J Korean Soc Spine Surg.  2003 Sep;10(3):261-268. 10.4184/jkss.2003.10.3.261.

Learning Curve for the Thoracoscopic Correction of Spinal Deformities

• Kim HS
• Choi YR
• Lee HM
• Moon SH
• Kim KH
• Park JO
• Ha JW
• Shin DE

• KMID: 2209695
• DOI: http://doi.org/10.4184/jkss.2003.10.3.261

Abstract

STUDY DESIGN: Twenty-six consecutive cases were prospectively studied by chart review and radiography.
OBJECTIVES
The aim of this study was to find the learning curve of spinal thoracoscopy in spinal deformity surgery. SUMMARY OF LITERATURE REVIEW : Although the efficacy and learning curve of thoracoscopic deformity spinal surgery are well documented in many countries, there is no report in Korea.
METHODS
Twenty-six consecutive patients who were underwent VATS were studied. Idiopathic scoliosis was diagnosed in 23 patients (King type II in 15, type III in 5, type IV in 3), neuromuscular scoliosis in 2 and kyphotic deformity in one. In 14 cases of idiopathic scoliosis VATS for anterior release, bonegraft and instrumentation were performed. In the remaining 12 cases of anterior release, bone graft by VATS was done without instrumentation.
RESULTS
The average number of discs excised was 5.2+/-0.97. The average time of surgery for the 14 cases was 7.3+/-1.3 hours, which represented 1.37+/-0.25 hours per disc. Excluding the time of instrumentation in the 26 cases, the average time for anterior release and bone grafting was 3.87+/-0.87 hours, which represented 0.76+/-0.18 hours per disc. The average operation time diminished as the series continued. Average blood loss was 748.9+/-254 mL, which represented 152.6+/-65.6 mL per disc. The Cobb's angle was corrected by 62% on average. Complications were found in 11 cases: screw cap breakage in 3, atelectasis in 4, and intercostal nerve injury in 4. There was no serious complication.
CONCLUSIONS
VAST for spinal deformity is a safe and effective alternative to thoracotomy, however, the learning curve for this procedure is quite difficult.

Keyword

Scoliosis; Thoracoscopy; Learning curve

MeSH Terms

Bone Transplantation
Congenital Abnormalities*
Humans
Intercostal Nerves
Korea
Learning Curve*
Learning*
Prospective Studies
Pulmonary Atelectasis
Radiography
Scoliosis
Thoracic Surgery, Video-Assisted
Thoracoscopy
Thoracotomy
Transplants

Figure

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  Fig. 1. The portals of the thoracoscopic spinal deformity surgery should be located in the axillary line.

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  Fig. 2. Harmonic Scarlpel is very useful and convenient devise for bleeding control.

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  Fig. 3. The K-wire can be used as the marker in the intra-operative fluorescopy exam.

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  Fig. 4. Two instruments were invented for rod de-rotation and screw wing cutting under the thoracoscopic guide.

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  Fig. 5. The screw cap was broken during the wing cutting.

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  Fig. 6. The operating time per disc by case number in total case (n=26).

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  Fig. 7. Total operation time in instrumented cases (n=14).

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  Fig. 8. Operating time per disc by case number in instrumented case (n=14).

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