TUSILS-SRA: A Modified Way of Costal Cartilage Harvest for Rhinoplasty

Jiang M, Sun X, Cheng L, Huo H, Mao X, Zhang L.

PubMed 40790386 Publisher (DOI)Free full text (PMC)

What this paper says

Harvesting rib cartilage through a single hidden umbilical incision using a laparoscope passed within the rectus sheath caused less pain and higher satisfaction than open harvest in 20 versus 20 patients, at the cost of about 6.5 extra minutes.

Overview

Open rib-cartilage harvest leaves a visible chest scar and a longer recovery. The authors had previously described a trans-umbilical single-incision laparoscopic harvest (TUSILS); this version routes the scope through the rectus abdominis sheath so the abdominal cavity is not entered (TUSILS-SRA). They compared 20 TUSILS-SRA patients with 20 open-harvest controls from 2020 to 2023 on pain, satisfaction, operative time and complications.

Sections of note

Pain (VAS) on days 1, 2, 3 and 7 was significantly lower with TUSILS-SRA (P < 0.05).
Harvest time was longer: 33.5 (SD 4.9) minutes versus 27.0 (SD 4.7) minutes (P < 0.05).
Satisfaction was higher in the TUSILS-SRA group (P < 0.05).
Complications were rare over 6 months of follow-up.
Level of Evidence III.

What it means for a patient

A rib harvest can leave a scar hidden in the navel instead of on the chest.
In this small comparison, patients had less pain in the first week.
The technique requires laparoscopic equipment and skill; it is offered at few centres.

Why this paper matters

It is a refinement of a minimally invasive harvest route that avoids entering the abdomen. Limits: 40 patients, retrospective, single centre, 6-month follow-up, no cartilage-quality outcome reported.

Terms

Costal cartilage: rib cartilage.
Laparoscopic: performed with a thin camera and instruments through small incisions.
Rectus sheath: the fibrous envelope around the rectus abdominis (six-pack) muscle.
VAS: visual analogue scale for pain, 0-10.

Summary written by rhinoplasty.cc from the abstract, 2026-09-08; not medical advice. The authors' own abstract follows.

Abstract

Background: Autogenous rib cartilage is a common material for rhinoplasty, especially for nose extension and revision. At present, open surgery is the most mature method for rib extraction. However, it has many disadvantages, such as long recovery and visible incision. Our previous study reported a TUSILS method, leaving invisible incisions in the umbilical folds. Recently, we made a further optimization to avoid abdominal cavity intrusion: the trans-umbilical single-incision laparoscopic surgery through the sheath of rectus abdominis for costal cartilage harvest (TUSILS-SRA).

Objectives: This study aims to test the efficacy and safety of TUSILS-SRA.

Methods: We reviewed 40 patients who underwent costal cartilage harvest in our department from 2020 to 2023, with 20 in the TUSILS-SRA group and 20 in the open harvest group as control. The pain scores [visual analog scale (VAS)] 1/2/3/7 day after surgery, satisfaction assessments, operation time, and complications were compared as measurements.

Results: By repeated measures ANOVA, the VAS values in 1/2/3/7 days after surgeries were significantly (P < 0.05) lower in the TUSILS-SRA group. Surgical time is a little longer (P < 0.05) in the TUSILS-SRA group (33.5 ± 4.9 min), compared with the traditional group (27.0 ± 4.7 min). TUSILS-SRA did a better job in satisfaction assessment (P < 0.05). Complications were rare during our 6-month follow-up.

Conclusions: Overall, TUSILS-SRA is a safe, effective, and promising surgical method of costal cartilage harvest for rhinoplasty.

Level Of Evidence Iii: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Abstract as indexed by PubMed; the article is open access (PubMed Central).