Postoperative pain-related morbidity: Video-assisted thoracic surgery versus thoracotomy

Landreneau, Rodney J.; Hazelrigg, Stephen R.; Mack, Michael J.; Dowling, Robert D.; Burke, David; Gavlick, Joseph; Perrino, Maureen K.; Ritter, Pamela; Bowers, Claudia M.; Defino, Jennifer; Nunchuck, Susan; Freeman, J. A.; Keenan, Robert J.; Ferson, Peter F.

doi:10.1016/0003-4975(93)90667-7

Cited by 566 publications

(273 citation statements)

References 14 publications

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“…We observed no major spinal deformities on long-term follow-up in our series, and in our opinion these good results, even during the learning period, were due to careful patient selection and to our past experience in doing similar operations by open techniques. One of the major reported advantages of VATS [21,22] is the reduction in intraoperative blood loss and postoperative stay, and this was also observed in our series. The average duration of surgery and blood loss in our series is less than that reported by other authors [11,23], which may be attributed to limitation to debridement and grafting only without the use of instrumentation in our patients.…”

Section: Discussionsupporting

confidence: 85%

Thoracoscopic decompression in Pott’s spine and its long-term follow-up

Kapoor

Agrawal

et al. 2012

International Orthopaedics (SICOT)

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Purpose Video-assisted thoracoscopic surgery (VATS) has become an alternative tool for a variety of spinal conditions as this approach minimises much morbidity related to conventional thoracotomy. The purpose of this study was to determine the efficacy of VATS and its long-term results in patients with dorsal spinal tuberculosis. Materials and methods This retrospective long-term follow-up study of VATS-assisted surgical treatment of dorsal spine tuberculosis included 30 patients with a mean age of 33.5 years (range 15-60). Patients with dorsal spine tuberculosis who were suitable surgical candidates for VATS underwent a three-portal thoracoscopy for decompression with/without fusion of the spine along with routine chemotherapy for tuberculosis (TB). Patients were assessed for blood loss, duration of surgery, postoperative incision pain, duration of hospital stay, neurological recovery, and progression of deformity. Patients were observed for a minimum of five years. Results The mean duration of surgery was 158.8 min (range 90-220 min) with mean blood loss of 296.7 ml (range 200-450 ml). Complications were seen in ten patients. The mean follow-up was 80 months (range 60-90 months) with neurological improvement and return of ambulatory power in all patients at final follow-up. There was an average increase in kyphus angle by 7.5°at final follow-up and 95% of patients achieved an excellent or good subjective outcome. Conclusion VATS-assisted surgical decompression can be a safe and effective technique for anterior debridement and fusion in tuberculosis of the dorsal spine to achieve neurological recovery with reduced morbidity, blood loss, and hospital stay compared to thoracotomy.

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Section: Discussionsupporting

confidence: 85%

Thoracoscopic decompression in Pott’s spine and its long-term follow-up

Kapoor

Agrawal

et al. 2012

International Orthopaedics (SICOT)

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“…The scope times reported in several publications lie between 106 and 473 min [4,5,6,7,9,10,11,16]. We noticed a significant reduction in the thoracoscopic procedure time as the series progressed -an experience that has been shared by many others [1,2,3,4,7,9,10,11,12,14,18,20].…”

Section: Discussionsupporting

confidence: 57%

“…Most authors describe isolated case reports or experimental results only on animals [1,2,3,4,7,8,15,16,18]. An advantage of thoracoscopy is the reduced morbidity, which is thought to prevent postoperative pain at the thoracotomy site [5].…”

Section: Introductionmentioning

confidence: 99%

Anterior thoracoscopic surgery followed by posterior instrumentation and fusion in spinal deformity

