Video-assisted thoracoscopic surgery to the upper thoracic spine

Background: The standard open technique for exposure of the upper thoracic spine, T1-T4, usually requires a difficult thoracotomy. From November 1, 19 95 to June 30, 1997, eight patients underwent video-assisted thoracoscopic spinal surgery in our institute to treat their upper thoracic spinal lesion s endoscopically. Methods: A new approach, the so-called "extended manipulating channel metho d," was used in this series that allows the combined use of video-assisted thoracoscopy and conventional spinal instruments to enter the chest cavity freely for the procedures. Patients' ages ranged from 44 to 89 years (avera ge, 60 years). Definitive diagnoses included two pyogenic spondylitis and s ix spinal metastases. Five patients presented initially with myelopathy. Results: There were no deaths or neurologic injuries associated with this t echnique. The mean surgical time was 3.1 h. The mean duration of chest tube retention was 3.3 days. The mean total blood loss was 1,038 ml, and two pa tients had a blood loss of more than 2,000 ml owing to bleeding from epidur al veins or raw osseous surfaces. Complications included one superficial wo und infection and one subcutaneous emphysema that resolved spontaneously. I n this series, there was no need of conversion to open thoracotomy for the patients. Conclusions: The thoracoscopy-assisted spinal technique using the extended manipulating channels, usually 2.5-3.5 cm, allows variable instrument angul ations for manipulation. The mean surgical time (3.1 h) was considered no l onger than for an open technique for the equivalent anterior procedure. Suc h an approach can achieve less procedure-related trauma and has proved to b e a good alternative to ether treatment modalities.