Background/Purpose: The minimally invasive Nuss procedure is emerging as the p referred technique for repair of pectus excavatum. Original methods of pectus ba r placement have been modified to improve safety and efficacy and avoid cardioth oracic complications. The currently reported modifications to facilitate retrost ernal pectus bar placement include routine use of right thoracoscopy or a subxip hoid incision. The purpose of this article is to describe additional modificatio ns of the Nuss procedure to improve safety and efficacy. Methods: A retrospectiv e analysis was performed on 51 patients who have had a thoracoscopic-assisted N uss procedure at The Children’s Hospital, Denver, Colo, between 1999 and 2002. Technical modifications included patient positioning, routine use of left thorac oscopy, and an Endo-kittner. Results: Fifty-one patients have successfully und ergone the Nuss procedure using the new modifications. Surgical time ranged from 45 to 120 minutes. There have been no intraoperative or postoperative bleeding complications. There have been 2 large pneumothoraces requiring needle thoracent eses in the operating room before extubati’on. No chest tubes were required pos toperatively. Subjectively, all patients have been satisfied with their surgical correction. Average length of hospital stay was 4 to 6 days. Conclusions: By us ing left chest thoracoscopy and Endo-kittner dissectors, the risk of cardiothor acic injury can be eliminated. Moreover, other methods to ensure safe substernal dissection are unnecessary. Background / Purpose: The minimally invasive Nuss procedure is emerging as the p referred technique for repair of pectus excavatum. Original methods of pectus ba r placement have been modified to improve safety and efficacy and avoid cardioth oracic complications. The current reported modifications to facilitate retrost ernal pectus bar placement include routine use of right thoracoscopy or a subxip hoid incision. The purpose of this article is to describe additional modificatio ns of the Nuss procedure to improve safety and efficacy. Methods: A retrospectiv e analysis was performed on 51 patients who have had a thoracoscopic-assisted Nuss procedure at The Children’s Hospital, Denver, Colo, between 1999 and 2002. Technical modifications included patient positioning, routine use of left thorac oscopy, and an Endo-kittner. Results: Fifty-one patients have successfully und ergone the Nuss procedure using the new modifications. Surgical time ranged from 45 to 120 minutes. There have been There are been 2 large pneumothoraces requiring needle thoracent eses in the operating room before extubati’on. No chest tubes were required pos toperatively. Subjectively, all patients have been satisfied with their surgical correction. Average length of hospital stay was 4 to 6 days. Conclusions: By us ing left chest thoracoscopy and Endo-kittner dissectors, the risk of cardiothor acic injury can be eliminated. Moreover, other methods to ensure safe substernal dissection are unnecessary.