The published reply on the safety survey
When another group challenged the RibXcar safety survey in print, Dr. Manzaneda answered in the same journal, under his own name and with references. The reply clarifies what the 2.65% actually measures, defends surveys as a legitimate method, and acknowledges a table transcription error, supporting its formal correction.
What was challenged
The letter it answers raised three objections: that a surgeon survey cannot evaluate procedural safety, that the complication rate was misinterpreted, and that validated patient-reported outcome measures were missing.
What the reply establishes about the 2.65%
This is the central point, and it matters because the figure circulates misquoted. The study's 2.65% refers specifically to potentially life-threatening complications — pneumothorax and hemothorax — and the original study's own abstract puts it in these words: “Of 113 respondents, 2.65% of respondents reported serious complications.”
Pooling those events with subjective outcomes such as prolonged postoperative pain is, per the reply, a misclassification inconsistent with standard surgical outcome frameworks.
For a per-patient figure, see the 3,805-patient cohort.
Why a survey is an acceptable method
The reply holds that surveying experienced practitioners is routinely used to characterise complication profiles and real-world practice patterns, particularly when a technique is too new to support large prospective multicenter trials. It cites published methodology on the point.
The acknowledged error
This says the most about how the record is being kept: the reply admits a typographical transposition between Table 3 and the main text, in the pneumothorax and prolonged-pain percentages, and supports publication of a corrigendum.
It further clarifies that, recalculated from the original survey data, the combined incidence of pneumothorax and hemothorax remains consistent with the rate reported in the abstract.
Conflict-of-interest statement
The letter states openly that Dr. Manzaneda is the creator of the RibXcar technique, serves as an invited speaker at meetings on rib remodeling, and developed a proprietary surgical tip for which he receives financial remuneration through its commercialisation.
We record it because it is in the document and because it belongs here: a reader is entitled to know it when weighing the argument.