Results: Spine
Early Experiences With Video-Assisted Thoracoscopic Surgery: Our First 70 Cases
ISSN: 0362-2436Accession: 00007632-200409010-00020Full Text (PDF) 1103 K
Author(s):
Al-Sayyad, Mohammed J. MD, FRCSC; Crawford, Alvin H. MD, FACS; Wolf, Randal
K.
MD, FACS
Issue:Volume 29(17), 1 September 2004, pp 1945-1951
Publication Type:[Surgery]
Publisher:(C) 2004 Lippincott Williams & Wilkins, Inc.
Institution(s):From the Department of Pediatric Orthopaedic Surgery, Cincinnati
Children's Hospital Medical Center, Cincinnati, Ohio.
Acknowledgment date: July 2, 2002. First revision date: November 27, 2002.
Second revision date: May 29, 2003. Acceptance date: October 20, 2003.
The manuscript submitted does not contain information about medical device(s)/drug(s).
No funds were received in support of this work. Although one or more of the
author(s) has/have received or will receive benefits for personal or professional
use from a commercial party related directly or indirectly to the subject of
this manuscript, benefits will be directly solely to a research fund, foundation,
educational institution, or other nonprofit organization with which the
author(s) has/have been associated. One or more of the author(s) has/have
received or will receive benefits for personal or professional use from a
commercial party related directly or indirectly to the subject of this
manuscript: e.g., royalties, stock, stock options, decision-making position
Address correspondence and reprint requests to Alvin H. Crawford, MD, Division
of Pediatric Orthopaedic Surgery, Children's Hospital Medical Center, 3333
Burnet Avenue, Cincinnati, OH 45229-3039, USA; E-mail: alvin.crawford@chmcc.org
Keywords: video assisted thoracoscopic surgery, scoliosis, kyphosis
---------------------------------------------Outline
Abstract
Materials and Methods
Surgical Technique.
Statistical Analysis.
Results
Discussion
1
Key Points
References
Graphics
Figure 1
Figure 2
Figure 3
Figure 4
Table 1
Table 2
Abstract
Study Design. Prospective consecutive series.
Objective. Analysis of the results and outcomes of patients treated with
video-assisted thoracoscopic surgery for spinal pathology.
Summary of Background Data. Video-assisted thoracoscopic surgery is an
alternative to open thoracotomy. It has been suggested that the learning curve
is substantial. The authors present their early experience in treating a variety
of spinal pathologies with this technique.
Methods. Seventy cases were available at the 2-year follow-up. Video-assisted
thoracoscopic surgery with the goal of anterior spinal release and fusion was
carried out on patients with the following diagnoses: idiopathic scoliosis,
neuromuscular spinal deformity, Scheuermann kyphosis, congenital and infantile
scoliosis, neurofibromatosis, Marfan syndrome, postradiation scoliosis, and
repair of pseudarthrosis. Three patients had excision of the first rib to treat
thoracic outlet syndrome. Two patients had excision of intrathoracic neurofibroma
and a benign rib tumor. One had anterior fusion following thoracic spine
fracture-dislocation.
Results. The average operative time for the thoracoscopic anterior release with
discectomy and fusion procedure was 256 minutes (range 150-405 minutes). The
average number of discs excised was 8 (range 4-11 discs). The average operative
time per disc was 32.5 minutes (range 20-45 minutes). The average blood loss
during the thoracoscopic anterior release with diskectomy and fusion was 285 mL
(range 150-405 mL). Final postoperative scoliosis and kyphosis corrections were
68% (range 41-91%) and 90% (range 47-100%), respectively. Complications related
to thoracoscopy occurred in 3 patients. All deformity patients had evidence of
anterior fusion radiographically.
Conclusion. Video-assisted thoracoscopic surgery provides a safe and effective
alternative to open thoracotomy in the treatment of thoracic pediatric spinal
deformities. The procedure remains time consuming.
---------------------------------------------Thoracoscopic spine surgery is a new technique that allows for reaching and
treating pathology of the spine and ribs with the same accuracy and completeness
2
as is possible by the open approach but through smaller skin and muscle
incisions. The body of knowledge currently available began with a single report
in 1993 1 and progressed to 15 articles in the year 2000.2-16 Several animal
studies have demonstrated endoscopic and open techniques to be equally effective
in increasing spine flexibility in porcine and goat models.17,18 In December
1993, at Cincinnati Children's Hospital Medical Center, the senior author
(A.H.C.) began performing video-assisted thoracoscopic surgery (VATS).
Our indications for thoracoscopy in pediatric spinal deformities include: 1)
rigid idiopathic scoliosis deformities at or about 75[degrees] in magnitude
without correction to less than 50[degrees] on side bending radiographs; 2) to
prevent crank shaft phenomena in the skeletal immature child with greater than
50[degrees] curvature; 3) kyphotic deformities of greater than 70[degrees] that
do not correct to less than 50[degrees] on hyperextension films over a bolster;
4) progressive congenital deformities within the thorax requiring anterior
epiphysiodesis; 5) patients with neuromuscular deformities with at-risk
pulmonary status; 6) severe rib hump deformity not corrected by spinal
instrumentation; 7) those patients with neurofibromatosis who had intrathoracic
tumors in addition to a significant spinal deformity; 8) pseudarthrosis
following anterior intervertebral fusion; 9) excision of first rib for thoracic
outlet syndrome; 10) rib and intercostal nerve tumors; and 11) most recent,
instrumentation of thoracic spinal deformities above the diaphragm. Our
contraindications include: 1) inability to tolerate single lung ventilation; 2)
severe or acute respiratory insufficiency; 3) high airway pressures with
positive pressure ventilation; 4) pleural symphysis; and 5) empyema.19,20
The learning curve of VATS in the pediatric spine has been studied previously.10
The author's purpose is to analyze their acquired experience during a consecutive
series VATS with the majority of cases involving disc release and rib graft
fusion.
Materials and Methods
Seventy consecutive cases of VATS were carried out between December 1993 and May
of 1999 and had a minimum of a 2-year follow-up. Video-assisted thoracoscopic
surgery release of the anterior spine by disc excision and anterior fusion were
carried out on patients with the following diagnoses: idiopathic scoliosis (n =
32), neuromuscular spinal deformity (n = 13), Scheuermann kyphosis (n = 9),
congenital and infantile scoliosis (n = 3), neurofibromatosis (n = 4), Marfan
syndrome (n = 1), postradiation scoliosis (n = 1), and repair of pseudarthrosis
(n = 1). Three patients had excision of the first rib to treat thoracic outlet
syndrome. Two patients had excision of intrathoracic neurofibroma and a benign
rib tumor. One patient had anterior fusion following thoracic spine fracture-dislocation.
All cases were followed prospectively. Patient data collected from our
computerized database included gender, age at the time of surgery, specific
diagnosis, and indication for VATS. Perioperative data included the number of
discs excised, anterior operative time, posterior operative time, anterior
operative time per disc, anterior blood loss, posterior blood loss, and anterior
blood loss per disc excised. Postoperative data included hospital stay (in
days), days in the intensive care unit, days of chest tube use, chest tube
3
output, chest tube output per disc, and complications.
Radiographic data were collected by the same author (M.J.A.) for all cases; the
author was blinded to the functional and perioperative data at the time of the
radiograph review. Deformities were measured on upright anteroposterior and
lateral films using the Cobb method.21 Calculations for curve magnitude and
percent correction were made using the worst deformity value that was recorded.
Thoracic kyphosis was measured from T3-T12. Preoperative and postoperative films
were measured. One-year and final follow-up radiographs were also measured and
examined for fusion mass and implant failure. The presence of an anterior fusion
mass was determined by the presence of a bridge of bone connecting the vertebral
bodies in place of the old disc in the lateral view. The percent correction was
calculated initially, at 1 year and at final follow-up. In calculating
percentage correction for kyphosis cases, normal thoracic kyphosis was
considered to be 40[degrees]. Percentage of kyphosis correction = {100 x
[preoperative kyphosis - (postoperative kyphosis - 40[degrees])]/preoperative
kyphosis}. If correction was below 40[degrees], the correction was considered
100%.10,22
Surgical Technique.
In 65 of the 70 VATS cases, anterior release, endplate ablation, and grafting
using autogenous rib graft were performed. Single-lung ventilation was performed
with the use of a double lumen tube in all except 2 patients, who were 5 years
old. Both patients had endotracheal intubation and a bronchial blocker (Fogarty
catheter), allowing for collapse of the lung on the convex side of the curve in
scoliosis cases and on the right side in kyphosis cases. The time for intubation
was not included in the operative time.
The patient was placed convex side up onto the lateral decubitus position with
kidney rest support. Although not draped out, the arm was hyperflexed at the
shoulder to allow the placement of portals higher into the axilla. All pressure
points were well padded. In all cases, an experienced access surgeon (R.K.W.)
was present; we were fortunate enough that our access surgeon had experience
with over 400 thoracoscopies before working with us. The first portal, i.e., the
visual panorama portal, was most frequently placed at or about the T6 or T7
interspace in the midaxillary line. A 15 mm Trochar was used, through which a
10-mm 30[degrees] angled rigid telescope was placed. The lung was observed as it
deflated. A panoramic assessment was then carried out to determine the
topographical anatomy. The rest of the portals were done under direct visualization.
Generally, 4 portals were used for spinal deformity cases. The ribs were counted
in order to identify the levels to be treated. The parietal pleura was opened in
a longitudinal fashion. Early in the series, electrocautery was used; however,
after the first 20 cases, an ultrasonic device was used (ultracision LCS,
Ethicon Endosurgery Inc., Piscataway, NJ). The harmonic scalpel produced less
smoke, which improved visualization. The intervertebral discs were identified. A
vessel sparing approach was used early in the series, but now because we
consider transligation of the segmental vessels to be fairly safe, the segmental
vessels were coagulated with the harmonic scalpel, incised, and retracted with
the pleura.23 The pleura was further elevated and retracted using the harmonic
scalpel, thoracoscopic periosteal elevators, and blunt dissectors. A transverse
4
cut was made across the vertebral endplate parallel to the disc both rostral and
caudal to it using electrocautery. An elevator was then used to elevate the
vertebral endplate to isolate the disc. Rongeurs, curettes, and periosteal
elevators were then used to assure complete removal of the disc material and the
endplates. The anulus and disc space contents were excised; we strived to
achieve an approximately 250[degrees] arc of release or from rib head to
opposite posterolateral body (except in extreme levels like T2-T3, T3-T4, L1-L2,
and L2-L3). In this series, ribs were harvested to perform intervertebral
fusion. Early in the series (first 3 cases), the pleura were closed, but we no
longer attempt to close it. A chest tube was then placed through the inferior
most portal and observed thoracoscopically. The chest tube was then placed under
water seal, and the anesthesiologist inflated the lung to determine whether
there was an air leak. The patient was usually reintubated and turned prone for
a posterior spinal fusion if one was planned.19,20,23,24 We now recommend
routine suction of the inflated lung because of previous experiences in other
centers with mucous plugs causing significant respiratory distress. We began
routine suction after the fourth case, and we did not encounter mucus plugs with
our current protocol.25
A total of 8 cases included in our study varied from the typical thoracoscopic
release and fusion for spinal deformity. Case 25, a 16-year-old male with
neurofibromatosis, had a large thoracic intercostal neurofibroma, which required
thoracoscopic removal. Case 26, a 17-year-old male with neuromuscular scoliosis
who underwent a previous spinal fusion and ended up with a painful pseudarthrosis
at the level of T10-T11, had thoracoscopic rib grafting. Case 35, a 13-year-old
female with adolescent idiopathic scoliosis of 54[degrees], underwent thoracoscopic
anterior instrumented fusion from T5-T11 with autogenous rib grafting. Case 37,
a 17-year-old male patient, presented with a painful 10th rib mass, and the
benign nature of the mass was determined radiographically and was excised
thoracoscopically. Case 39, a 12-year-old boy with a T11-T12 spine fracture
dislocation, underwent thoracoscopic decompression and fusion followed by
posterior instrumented spinal fusion. Three patients (cases 40, 65, and 67) aged
31, 51, and 16 years old, respectively, had thoracic outlet syndrome. These
patients had thoracoscopic first rib excision, the technical details of which
can be reviewed in Minimal Access Cardiothoracic Surgery.26
All patients were given questionnaires (self-administered) at their latest
postoperative visit to rate their satisfaction with surgery on a scale from 1 to
5 with 1 being extremely unsatisfied, 2 being somewhat dissatisfied, 3 being
neither satisfied nor dissatisfied, 4 being somewhat satisfied, and 5 being
extremely satisfied. Patients were also asked if they would have the same
management again if they had the same condition, and this was graded as follows:
1 definitely not, 2 probably not, 3 not sure, 4 probably yes, and 5 definitely
yes. These 2 measures were taken word for word from the Scoliosis Research
Society outcomes instrument, questions 22 and 23, respectively.27
Statistical Analysis.
Statistical analysis was done using SPSS for Windows version 9.0 (SPSS, Cary,
NC). Descriptive statistics including mean and standard deviation of the results
were calculated. Student t test analyses were used in the comparison between the
5
halofemoral traction and nontraction groups and the group electrocautery versus
the harmonic scalpel group. Statistical results at P
Results
Of the seventy patients, 46 were females and 24 were males. Patients' ages at
surgery varied from 5.1 to 51.5 years with an average of 15 years. The average
follow-up was 4.1 year (range 2-7 years). All patients had a minimum of 2 years
follow-up. No patients were lost to follow-up.
Fifty-one of the 70 patients underwent same-day anterior thoracoscopic release
and fusion followed by posterior instrumented spinal fusion. Eleven patients had
an anterior thoracoscopic release and fusion followed by halofemoral traction
for an average of 9 days (range 5-12 days) followed by posterior instrumented
spinal fusion (Figure 1). The halofemoral traction group included 7 patients
with idiopathic scoliosis, 3 neuromuscular scoliosis patients, and 1 patient
with Scheuermann kyphosis (Figure 2). The mean scoliosis curve measurement in
the halofemoral traction group was 89[degrees] (range 75-112[degrees]). Six
patients had formal anterior thoracoscopic costoplasty with an average of 5
harvested ribs (range 3-7 ribs). Twenty-six patients had a posterior costoplasty.
No cases were canceled or delayed because of failure to achieve single-lung
ventilation, and no technical difficulties were encountered from the prospective
of anesthesia.
---------------------------------------------Figure 1. This 14-year-old female presented with a double curve of
120/73[degrees] with significant deformity. She underwent VATS costoplasty and
rib grafting followed by halo-femoral traction with consequent posterior spinal
fusion. A, Standing and bending clinical photographs illustrating severe trunk
deformity. B, Standing posteroanterior and lateral preoperative and postoperative
radiographs showing correction of both curves in the frontal and sagittal
planes. C, Lateral spine radiographs at 1 year illustrating anterior intervertebral
fusion. D, Standing postoperative clinical photographs illustrating correction
in the trunk deformities.
---------------------------------------------Figure 2. This 24-year-old patient presented with a 98[degrees] Scheureman
kyphosis and underwent VATS release and rib fusion, followed by traction and
consequent posterior spinal instrumented fusion. A, Lateral bending photograph
illustrating severe clinical kyphosis. B, Standing preoperative and postoperative
lateral radiograph showing correction of curvature to 38[degrees]. Anterior
fusion is noted. C, Lateral bending lateral photograph at 1 year showing
clinical correction of deformity.
---------------------------------------------Patient data including the number of discs released and operative time per disc
were plotted, and a curve fit was performed. A straight line showed the proper
fit as seen in Figures 3 and 4. Table 1 provides a summary of the operative and
postoperative data. Data from case 35 (anterior thoracoscopic instrumentation)
were excluded from the calculations, as surgical time and blood loss increased
in instrumentation cases.
---------------------------------------------Figure 3. Shows curve fit for the operative time per disc released by case
6
number.
---------------------------------------------Figure 4. Shows curve fit for the number of discs released in each case as
the series progressed.
---------------------------------------------Table 1. Operative and Postoperative Data
---------------------------------------------There was no change in the number of discs released as the series progressed, as
shown in Figure 4. The mean operative time per disc for discectomy alone
averaged 13 minutes (range 8-18), but when considering the total procedure
including rib harvesting, endplate ablation, and intervertebral fusion,
operative time per disc was 32.5 minutes +/- 7.8 minutes.
The mean hospital stay was 8.3 days +/- 3.7 days (range 5-20 days). The
halofemoral traction group had a mean hospital stay of 14.4 days +/- 2.95 days.
If the halofemoral traction group is excluded from these calculations, the mean
hospital stay was 7.1 +/- 2.4 days. A t test comparison of the hospital stay for
the traction and nontraction groups showed that there was a significant
difference between the traction and nontraction group, with P P P = 0.0114),
with the drainage for the traction group being 104 mL +/- 79 mL and the
nontraction group was 64 +/- 42 mL.
In this series, the anterior release and discectomy was done at levels between
T2-T3 and L2-L3. The total number of discs released was 487 discs, and the
frequencies of the particular discs released are shown in Table 2.
---------------------------------------------Table 2. Levels of Discs Released and Fused
---------------------------------------------There was no statistically significant difference (P > 0.05) between cases
carried out using the electrocautery and the harmonic scalpel in the areas of
anterior blood loss, anterior operative time, and anterior operative time per
disc. The vessel-sparing approach was used in the first 4 cases of this series.
