Thoracoscopic anterior spinal release and fusion: Evolution of a faster, improved approach

Purpose: The aim of this study was to compare the perioperative parameters and outcomes of video-assisted thoracoscopic surgery (VATS) with open thoracotomy for anterior release and fusion in the treatment of pediatric spinal deformities. Methods: Twenty-six patients treated with VATS anterior spinal release and posterior spinal fusion by the authors were reviewed retrospectively. Fourteen age- and disease-matched patients who underwent open thoracotomy for anterior spinal release and posterior spinal fusion by the same group of surgeons during the same time period were evaluated for comparison. Patients whose anterior level of exposure extended below the diaphragm were excluded. Results: Blood loss, operative transfusion, and length of postoperative chest tube use all were decreased in the VATS patients compared with thoracotomy patients (P less than or equal to .05). The average operating time for VATS was less than that for thoracotomy but did not reach statistical significance. However, operating time was significantly shorter in the second 13 VATS patients compared with the first 13 patients. No complications specifically related to the VATS approach were identified. Conclusions: The VATS technique is a safe and comparable alternative to open thoracotomy. Although there is a learning curve for VATS, greater experience could show an advantage in this approach to the anterior spine for the treatment of pediatric spinal deformity. Copyright 2002, Elsevier Science (USA). All rights reserved.