Video-assisted thoracoscopic surgery in the prone position

Study Design. Review of 27 consecutive patients who underwent video-assiste d thoracoscopic surgery (VATS) in the prone position for anterior release a nd discectomy. Objectives. To convey the benefits and safety of this new technique for tre ating spinal deformities through VATS. Summary of Background Data. All reports using VATS for spinal deformities d escribe the patient in the lateral position. This is the first study to dem onstrate the bene fits and safety of the prone position. Methods, The patient is positioned prone, prepared, and draped allowing roo m for lateral portals on the convexity of the curve. Traditionally, a doubl e-lumen endotracheal tube is used to deflate the ipsilateral lung. Prone po sitioning eliminates this need, because gravity aids in retraction of the l ung. Results. All procedures were successfully performed using the VATS techniqu e with the patient prone. After the anterior release and discectomy, poster ior instrumentation (n = 27), costoplasty (n = 16), and fusion (n = 27) wer e performed. The time(n = 20) and blood loss(n = 16) for the anterior appro ach averaged 129 +/- 35 minutes and 221 +/- 231 mt, respectively. The mean number of disks resected was 3.3 +/- 0.7 (range, 2-5), Conclusion. The prone position is both safe and effective for VATS when tre ating spinal deformity. The current results confirm that there is no need t o insert a double- lumen tube, there is gravity-assisted correction of kyph osis when the patient is prone, and significant operative time is saved wit h the elimination of repositioning and redraping before the posterior proce dure. Surgical times and blood loss compare very favorably with those repor ted for VATS in the lateral position.