Niemeyer¹,

Freeman

Grevitt

et al. 2000

European Spine Journal

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Many authors believe thoracoscopic surgery is associated with a lower level of morbidity compared to thoracotomy, for anterior release or growth arrest in spinal deformity. Others believe that anterior release achieved thoracoscopically is not as effective as that achieved with the open procedure. We evaluated the clinical results, radiological correction and morbidity following anterior thoracoscopic surgery followed by posterior instrumentation and fusion, to see whether there is any evidence for either of these beliefs. Twentynine patients undergoing thoracoscopic anterior release or growth arrest followed by posterior fusion and instrumentation were evaluated from a clinical and radiological viewpoint. The mean follow-up was 2 years (range 1-4 years). The average age was 16 years (range 5-26 years). The following diagnoses were present: idiopathic scoliosis (n = 17), neuromuscular scoliosis (n = 2), congenital scoliosis (n = 1), thoracic hyperkyphosis (n = 9). All patients were satisfied with cosmesis following surgery. Twenty scoliosis patients had a mean preoperative Cobb angle of 65.1°(range 42°-94°) for the major curve, with an average flexibility of 34.5% (42.7°). Post operative correction to 31.5°(50.9%) and 34.4°( 47.1%) at maximal follow-up was noted. For nine patients with thoracic hyperkyphosis, the Cobb angle averaged 81°(range 65°-96°), with hyperextension films showing an average correction to 65°. Postoperative correction to an average of 58.6°was maintained at 59.5°at maximal follow-up. The average number of released levels was 5.1 (range 3-7) and the average duration of the thoracoscopic procedure was 188 min (range 120-280 min). There was a decrease in this length of time as the series progressed. No neurologic or vascular complications occurred. Postoperative complications included four recurrent pneumothoraces, one surgical emphysema, and one respiratory infection. Thoracoscopic anterior surgery appears a safe and effective technique for the treatment of paediatric and adolescent spinal deformity. A randomised controlled trial, comparing open with thoracoscopic methods, is required.

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“…This means also to reduce operative and postoperative morbidities. The clinical comparison demonstrated the advantages of reduced early postoperative pain, improved shoulder girdle function, reduced impairment in the early postoperative pulmonary functions and shortened ICU stay [27,28].…”

Section: Thoracoscopic Corpectomymentioning

confidence: 99%

Thoracoscopically assisted corpectomy and percutaneous transpedicular instrumentation in management of burst thoracic and thoracolumbar fractures

et al. 2013

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Study design This is a prospective observational study. Purpose The aim of this study was to determine whether the combination of thoracoscopically assisted corpectomy with posterior percutaneous transpedicular instrumentation in prone position achieves treatment goals in burst thoracic or thoracolumbar fractures and minimizes the associated morbidities. Methods Between December 2007 and December 2008, 26 patients with acute burst spinal fractures were operated upon in our hospital. Those patients underwent posterior percutaneous stabilization plus anterior thoracoscopically assisted corpectomy and fusion in prone position. Clinical and radiological outcomes of these patients were evaluated after a minimum follow-up period of 2 years. The Oswestry Disability Index (ODI) combined with clinical examination was used for clinical evaluation. Plain X-ray in two views was used for the radiological evaluation. Results The mean operative time was 248 min. The average blood loss was 765 ml. Ten patients had preoperative neurological deficits ranging from Frankel A to D. One patient did not show any neurological improvement at the final follow-up. The mean ODI at final follow-up was about 7. The mean preoperative kyphosis angle was 25.58°, improved to 9.2°postoperatively and to 13.8°at the final follow-up. No cases of implant failure were reported at the final follow-up.Conclusions Minimal invasive spinal techniques including thoracoscopic decompression and fusion and short segment posterior percutaneous instrumentation showed good clinical outcomes and can be considered as alternative to open procedures with decreased rates of morbidities in managing burst thoracic and thoracolumbar fractures.

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Postoperative pain-related morbidity: Video-assisted thoracic surgery versus thoracotomy

Cited by 566 publications

References 14 publications

Thoracoscopic decompression in Pott’s spine and its long-term follow-up

Thoracoscopic decompression in Pott’s spine and its long-term follow-up

Anterior thoracoscopic surgery followed by posterior instrumentation and fusion in spinal deformity

Thoracoscopically assisted corpectomy and percutaneous transpedicular instrumentation in management of burst thoracic and thoracolumbar fractures

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