TECHNIQUE OF VIDEO-ASSISTED THORACOSCOPIC SURGERY FOR THE SPINE - NEWAPPROACH

Although video-assisted thoracoscopy has only recently been applied to treat a variety of thoracic spine lesions, many problems and difficul ties are encountered with this technique owing to limited trocar space and lack of suitable endoscopic instruments. Between November 1995 an d March 1996, we practiced a new approach fur video-assisted thoracosc opic surgery, the ''extended manipulating channel method,'' for treati ng 18 patients with thoracic spinal lesions endoscopically. The thorac oscopic portals were made larger (usually 3-4 cm) and placed slightly more posterior than usual, which allows use of a combination of conven tional spinal instruments and video-assisted thoracoscopy to enter the chest cavity and be manipulated similar to that with techniques used for standard open surgical procedures. In our series the endoscopic sp inal procedures included biopsy only (n = 1), thoracic discectomy (n = 1), multilevel anterior discectomy and fusion (n = 1), corpectomy for decompression (n = 4), decompressions and interbody fusions (n = 10), and internal instrumentations (n = 4). Throughout the operation only one trocar mas used for introducing the thoracoscope. There were no in traoperative deaths, and no patients showed neurologic deterioration d ue to the procedures. We conclude that such a technique makes thoracos copy-assisted spinal surgery simpler and easier and has proved to be a n effective, promising procedure, It does not appear to compromise the therapeutic goals set for the patients. The intraoperative vessel ble eding can be easily controlled, and the number of portals for the proc edures can be reduced (on average, three portals are enough). Few endo scopic materials were used with our patients, and thus the total econo mic cost to the patients was reduced.