The small number of cases in the vessel-sparing group limited the statistical
analysis that could be carried out to compare operative time and estimated blood
loss in both groups.
In patients treated for scoliosis, the mean preoperative scoliosis value was 72
+/- 17[degrees] (range 42-120[degrees]), the mean 1-year postoperative scoliosis
was 22 +/- 13[degrees] (range 7-48[degrees]) and the mean final postoperative
scoliosis was 24 +/- 15[degrees] (range 7-50[degrees]). The mean initial
scoliosis correction was 67 +/- 16% (range 43-91%), the mean scoliosis
correction at 1 year was 67 +/- 17% (range 41-91%), and at final follow-up was
68 +/- 18% (range 41-91%). For the kyphosis patients, the mean preoperative
kyphosis value was 83 +/- 6[degrees] (range 70-110[degrees]), the mean 1-year
postoperative kyphosis was 43 +/- 6[degrees] (range 39-55[degrees]), and the
mean final postoperative kyphosis was 46 +/- 6[degrees] (range 39-57[degrees]).
The mean initial kyphosis correction was 92 +/- 7% (range 48-100%), the mean
kyphosis correction at 1 year was 90 +/- 5% (range 50-100%), and at final
7
follow-up was 90 +/- 8% (range 47-100%). Solid anterior fusion mass was seen in
all fusion cases, and Figure 1C shows a close-up of the anterior fusion mass at
the T10-T11 level.
Case 25, the neurofibromatosis patient with a thoracic intercostal neurofibroma,
had a successful thoracoscopic excision. Case 26, the painful pseudarthrosis at
the level T10-T11, went on to have a successful painless fusion. Case 35 had a
thoracoscopic anterior instrumented fusion from T5-T11 with autogenous rib
grafting, was corrected to 25[degrees] after surgery, and had a successful
fusion. Case 37, with the painful 10th rib mass, had the mass excised successfully,
which proved to be a simple bone cyst. Case 39, with the T11-T12 spine fracture
dislocation, had a solid anterior and posterior fusion. The thoracic outlet
syndrome patients had a successful first rib excision and a successful clinical
outcome.
Complications occurred in 8 patients, 3 of which were related to thoracoscopy.
Case 20, a 13-year-old male patient with neuromuscular scoliosis, suffered from
a left upper lobe atelectasis that was treated with Bipap. He also had a
posterior spine wound infection that was treated with multiple debridements and
retention of the spinal implant. Postoperative pneumonia occurred in case 34 an
11-year-old female with idiopathic scoliosis who underwent an anterior release
to avoid the crankshaft phenomena; she was treated with antibiotics and
recovered. The third patient (case 35), a 13-year-old girl with right thoracic
scoliosis of 54[degrees], underwent VATS discectomy and anterior spinal fusion
with instrumentation from T5-T11 and developed an intraoperative tension
pneumothorax. During surgery, overadvancement of a guide wire into the opposite
(left) hemithorax resulted in a tension pneumothorax in the left hemithorax.
This was treated with a chest tube inserted into the left hemithorax and had no
long-term consequences.33
Other complications included a myelomeningocele patient (case 5) with severe
kyphoscoliosis who suffered an iliac crest bone graft site infection. This
patient had a chronic sinus that required multiple debridements. Fluid overload
occurred in case 31, a 10-year-old male who was born with tetralogy of Fallot
and had a 60[degrees] curve corrected to 18[degrees] by VATS discectomy and
posterior instrumented fusion. He required reintubation and diuresis after
surgery but fortunately was extubated in 48 hours and went back to his baseline
function. Superior mesenteric artery syndrome occurred in case 38, a skeletally
immature 11-year-old girl with idiopathic scoliosis of 55[degrees] that was
corrected to 13[degrees]. This patient was treated by nasojejunal tube feeding
and regained normal function following 2 weeks of treatment. A pulmonary embolus
occurred in case 53, a 16-year-old female who had VATS discectomy and anterior
spinal fusion followed by posterior instrumented fusion from T2-L3 for
Scheuermann kyphosis of 85[degrees]. She was anticoagulated and has recovered
completely. There were no chylothorax, incorrect levels of fusion, and no
conversions to thoracotomy.
Results of the satisfaction questionnaire showed 48 of the 70 (68.57%) VATS
patients to be extremely satisfied. Eighteen patients were somewhat satisfied
(25.71%), and 4 patients were neither satisfied nor dissatisfied (5.72%). Fifty
patients (71%) answered that they definitely would have the procedure again if
8
they had the same condition. Eleven patients (16%) selected probably yes, 6
patients (9%) selected not sure, and 3 patients (4%) selected probably not
(these 3 included 1 patient with tetralogy of Fallot with history of recurrent
cardiac failures, 1 neurofibromatosis patient with scoliosis, and 1 patient with
neuromuscular scoliosis).
