title: Thoracoscopic anterior spinal release and fusion: evolution of a faster, improved approach.
abstract: OBJECTIVE
  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 < or =.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.
authors.affiliation: Division of Pediatric Surgery and Orthopedic Surgery, Childrens Hospital Los Angeles and the University of Southern California Keck School of Medicine, Los Angeles, CA 90027, USA.
authors.forename: Eunice Y
authors.initials: EY
authors.lastname: Huang
authors.forename: Juan M
authors.initials: JM
authors.lastname: Acosta
authors.forename: Raymond J
authors.initials: RJ
authors.lastname: Gardocki
authors.forename: Paul D
authors.initials: PD
authors.lastname: Danielson
authors.forename: David L
authors.initials: DL
authors.lastname: Skaggs
authors.forename: Richard A K
authors.initials: RA
authors.lastname: Reynolds
authors.forename: Vernon T
authors.initials: VT
authors.lastname: Tolo
authors.forename: James E
authors.initials: JE
authors.lastname: Stein
mesh_terms: D000293:Adolescent; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D013122:Spinal Diseases / Q000601:surgery*; D013123:Spinal Fusion / Q000379:methods*; D020775:Thoracic Surgery, Video-Assisted / Q000379:methods*; D013908:Thoracotomy; D016896:Treatment Outcome