The comparison, with sources
| Incision-based method (2021) | Scarless rib remodeling (2023) | |
|---|---|---|
| Access | Scapular-line incisions (up to ~3 cm) | Punctures, no external cuts |
| Guidance | No imaging guidance | Real-time ultrasound |
| Instrument | Oscillating saw | Published specific instrument (Manzaneda's Tool) |
| External scar | Yes | No |
| Indexed publications | 1 article (2021) | 12 articles |
| Published follow-up | 14 patients >6 months | 328-patient 1-year cohort + independent 220-case series |
| Certified training | — | Official course + verifiable directory |
Sources: DOI 10.1097/GOX.0000000000003680 (Kudzaev 2021) · 10.1097/GOX.0000000000005499 (foundational study 2023) · 10.1097/GOX.0000000000006595 (independent series 2025).
What they share — and what they don't
Both techniques avoid rib removal: they bend the bone instead of taking it out. The difference is in the how: access, visibility of the field (ultrasound guidance keeps the rib and neighboring structures visible throughout) and the volume of evidence behind each protocol. The published safety, respiratory-function and follow-up studies correspond to the ultrasound-guided version.
For anyone evaluating the surgery
Always ask: does the procedure leave an external scar? Is it ultrasound-guided? Which publications back the exact protocol I would receive? Does the surgeon hold verifiable certification in the technique? The answers separate the two generations — and trained surgeons from improvisers.
Informational page for educational purposes; it does not replace medical consultation. All figures refer to publications with DOIs.