Dr. Francis Robicsek, based at Carolinas HealthCare System in Charlotte, NC developed the Robicsek procedure in 1965. Each time the procedure is performed, it is individually tailored based on the extent and location of the deformity in the patient. The operation begins with an incision, no more than 4-6 centimeters, to the sternum. The pectoralis major muscles are then detached from the sternum. Using the upper limit of the sternal depression as a guide, the deformed cartilages are removed one-by-one, using sharp and blunt dissection. The lower tip of the sternum is then grabbed with a towel-clip and, using blunt dissection, is freed of tissue connections with the pericardium and the pleura. The sternum is then forcefully bent forward into a corrected position.
To keep the sternum elevated, a piece of mesh is placed under the mobilized sternum and sutured under moderate tension bilaterally to the stumps of the ribs. After appropriate hemostasis, the pectoralis muscles are united in front of the sternum and the wound is closed without additional drainage. Any pressure-dressing should be avoided.