Discussion
In order to put VATS into perspective, the surgeon needs to be aware of the
short-term results and outcome measures. In this series, we reported our results
with VATS, beginning with the selection criteria, passing by evolution of the
surgical technique, and progressing to spinal fusion.
In December 1993, at Cincinnati Children's Hospital Medical Center, the senior
author (A.H.C.) began performing VATS. He subsequently compared VATS patients to
a thoracotomy group, the first group had 39 patients and the second had 40
patients respectively. Video-assisted thoracoscopic surgery was equally
effective as thoracotomy in achieving adequate anterior spinal release with no
difference in the adequacy of fusion as judged by osseous bridging across the
disc spaces. Blood loss in the VATS group was significantly less than the
thoracotomy group, being a mean of 412 mL compared to 804 mL in the thoracotomy
group.28 Video-assisted thoracoscopic surgery patients in that presentation are
included in this study.
This study includes the largest number of idiopathic scoliosis patients
receiving anterior thoracoscopic release and fusion ever reported. The largest
number of idiopathic scoliosis patients receiving anterior thoracoscopic release
previously reported was 13 patients.2 This series also includes the longest
follow-up to date on a thoracoscopic release, being an average of 4.1 years
(with a minimum of 2 years follow-up) with the longest follow-up previously
reported by Waisman and Saute (3 years in a report of 3 patients).23 Previous
studies had a large number of neuromuscular scoliosis cases and lacked a
follow-up that included achieving fusion and a maintained correction.10,13,29
The work of Landreneau et al and Mangione et al documented that the thoracoscopic
procedure 20 and thoracoscopic spinal procedures are less painful when compared
to open thoracotomy.30-32 Arlet, in a meta-analysis and review of anterior
thoracoscopic spine release in deformity surgery, made the comment that the
quality of disc excision was rarely reported.2 In our series, we strived to
obtain complete disc excision to an approximately 250[degrees] arc or from rib
head to the opposite posterolateral body to the best of our visual and tactile
judgment. In the series by Newton et al,10 no comment was made regarding the
quality of the disc excision and utilization of allograft and posterior iliac
crest bone graft. Specific numbers were not given to indicate how many patients
received either type of graft, as the paper did not concentrate on comments
regarding achieving fusion. The complication rate in this series compared
favorably with previous thoracoscopic studies.10,33
Newton et al considered severe scoliosis, particularly in patients with
neuromuscular disorders or small children, to be a relative contraindication to
the thoracoscopic approach and may be best treated by open surgery; this has not
9
been our experience.10 In this series, the authors treated 8 scoliosis patients
with curves >90[degrees] (range 94-120[degrees]) with no need to convert to open
thoracotomy.
Excellent final correction was obtained in the scoliosis and the kyphosis
patient population, being 68 +/- 18% and 90 +/- 8%, respectively. Newton et al
reported postoperative scoliosis correction of 56 +/- 22% and postoperative
kyphosis correction of 80 +/- 17%, and in the meta-analysis by Arlet, the
correction obtained in scoliosis cases varied from 55% to 63%.2,10 The
satisfaction questionnaire showed 66 patients to be satisfied with the result of
their surgery (94.28%), and 4 patients were neither satisfied nor dissatisfied
(5.72%). These satisfaction questions were asked regarding the anterior
thoracoscopic surgery specifically, the chance is still there that such a high
satisfaction rate is partially or totally related to the achieved correction of
the deformity.
Video-assisted thoracoscopic surgery clearly provides a safe and effective
alternative to open thoracotomy for thoracic spinal deformities, as documented
by our corrections obtained and fusion rates achieved. The time invested in
training and the assistance of an experienced access surgeon made for a positive
outcome with the procedure. The authors now use VATS for nearly every case
previously requiring thoracotomy.
Key Points
* Video-assisted thoracoscopic surgery provides a safe and effective alternative
to open thoracotomy for thoracic spinal deformities.
* Time invested in training and assistance of an experienced access surgeon made
for a positive outcome with the procedure.
* Excellent anterior fusion mass was observed in all of our deformity cases.
* The authors now use VATS for nearly every case previously requiring thoracotomy.
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Key words: video assisted thoracoscopic surgery; scoliosis; kyphosis
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