The Vacuum Bell

A suction cup is used to create a vacuum at the chest wall. A vacuum up to 15% below atmospheric pressure is created by the patient using a hand pump (Fig. 1 ). Three different sizes (16 cm, 19 cm and 26 cm in diameter) exist allowing selection according to the individual patients age. The development of a specific fitted model suitable for women is in progress. Pilot studies performed by Bahr and Schier in Jena, Germany (http://www.trichterbrust.de) showed that the device lifted the sternum and ribs immediately (Fig. 2 ). In addition, this was confirmed thoracoscopically during the MIRPE procedure. According to the user instructions and our experience, the vacuum bell should be used for a minimum of 30 min, twice per day, and may be used up to a maximum of several hours daily.

Complications and relevant side effects include subcutaneous haematoma, petechial bleeding, dorsalgia and transient paresthesia of the upper extremities during the application as well as rib fractures in rare cases. Contraindications of the method comprise skeletal disorders such as osteogenesis imperfecta and Glisson's disease, vasculopathies (e.g. Marfan's syndrome, abdominal aneurysm), coagulopathies and cardiac disorders. To exclude these disorders, a standardised evaluation protocol was routinely performed before beginning the therapy.

Pectus Excavatum

Pectus excavatum (PE) is the most common chest wall malformation and one of the most frequent major congenital anomalies. The surgical repair of PE in childhood is a well-established procedure. Previously used operative techniques to correct PE were largely based on the Ravitch technique. Today, the minimally invasive repair (MIRPE) by Nuss is well established. Conservative treatment with the vacuum bell to elevate the funnel in patients with PE represents a potential alternative. Methods: A suction cup is used to create a vacuum at the anterior chest wall. A patient-activated hand pump is used to reduce the pressure up to 15% below atmospheric pressure. Three different sizes of vacuum bell exist which are selected according to the individual patients age. When creating the vacuum, the lift of the sternum is obvious and remains for a different time period. The device should be used for a minimum of 30 min (2 per day), and may be used up to a maximum of several hours daily. Presently, a 12–15-month course of treatment is recommended. In addition, the device was used intraoperatively during the MIRPE procedure to enlarge the retrosternal space to ensure safer passage of the introducer in a few patients. Results: Thirty-four patients (31 males, 3 females), aged 6–52 years (median 17.8 years) used the vacuum bell for 1 to maximum 18 months (median 10.4 months). Follow-up included photography and clinical examination every 3 months. Computed tomographic scans showed that the device lifted the sternum and ribs immediately. In addition, this was confirmed thoracoscopically during the MIRPE procedure. After 3 months, an elevation of more than 1.5 cm was documented in 27 patients (79%). After 12 months, the sternum was lifted to a normal level in five patients (14.7%). Relevant side effects were not noted. Conclusions: 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. In addition, the method may assist the surgeon during the MIRPE procedure.
For more information on the Pectus Excavatum deformity, please visit www.whatispectusexcavatum.com.

Method of Usage

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.

Definition of Vacuum Bell Therapy

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.

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.

About Vacuum Bell Therapy

This is an experimental approach which offers a non-surgical solution to pectus excavatum. It works by pulling the depressed chest forwards and, by holding this position and with treatment over a few years, to re-shape the chest. A suction cap is placed over the depressed area and a vacuum is created between it and the underlying chest wall. A patient-activated hand pump is used to reduce the pressure up to 15% below atmospheric pressure. It is suggested that the device be used for a minimum of 30 minutes, at least twice a day. It may be used for a maximum of several hours each day. Excessive negative pressure or more prolonged application can cause bruising and swelling with damage to the chest wall.

Presently, the daily treatments are recommended for 12 – 15 months. Some successes have been reported in young children. However, at present its place in the management of older people and the durability of any improvement reported is not known

The Differences Between Costa and Klobe Vacuum Bells

The Costa vacuum bell is black, whilst the Klobe vacuum bell is white, and both the vacuum bells have a slightly different positions for the suction pipe, but other than that they are identical in design and materials used.

The two versions of Vacuum bell do, however, differ greatly in price; the Costa vacuum bell is priced at 450 USD, whilst the Klobe vacuum bell is more expensive; priced at 600 USD. Moreover, whilst the Costa Vacuum bell is available in the US and Europe, the Klobe vacuum Bell is only attainable in Europe.

However, whilst it is only possible to get the Costa vacuum bell in one size; 10 inch vacuum bell intended for male adults 5'7 or taller.

The Klobe vacuum bell comes in 5 different sizes:

The Large Vacuum Bell, diameter about 10", for male persons taller than approx. 5´ 7" (1.70 meters)

The Small Vacuum Bell, diameter about 7.5", for person taller than approx. 4´ 7" (1.40 meters)

The Small Vacuum Bell Type Bodybuilder for bodybuilders and special applications

The Mini Vacuum Bell, diameter about 6.3", for children taller than approx. 3´ 5" (1.04 meters) The Vacuum Bell for women

Please follow these links for more information on the Vaccum Bell and the treatment of Pectus Excavatum.

How to Buy a Vacuum Bell

If you are interested in buying a vacuum bell, then you need to get in contact with the manufacturer by email.

Costa Vacuum Bell - costapectus@yahoo.com

Klobe Vacuum Bell - webmaster@trichterbrust.de

Simply state that you are interested in purchasing their product, and tell them you height and weight. They will promptly respond to your query with more information to help you decide whether their product is right for you.

You should also be aware that both manufacturers require that you consult a medical doctor before buying their product. Whilst Costa will accept your word, Klobe, will not sell you his product until you provide him with written permission from a medical doctor.
For more great information on the Vaccum Bell and the treatment of Pectus Excavatum please visit www.whatispectusexcavatum.com.