title: Video-assisted thoracoscopic surgery in idiopathic scoliosis: evaluation of the learning curve.
abstract: METHODS
  Retrospective review of patients with idiopathic scoliosis who underwent same-day or staged anterior and posterior spinal fusion and segmental spinal instrumentation.
  
  
  OBJECTIVE
  Evaluation of our learning curve with video-assisted thoracoscopic surgery (VATS) with respect to operative time, blood loss, and complications in patients with idiopathic scoliosis.
  
  
  BACKGROUND
  VATS is a minimally invasive alternative to thoracotomy in the management of idiopathic scoliosis. An increased or steep learning curve has been described in the initial application of this technique.
  
  
  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 our previous 16 consecutive patients (Group 1) with a thoracotomy (1991-1998) for idiopathic scoliosis. Training at a sponsored regional course was obtained before performing our first VATS procedure.
  
  
  RESULTS
  VATS allowed more disc to be excised in Group 2 (4.5 +/- 1, 5.7 +/- 1, and 4.4 +/- 1 discs in Group 1, Group 2, and Group 3, 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 intraoperative anterior blood loss (228 +/- 213, 183 +/- 136, and 211 +/- 158 mL), estimated blood loss per disc excised (51 +/- 42, 34 +/- 29 and 48 +/- 37 mL), 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 +/- 261 mL) and total perioperative anterior blood loss (1083 +/- 507, 647 +/- 309, and 773 +/- 308 mL) were significantly decreased in the VATS groups, but this was attributed to the use of Amicar.
  
  
  CONCLUSIONS
  VATS is an effective procedure for anterior spinal fusion in idiopathic scoliosis. The learning curve is short, provided appropriate training is obtained.
authors.affiliation: Division of Pediatric Orthopedics, Rainbow Babies and Children's Hospital, Case Medical Center, Case Western Reserve University, Cleveland, OH 44106, USA.
authors.forename: Jochen P
authors.initials: JP
authors.lastname: Son-Hing
authors.forename: Laurel C
authors.initials: LC
authors.lastname: Blakemore
authors.forename: Connie
authors.initials: C
authors.lastname: Poe-Kochert
authors.forename: George H
authors.initials: GH
authors.lastname: Thompson
mesh_terms: D000293:Adolescent; D016063:Blood Loss, Surgical; D002648:Child; D002983:Clinical Competence; D017586:Diskectomy / Q000009:adverse effects / Q000193:education*; D004503:Education, Medical, Graduate; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011859:Radiography; D012189:Retrospective Studies; D012600:Scoliosis / Q000000981:diagnostic imaging / Q000601:surgery*; D012720:Severity of Illness Index; D013123:Spinal Fusion / Q000009:adverse effects / Q000193:education*; D020775:Thoracic Surgery, Video-Assisted / Q000009:adverse effects / Q000193:education*; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D013908:Thoracotomy / Q000009:adverse effects; D013997:Time Factors; D016896:Treatment Outcome