bar's force. Since 2019, a crane-powered strategy has been applied in all patients, minimizing complications and enhancing outcomes. For PC and complex deformities such as pectus concavo-convexus, the Easy Compressor system provides targeted, stable compression through a minimally invasive Sandwich Technique. A complementary Hook Puller device allows precise approximation of external bars to bridge plates during PC repair. These adjuncts have been used in thousands of cases, demonstrating high safety and efficacy across pediatric and adult patients. In addition, bar removal is performed with concurrent sternal elevation to prevent bleeding complications and procedural trauma. Adjunct-powered correction has redefined chest wall deformity repair by turning the anatomy-respecting approach into a new standard of precision, reliability, safety, and superior outcomes.