Abstract
Introduction: Retrospective review of patients with idiopathic scoliosis who underwent same-day or staged anterior (ASF) and posterior spinal fusion (PSF) and segmental spinal instrumentation (SSI). We evaluated our learning curve with video-assisted thoracoscopic surgery (VATS) with respect to operative time, blood loss, and complications in patients with idiopathic scoliosis. An increased or steep learning curve has been described in the initial application of VATS.
Methods: We began performing VATS in 1998. We compared our first 25 consecutive VATS patients (Group 2) and subsequent 28 consecutive VATS patients (Group 3) to 16 consecutive patients (Group 1) with a thora-cotomy (1991–1998) for idiopathic scoliosis. Training at a sponsored regional course was obtained prior to our first VATS procedure.
Results: VATS allowed more discs to be excised in Group 2 (4.5±1, 5.7±1 and 4.4±1 discs in the 3 groups, respectively) and significantly decreased the anterior operative time (215±33, 260±56 and 177±47 minutes) and time per individual disc excision (50±13, 47±12 and 41±12 minutes), while providing comparable correction of the thoracic deformity (67±12, 66±10 and 70±13% correction). There was no increase in estimated intra-operative anterior blood loss (228±213, 183±136 and 211±158ml), estimated blood loss per disc excised (51±42, 34±29 and 48±37ml), or complications in the VATS groups. Complications were primarily pulmonary and resolved with medical therapy. Postoperative chest tube drainage (855±397, 462±249 and 561±26lml) and total perioperative anterior blood loss (1083±507, 647±309 and 773±308ml) were significantly decreased in the VATS groups, but this was attributed to the use of Amicar.
Conclusions: VATS is an effective procedure for ASF in idiopathic scoliosis. The learning curve is short, provided appropriate training is obtained.
Correspondence should be addressed to: Dr Caroline Goldberg, The Research Centre, Our Lady’s Children’s Hospital Crumlin, Dublin 12, Ireland.
