Video-assisted thoracoscopic surgery compared with thoracotomy: early and late follow-up of radiographical and functional outcome.

BACKGROUND CONTEXT: Video-assisted thoracoscopic surgery (VATS) is a new technique that allows for access to anterior spinal pathology using a minimally invasive approach. Proponents of this procedure argue that anterior thoracic spine surgery can be performed with the same accuracy and completeness as is possible by the conventional open approach but through much smaller skin and muscle incisions. Advantages of VATS include decreased blood loss, shorter hospital stay, and improved cosmesis. PURPOSE: To detect if VATS is equally as effective as open thoracotomy, both combined with instrumented posterior spinal fusion, with respect to fusion rate, percent curve correction, and functional outcome. STUDY DESIGN: Retrospective case control. PATIENT SAMPLE: Seventeen patients underwent VATS/instrumented posterior spinal fusion for thoracic curvatures exceeding 50 degrees . A control cohort of patients that were age matched, sex matched, and curve magnitude matched underwent open thoracotomy/instrumented posterior spinal fusion. OUTCOME MEASURES: Percentage of curve correction, fusion rate, intraoperative and postoperative clinical parameters, and functional outcome scores. METHODS: Preoperative and postoperative radiographs were analyzed to calculate the percentage of major curve correction in the coronal and sagittal planes as well as the rate of fusion. In addition, operative reports and medical records were analyzed for the following outcomes: estimated operative blood loss, length of surgery, chest tube output, length of hospitalization, and complications. Average follow-up time was 26 months in the VATS group and 27 months in the thoracotomy group. Finally, functional outcome was assessed using the Scoliosis Research Society (SRS-22) and Oswestry Disability Index (ODI) scoring system. RESULTS: The VATS group (mean age, 30) averaged 5.4 anterior levels and 11 posterior levels fused. The thoracotomy group (mean age, 32) averaged 5.8 anterior levels and 12 posterior levels fused. Estimated blood loss was nearly identical for the posterior procedures in both groups, whereas the anterior blood loss was significantly higher in the thoracotomy group as compared with the VATS group (541 cc vs. 288 cc). Operative time did not differ significantly between the two cohorts. Percent curve correction immediately postoperative (52% correction VATS; 51% correction thoracotomy) as well as at the 2-year follow-up (50% VATS and 54% thoracotomy) was nearly identical. There was no difference in postoperative ODI (p=.6) or SRS scores (p=.5) between groups. Complications were frequent but not significantly different between the two groups (p=.3). CONCLUSION: VATS is equally effective as thoracotomy with respect to fusion rate, major curve correction, and functional outcome scores. Although a decrease in operative blood loss was seen in the VATS patients, this was not clinically significant.     

Minimally Invasive Anterior Spinal Exposure and Release in Children with Scoliosis

Background:

The early experience with thoracoscopy in children has involved the diagnosis and treatment of pleural and pulmonary diseases. Recent advances have allowed surgeons to perform more complex procedures through video-assisted thoracoscopic surgery (VATS), potentially decreasing the pain and pulmonary impairment associated with an open thoracotomy. The authors report their initial experience with thoracoscopic assisted anterior spinal exposure and release as part of the treatment for children with spinal deformities.

Methods:

A retrospective chart review of five children who underwent VATS for anterior spinal surgery between June 1995 and January 1997 was performed.

Results:

The ages of the patients ranged from 11 to 16 years with a mean of 13.4 years. All patients had an anterior spinal release with or without fusion and same-day posterior spinal fusion with instrumentation. VATS was successfully completed in all patients without major morbidity and no mortality. The average operative time for the anterior portion of the procedure was 305 minutes, and a mean of 7 disc levels were released. Mean length of chest tube drainage and hospitalization were 6.8 and 8.6 days, respectively.

Conclusions:

The objectives of anterior exposure for spinal surgery in children can safely and effectively be accomplished using minimally invasive surgery.     

Thoracoscopic anterior spinal release and fusion: evolution of a faster,improved approach

Purpose: The aim of this study was to compare the perioperative parameters and outcomes of video-assisted thoracoscopic surgery (VATS) with open thoracotomy for anterior release and fusion in the treatment of pediatric spinal deformities. Methods: Twenty-six patients treated with VATS anterior spinal release and posterior spinal fusion by the authors were reviewed retrospectively. Fourteen age- and disease-matched patients who underwent open thoracotomy for anterior spinal release and posterior spinal fusion by the same group of surgeons during the same time period were evaluated for comparison. Patients whose anterior level of exposure extended below the diaphragm were excluded. Results: Blood loss, operative transfusion, and length of postoperative chest tube use all were decreased in the VATS patients compared with thoracotomy patients (P [le ] .05). The average operating time for VATS was less than that for thoracotomy but did not reach statistical significance. However, operating time was significantly shorter in the second 13 VATS patients compared with the first 13 patients. No complications specifically related to the VATS approach were identified. Conclusions: The VATS technique is a safe and comparable alternative to open thoracotomy. Although there is a learning curve for VATS, greater experience could show an advantage in this approach to the anterior spine for the treatment of pediatric spinal deformity.     

电视胸腔镜与小切口开胸手术治疗食管良性疾病的比较

目的比较电视胸腔镜手术与小切口开胸手术治疗食管良性疾病的临床效果和适应证。方法1995年1月至2007年1月我院胸外科应用微创手术治疗食管良性疾病患者52例。其中贲门失弛缓17例,食管平滑肌瘤24例,食管憩室7例,食管脂肪瘤1例,食管囊肿1例,贲门失弛缓合并食管憩室1例,贲门失弛缓球囊扩张食管破裂1例。根据手术方式分为电视胸腔镜手术组25例,小切口开胸手术组27例。结果两组患者手术治疗效果均良好,无术后并发症,无手术死亡。电视胸腔镜手术组有2例因胸腔内广泛粘连和食管黏膜损伤中转开胸。两组患者手术时间、术后胸腔闭式引流时间、胃肠减压时间以及术后住院时间均无明显差异。结论电视胸腔镜手术和小切口开胸手术治疗食管良性疾病安全有效,术后恢复快。电视胸腔镜手术切口符合美观要求,可作为治疗食管良性疾病的常规术式。小切口开胸手术更适合于病情较复杂的患者。     

Thoracoscopic anterior instrumented fusion for adolescent idiopathic scoliosis with emphasis on the sagittal plane

Background contextAnterior fusion through an open thoracotomy restores kyphosis more reliably than posterior techniques in patients with thoracic adolescent idiopathic scoliosis (AIS). Video-assisted thoracoscopic spinal fusion and instrumentation (VATS) minimizes the morbidity, from soft tissue and muscle dissection that accompanies traditional open thoracotomy. To our knowledge, there has not been a comprehensive analysis of VATS with respect to radiographic and clinical outcomes in the sagittal plane.PurposeTo measure the radiographic and clinical outcomes after VATS with emphasis on the sagittal plane.Study design/settingA retrospective, radiographic review of 26 consecutive patients with Lenke type-I AIS who underwent VATS.MethodsRadiographs of 26 consecutive patients with Lenke type-I AIS curves operated by a single surgeon were retrospectively reviewed after VATS. Sagittal and coronal parameters were compared with reported data for open anterior and posterior procedures.ResultsThere was an increase in kyphosis from baseline to final follow-up by 6.6° (25%) from T2 to T12 (p<.0001), 8.7° (50%) from T5 to T12 (p<.0001), and 8° (54%) in the instrumented segment (p<.0001). Junctional kyphosis did not occur. No differences were detected in sagittal measurements between the first postoperative erect and the final radiographs. Patients experienced significant improvements from baseline to 2 years in Scoliosis Research Society-22 Health-Related Quality-of-Life Outcome Questionnaire scores (p<.0001).ConclusionsVideo-assisted thoracoscopic spinal fusion and instrumentation, in agreement with results reported for open anterior instrumentation, reliably restores or increases thoracic kyphosis while preserving junctional alignment in thoracic AIS.     

The efficacy of video-assisted thoracoscopic surgery for anterior release and fusion in the management of pediatric spinal deformities.

PURPOSE: This study examined clinical and radiological outcomes following video-assisted thoracoscopic surgery (VATS) for anterior release and fusion in the correction of pediatric scoliotic deformities. METHODS: We undertook a detailed chart and radiographic review to determine the degree of correction and perioperative morbidity and complications, if any, of a sequential group of patients who underwent VATS between 2000 and 2004 at British Columbia's Children's Hospital. We used patients who underwent open thoracotomy immediately before the adoption of the VATS technique at the same hospital to evaluate the relative efficacy of VATS. RESULTS: There were 19 patients in each group, 17 with idiopathic scoliosis in the VATS group and 16 in the open thoracotomy group. Mean age, weight at surgery and preoperative Cobb angle were similar (p = 1.0, 0.8 and 0.05, respectively). There was no significant difference in operative time per level between the VATS group and the open thoracotomy group (37.2 v. 34.5 min, p = 0.2) or total blood loss (908 v. 823 mL, p = 0.5). There were no major complications encountered in the VATS group. One patient in the open thoracotomy group experienced atelectasis and subsequent lower lobe collapse. CONCLUSIONS: VATS has the potential to decrease postoperative morbidity while still allowing the same degree of correction as traditional open thoracotomies and is a good alternative in the pediatric population.     

Thoracoscopic interventions in deformities of the thoracic spine

AIM OF THE STUDY: We prospectively studied 9 patients with deformities of the thoracic spine who underwent thoracoscopic surgery to critically evaluate the benefits and limitations of thoracoscopy. METHODS: Seven patients with deformities of the thoracic spine (5 scoliosis, 2 kyphosis) underwent a thoracoscopic release and posterior correction and fusion in a single stage. In one case of a crankshaft-phenomenon a thoracoscopic epiphyseodesis und in another case of a posttraumatic kyphosis a thoracoscopic instrumentation and fusion were performed. The average age was 21 years, the follow-up was 18 months with a minimum of 12 months. The perioperative data including complications were collected and a radiographic analysis concerning curve correction was carried out. RESULTS: The scoliotic curves measured preoperatively 84 degrees on average with a Cobb angle of 62 degrees on the traction films and were corrected by 57% to averagely 36 degrees at follow-up. In the two cases of Scheuermann kyphosis a preoperative kyphosis of 94 degrees respectively 82 degrees was corrected to 52 degrees respectively 58 degrees. Between 4 and 5 discs were excised with an average operative time of 160 min and a blood loss of 380 ml. A conversion to open thoracotomy was not necessary in any case. There were no intraoperative neurovascular complications. CONCLUSIONS: Thoracoscopic procedures in deformities of the thoracic spine are technically demanding; however, it is a minimally invasive procedure with a reduced approach-related morbidity compared to open thoracotomy. The indications for a thoracoscopic release are rigid kyphosis and scoliosis with rigid curves between 80 and 90 degrees Cobb angle in which an anterior correction and instrumentation alone is not considered.     

Video-assisted thoracoscopic surgery

We describe our experience with video-assisted thoracoscopic surgery (VATS). Twenty-nine patients were operated on with this technique for various anterior thoracic spinal lesions. There were 6 cases of disc herniation with simple resection, 6 with acute thoracic fractures requiring anterior grafting and stabilization, 7 old fractures and malunions treated by corporectomy, grafting and anterior stabilization in 3, 4 with spinal metastases that were resected and stabilized, 3 with a paravertebral spinal tumor (2 schwannomas and 1 chondroblastoma), and 3 osteoid osteomas that were resected with anterior grafting in one case. Indications for these procedures are specified and the technical considerations discussed for each group of pathologies. We had three complications: one conversion to thoracotomy in a case of spinal metastasis, one pleural effusion, and one incomplete resection of a thoracic disc herniation. We emphasize the need for minimally invasive approaches in spinal surgery.     

Outcome of minimally invasive surgery in the management of tuberculous spondylitis

Introduction:

With the advancement of instrumentation and minimally access techniques in the field of spine surgery, good surgical decompression and instrumentation can be done for tuberculous spondylitis with known advantage of MIS (minimally invasive surgery). The aim of this study was to assess the outcome of the minimally invasive techniques in the surgical treatment of patients with tuberculous spondylodiscitis.

Materials and Methods:

23 patients (Group A) with a mean age 38.2 years with single-level spondylodiscitis between T4-T11 treated with video-assisted thoracoscopic surgery (VATS) involving anterior debridement and fusion and 15 patients (Group B) with a mean age of 32.5 years who underwent minimally invasive posterior pedicle screw instrumentation and mini open posterolateral debridement and fusion were included in study. The study was conducted from Mar 2003 to Dec 2009 duration. The indication of surgery was progressive neurological deficit and/or instability. The patients were evaluated for blood loss, duration of surgery, VAS scores, improvement in kyphosis, and fusion status. Improvement in neurology was documented and functional outcome was judged by oswestry disability index (ODI).

Results:

The mean blood loss in Group A (VATS category) was 780 ml (330-1180 ml) and the operative time averaged was 228 min (102-330 min). The average preoperative kyphosis in Group A was 38° which was corrected to 30°. Twenty-two patients who underwent VATS had good fusion (Grade I and Grade II) with failure of fusion in one. Complications occurred in seven patients who underwent VATS. The mean blood loss was 625 ml (350-800 ml) with an average duration of surgery of 255 min (180-345 min) in the percutaneous posterior instrumentation group (Group B). The average preoperative segmental (kyphosis) Cobb''s angle of three patients with thoracic TB in Group B was 41.25° (28-48°), improved to 14.5°(11°- 21°) in the immediate postoperative period (71.8% correction). The average preoperative segmental kyphosis in another 12 patients in Group B with lumbar tuberculosis of 20.25° improved to –12.08° of lordosis with 32.33° average correction of deformity. Good fusion (Grade I and Grade II) was achieved in 14 patients and Grade III fusion in 1 patient in Group B. One patient suffered with pseudoarthrosis/doubtful fusion with screw loosening in the percutaneous group.

Conclusion:

Good fusion rate with encouraging functional results can be obtained in caries spine with minimally invasive techniques with all the major advantages of a minimally invasive procedures including reduction in approach-related morbidity.     

Evolution to video-assisted thoracic surgery lobectomy after training: initial results of the first 30 patients

BACKGROUND: In early-stage lung cancer, evidence is accumulating for the benefits of lobectomy by video-assisted thoracic surgery (VATS) over open lobectomy. Few thoracic training programs offer sufficient experience in this technically demanding procedure. This article describes the evolution of a new graduate's practice from open thoracotomy to VATS lobectomy. STUDY DESIGN: Our model involves a transition in technique from posterolateral thoracotomy to muscle-sparing thoracotomy and, ultimately, to VATS lobectomy. This approach was evaluated by examining outcomes of open thoracotomy patients before VATS lobectomy and outcomes of the initial 30 VATS patients. Data were collected prospectively. RESULTS: Before undertaking VATS lobectomy, 94 major pulmonary resections were performed by thoracotomy. Mortality was 1.2% for lobectomy and 0% for pneumonectomy. Use of the muscle-sparing thoracotomy increased from 17% of patients in the first half to 70% in the latter half of this group. For the first 30 VATS lobectomy patients, the mean operative time was 168 minutes. Median blood loss was 200 mL. Conversion rate to open thoracotomy was 13.3%. Mortality was 3.3% and morbidity was 26.7%. After short-term followup (mean followup 16 months), overall survival for stage I lung cancer was 96%. CONCLUSIONS: With our approach, new graduates of thoracic surgery programs can safely transition to VATS lobectomy. Gaining experience with the lateral muscle-sparing thoracotomy is an important step in the transition, as it offers similar operative exposure. Longterm disease-free and overall survival data are needed to evaluate our oncologic efficacy with this approach.     

Minimally invasive 360° instrumented lumbar fusion

A retrospective preliminary study was undertaken of combined minimally invasive instrumented lumbar fusion utilizing the BERG (balloon-assisted endoscopic retroperitoneal gasless) approach ¶anteriorly, and a posterior small-incision approach with translaminar screw fixation and posterolateral ¶fusion. The study aimed to quantify the clinical and radiological results using this combined technique. The traditional minimally invasive approach to the anterior lumbar spine involves gas insufflation and provides reliable access only to L5-S1 and in some cases L4-5. A gas-mediated approach yields many technical drawbacks to performing spinal surgery. A minimally invasive posterior approach involving suprafascial pedicle screw instrumentation has been developed, but without widespread use. Translaminar facet fixation may be a viable alternative to transpedicular fixation in a 360° instrumented fusion model. Past studies have shown open 360° instrumented lumbar fusion yields high arthrodesis rates. The study examined the cases of 46 patients who underwent successful 360° instrumented lumbar fusion using a combined minimally invasive approach. Anterior lumbar interbody fusion (ALIF) at one or two levels was performed through the BERG approach; a gasless retroperitoneal approach to the lumbar spine allowing the use ¶of standard anterior instrumentation. Posteriorly, all patients underwent successful decompression, translaminar fixation, and posterolateral fusion at one or two levels through ¶one small (2.5-5.0 cm) incision. Results showed mean hospital stay of 2.02 days; mean combined blood loss was 255 cc; and mean pain relief was 56%, with 75.5% of patients reporting good, excellent, or total pain relief. Forty-two of 46 patients (93.2%) achieved a solid fusion ¶24 months after surgery. A total of 47% of all patients working prior to surgery returned to work following surgery. The study showed that minimally invasive 360° instrumented lumbar fusion, when performed utilizing these approaches, yields a high rate of solid arthrodesis (93.3%), good pain relief, short hospital stays, low blood losses, accelerated rehabilitation, and a quick return to the workforce. The BERG approach offers technical advantages over the traditional gas-mediated laparoscopic approach to the anterior lumbar spine.     

Minimally invasive 360° instrumented lumbar fusion

A retrospective preliminary study was undertaken of combined minimally invasive instrumented lumbar fusion utilizing the BERG (balloon-assisted endoscopic retroperitoneal gasless) approach ¶anteriorly, and a posterior small-incision approach with translaminar screw fixation and posterolateral ¶fusion. The study aimed to quantify the clinical and radiological results using this combined technique. The traditional minimally invasive approach to the anterior lumbar spine involves gas insufflation and provides reliable access only to L5-S1 and in some cases L4-5. A gas-mediated approach yields many technical drawbacks to performing spinal surgery. A minimally invasive posterior approach involving suprafascial pedicle screw instrumentation has been developed, but without widespread use. Translaminar facet fixation may be a viable alternative to transpedicular fixation in a 360° instrumented fusion model. Past studies have shown open 360° instrumented lumbar fusion yields high arthrodesis rates. The study examined the cases of 46 patients who underwent successful 360° instrumented lumbar fusion using a combined minimally invasive approach. Anterior lumbar interbody fusion (ALIF) at one or two levels was performed through the BERG approach; a gasless retroperitoneal approach to the lumbar spine allowing the use ¶of standard anterior instrumentation. Posteriorly, all patients underwent successful decompression, translaminar fixation, and posterolateral fusion at one or two levels through ¶one small (2.5–5.0 cm) incision. Results showed mean hospital stay of 2.02 days; mean combined blood loss was 255 cc; and mean pain relief was 56%, with 75.5% of patients reporting good, excellent, or total pain relief. Forty-two of 46 patients (93.2%) achieved a solid fusion ¶24 months after surgery. A total of 47% of all patients working prior to surgery returned to work following surgery. The study showed that minimally invasive 360° instrumented lumbar fusion, when performed utilizing these approaches, yields a high rate of solid arthrodesis (93.3%), good pain relief, short hospital stays, low blood losses, accelerated rehabilitation, and a quick return to the workforce. The BERG approach offers technical advantages over the traditional gas-mediated laparoscopic approach to the anterior lumbar spine.     

Video assisted thoracoscopic (VATS) Thymectomy-a better alternative

Background With the introduction of video imaging technique in late 1980s the field of thoracoscopy was expanded into video assisted thoracic surgery (VATS) in 1990. VATS has several unique advantages like reducing repiratory complications, hospital stay and post operative pain due to avoidance of thoracotomy/sternotomy. It is indicated in almost all thoracic surgical procedures-both diagnostic and therapeutic. VATS thymectomy is being practised more and more replacing conventional thymectomy with thoracotomy/sternotomy. Methods From 2000 to 2003 we have performed 22 cases of VATS thymectomy in Myesthenia Gravis. Surgery was performed in supine decubitus under General anaesthesia with Double Lumen E T Tube for epsilateral Lung Collapse. Three ports were made on the right chest at 2nd space parasternal, 4th space anterior axillary line and at 5th space just below the nipple. At the end of the procedure a chest drain was introduced through the lowest port. Results Out of 22 patients 12 were females and 10 males. Median age was 36 years (Range 16 years to 64 years). Median operating time was 2 hours and drainage was 200 ml. Median ventillation time was 6 hours. Median hospital stay was five days. There was no mortality and no major complications. Conclusion VATS thymectomy is a suitable alternative to conventional thymectomy with thoracotomy/sternotomy. Results are comparable. VATS is now developing into an exciting adjunct in thoracic surgery. The morbidity associated with this procedure is extremely low. VATS has become an essential component of all thoracic surgical units and more and more thoracic surgical dieases will be managed with this minimally invasive technique in future.     

Complications and surgical considerations in posterior lumbar interbody fusion with carbon fiber interbody cages and Steffee pedicle screws and plates

Sixty consecutive patients undergoing posterior lumbar interbody fusion with a carbon fiber cage and posterolateral fusion using Steffee VSP (Depuy, Raynham, Mass) pedicle screw and plate instrumentation were reviewed. Perioperative complications, operative blood loss, and operative time were evaluated. Six dural tears, three transient sensory deficits, and two cases of deep venous thrombosis were reported. Operative blood loss for primary cases averaged 269 cc for one level and 569 cc for two levels fused. Patients with prior surgery averaged 378 cc for one level and 470 cc for two levels fused. Operative time for primary cases averaged 202 minutes for one level and 251 minutes for two levels fused. Patients with prior surgery required 208 minutes for one level and 251 minutes for two levels fused. Posterior lumbar interbody fusion with instrumented posterolateral fusion can be performed with a low intraoperative complication rate. Blood loss and operative time compare favorably with alternative methods of obtaining 360 degree fusion. Radiographic fusion was obtained in 100% of patients. Outcome analysis revealed 67% excellent or good results.     

Financial analysis of circumferential fusion versus posterior-only with thoracic pedicle screw constructs for main thoracic idiopathic curves between 70° and 100°

Purpose Reports on thoracic pedicle screw (TPS) constructs have demonstrated their safety and efficacy; however, concerns exist regarding their increased cost. This is a review of adolescents with main thoracic scoliosis surgically treated with anterior release and posterior fusion or posterior fusion only. The objectives were to compare the radiographic outcomes and financial data of two surgical treatments: anterior/posterior spinal fusion (APSF) versus posterior spinal fusion (PSF-TPS) alone with TPSs, in patients with large 70–100° main thoracic adolescent idiopathic scoliosis (AIS) curves. Methods We identified 43 patients with main thoracic Lenke type 1–4 AIS curves between 70 and 100° who had been treated with either APSF or PSF-TPS. Results Both groups had equivalent radiographic corrections postoperatively. The PSF-TPS group patients had higher implant charges, but the APSF group had higher surgeon procedural charges, operating room charges, anesthesia charges, and inpatient room charges. Total charges were $75,295 for the APSF group and $71,236 for the PSF-TPS group (P > 0.05). Analyses of two subgroups of the APSF group, anterior release via thoracotomy versus VATS and same-day versus staged surgeries, failed to change any of the above findings. Conclusion Based on this financial analysis, there was no statistically significant differences between the APSF and PSF-TPS groups, with equivalent radiographic corrections.     

特发性胸椎侧凸胸腔镜下前路矫形与开放小切口前路矫形的疗效比较

目的对特发性胸椎侧凸胸腔镜下前路矫形与开放小切口前路矫形的近期疗效进行比较。方法将23例特发性胸椎右侧凸患者分为两组,A组行胸腔镜下胸椎侧凸前路Eclipse矫形术,共8例,均为女性,平均年龄148岁,平均Cobb角54°,Risser征 ～ 。B组行开放小切口前路CDHTSRH矫形手术,共15例,男2例,女13例,平均年龄138岁,Cobb角平均57°,Risser征 ～ 。对两组病例的手术时间、术中出血量、固定节段、术后引流量、矫正效果以及早期矫正丢失等进行分析。结果两组患者在年龄、Cobb角、侧凸柔软性和固定节段等方面均具有可比性。A组平均手术时间(360±72)min,术中平均出血量(629±145)ml,术后平均引流量(500±150)ml,平均固定节段(74±11)个,平均Cobb角矫正率(74±14)%,经6～18个月随访,近期矫正丢失率(86±27)%。B组平均手术时间(246±64)min,术中平均出血量(300±110)ml,术后平均引流量(210±90)ml,平均固定节段(78±09)个,平均Cobb角矫正率(70±12)%,近期矫正丢失率(46±19)%。A组与B组相比,侧凸矫正率相似(P>005),但手术时间、术中出血量、术后引流量,以及早期矫正丢失率等存在显著差异(P<005)。结论胸腔镜下胸椎侧凸前路矫形手术和开放小切口前路矫形手术具有各自的适应证和优缺点。对于青少年特发性胸椎侧凸     

Video-assisted thoracic surgery lobectomy (VATS), open thoracotomy, and the robot for lung cancer

Video-assisted thoracic surgery (VATS) lobectomy provides a minimally invasive approach for the management of early-stage lung cancer. Questions about the safety of VATS lobectomy and its adequacy as a cancer operation compared with open thoracotomy have hindered its universal acceptance among thoracic surgeons. Evidence suggests that VATS lobectomy can be safely performed and is an adequate cancer operation for early-stage non-small cell lung cancer. However, adequately powered well-balanced studies comparing VATS with open thoracotomy for lobectomy are lacking in the literature.     

