Thoracoscopic Approach to the Thoracic Spine

Kim, Jiha; Jahng, Tae Ahn

Abstract

Nowadays, the minimally invasive technique is the current trends in all medical fields. The spine is not the exception. By the development of modern optical devices and computer technology, thoracoscopy arose as new powerful tool in thoracic area. Many spinal disorders which were previously treated by transthoracic surgery are entering into the area of thoracoscopic surgery. The indication for thracoscopic surgery is getting wider and wider as technologies progress. So it seems to be difficult to define its indication strictly, as long as the patient can tolerate one-lung ventilation and endoscopy is accessible. In thoracic discectomy, thoracoscopy not only shortened operation time, hospital stay and chest tube insertion duration, but also lowered medical expense, postoperative pain and complication rate. But the patient selection is not yet established. Corpectomy can be performed in metastatic tumor removal or debridement of osteomyelitis by thoracoscopy. Thereafter, reconstruction or instrumentation is possible to prevent postoperative spinal deformity. In correction of spinal deformity, thoracoscopic surgery showed similar outcomes compared to thoracotomy in deformity correction, bone fusion, and functional outcome. There was also no statistical difference in complication rates between them. Pulmonary complications seen in thoracoscopic surgery such as atelectasis, pneumothorax and hemothorax were common. They seem to be related with the one-lung ventilation and the thoracoscopic approach itself, distinct from thoracotomy. But most complications were not life-threatening with some exceptions. Considering the development during the past two decades, the speed of development of thoracoscopic surgery will accelerate and the role of thoracoscopic surgery will become more important. In the development of thoracoscopy, the technical progression of optics and computer engineering will play important roles.