Video-assisted thoracoscopic spinal surgery: Technical considerations and preliminary clinical outcomes

Video-assisted thoracoscopic surgery (VATS) has only recently been applied in a variety of spinal procedures. Between November 1, 1995 and May 31, 1996, we used a new approach, the so-called "extended manipulating channel method", to treat 23 patients with anterior spinal abnormalities. The size of the thoracoscopic portals was made larger than usual, and placed more posteriorly so as to allow thoracoscopy and conventional spinal instruments to enter the chest cavity freely and to be manipulated similarly to techniques used in standard open surgical procedures. The total blood loss ranged from 100 to 3000 ml (average 1050 ml) and the total duration of surgery was 1 to 7.2 hours (average 3.7 hours). There was no injury to the internal organs, great vessels or the spinal cord intraoperatively. On the basis of these results, we believe that a combination of the use of thoracoscopy and conventional spinal instruments, as presented in this report, can be an ideal method for performing VATS spinal procedures. This type of approach makes endoscopic spinal surgery simpler to perform. Most complications in our patients were minor. This procedure is contraindicated for patients with severe pleurodesis or intolerance to intraoperative one-lung ventilation.