The Ponte procedure: posterior only treatment of Scheuermann's kyphosis using segmental posterior shortening and pedicle screw instrumentation

STUDY DESIGN: Case series. OBJECTIVE: To examine a consecutive series of surgically treated Scheuermann kyphosis that had a posterior only procedure with segmental pedicle screw fixation and segmental Ponte osteotomies. SUMMARY OF BACKGROUND DATA: The gold standard for surgical treatment of Scheuermann kyphosis (a rigid kyphosis associated with wedged vertebral bodies occurring in late childhood or adolescence) has been combined anterior and posterior approach surgery. Alberto Ponte has advocated a posterior-only procedure with posterior column shortening via segmental osteotomies, but his procedure has not been widely accepted owing to concerns that without anterior column support there would be a risk of correction loss and/or instrumentation failure. With the advent of improved spinal instrumentation and fixation with thoracic pedicle screws, the Ponte procedure may offer an advantage over anterior/posterior reconstruction. METHODS: The study prospectively enrolled 17 consecutive patients with Scheuermann kyphosis who were treated with the Ponte procedure by the senior surgeon at one institution. Standardized radiographic analysis was performed and included full-length coronal and sagittal radiographs preoperatively, postoperatively, and at final follow-up. Analysis also included the correction obtained through the most severe, wedged segments of the deformity by the osteotomies. RESULTS: Seventeen patients had the Ponte procedure satisfactorily performed. No patient needed an anterior approach to achieve sufficient correction or fusion. There were no reoperations for nonunion or instrumentation failure. Correction of the instrumented levels was 61% and of worst Cobb was mean 49%. The apex of the deformity was measured over the most deformed 3 to 7 wedged segments. The average correction across the apex was 9.3 degrees per osteotomy (range 5.9 to 15). No patient lost more than 4 degrees of correction through their instrumented and fused levels. There were no neurologic complications. There was one late infection with a solid fusion treated with instrumentation removal and intravenous antibiotics. CONCLUSIONS: Using thoracic pedicle screw instrumentation as the primary anchor, the Ponte procedure was successfully performed in 17 consecutive patients for Scheuermann kyphosis with no exclusions for the size or rigidity of the kyphosis. Results were as good as anterior/posterior historical controls with excellent correction and minimal loss of correction at final follow-up. This procedure avoids the morbidity and extended operative time attributed to the anterior approach. LEVEL OF EVIDENCE: Therapeutic study, level IV [case series (no, or historical, control group)].     

Assessment of the perioperative hemodynamics and right ventricular performance of lung cancer patients using a continuous cardiac output monitoring system: comparison between video-assisted thoracic surgery and muscle-sparing thoracotomy.

PURPOSE: This prospective study was conducted to assess the influences of hemodynamics and right ventricular (RV) performance after lobectomy by video-assisted thoracic surgery (VATS) and that by muscle-sparing thoracotomy (MST) using a continuous cardiac output (CCO) monitoring system. SUBJECTS AND METHODS: Between October 2002 and April 2004, 16 patients (VATS, 8; MST, 8) who underwent lobectomy with mediastinal lymphadenectomy were enrolled in this study. Changes in hemodynamics and RV performance were evaluated preoperatively and for 36 hours postoperatively. RESULTS: There were significant differences in operative blood loss (BL) and postoperative maxCPK/m(2) between VATS and MST groups. Postoperative values were expressed as a percentage of the preoperative values. For 36 hours perioperatively, the mean pulmonary artery pressure (mPAP), pulmonary capillary wedge pressure (PCWP) and total pulmonary resistance index (TPRI) decreased to greater extents in the VATS group than in the MST group. There were no significant differences between the two groups in RV performance including the continuous cardiac index (CCI), RV ejection fraction (RVEF), RV end-diastolic volume index (RVEDVI) and RV stroke index (SI) postoperatively. CONCLUSION: Considering our previous report about postoperative RV performance using the VATS procedure and posterolateral thoracotomy procedure, this study suggests that pulmonary resection using either VATS or MST could be employed as minimally invasive surgery.