The vacuum bell is a medical device used in the treatment of pectus excavatum, one of the most common chest wall defects.[1] The bell is mainly used to treat the cosmetic problems associated with the condition, as symptomatic cases of pectus excavatum are usually more severe, and may require surgery. It was invented by a German engineer named Eckart Klobe, and is sold in the European Union by Eckart Klobe himself and in the U.S. by Costa and ribcompressor.com.
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A 2006 study of 34 patients (31 male and 3 female), aged between 6–52 years, who used the bell for 1–18 months showed immediate improvements. The patients were followed up with clinical examination, photography and CT scans. After 3 months, 27 of the patients displayed an elevation of the sternum of more than 1.5 cm, and after 12 months the sternum was lifted to a normal level within 5 of the patients. Studies showing long term improvements are currently lacking.[2]
The vacuum bell may allow some patients with PE to avoid surgery. Especially patients with symmetric and mild PE may benefit from this procedure. The application is easy, with a good acceptance by both pediatric and adult patients. Computed tomographic scans showed that the device lifted the sternum and ribs immediately. In addition, this was confirmed thoracoscopically during the minimally invasive repair of pectus excavatum (MIRPE) procedure. After 18 months in average, the sternum was lifted to a normal level in 9 patients. Relevant side effects were not noted.
However, the time of follow-up was only 5 years, and further follow-up studies are necessary to evaluate the effectiveness of this therapeutic tool. Additionally, the intraoperative use of the vacuum bell during the MIRPE may facilitate the introduction of the pectus bar. In any case, the method seems to be a valuable adjunct therapy in the treatment.
The vacuum bell has proved to be an alternative therapeutic option in selected patients with PE. The initial results proved to be dramatic, but long term results are so far lacking, and further evaluation and follow-up studies are necessary.[3]
The rubber bell is placed onto the chest wall so that a seal is created, and a hand pump connected to the bell by an air tube is used to reduce pressure inside the bell to up to 15% below atmospheric pressure. The drop in pressure results in the sternum being lifted upwards and a temporary resolution of the deformity.[4]
Use of the bell is not advised if any of the following conditions are present in a patient:
Possible side effects from using the device include: