[Video-assisted thoracic surgery to treat spinal deformities: climbing the learning curve].
OBJECTIVE
The aim of this study was to analyze the impact of the learning curve on the preliminary results of video-assisted thoracic surgery for spinal deformities in a general hospital setting.


METHODS
We retrospectively reviewed the medical records of 15 patients who underwent video-assisted thoracic surgery performed by a multidisciplinary team comprising orthopedic and thoracic surgeons. Endoscopic anterior release and fusion were followed by posterior instrumentation in a single procedure. Demographic, orthopedic, morbidity, and mortality statistics were compiled for the 15 patients and compared to results reported for similar series.


RESULTS
Endoscopic surgery was indicated for 15 patients: 11 women (73.3%) and 4 men (26.7%). The median age was 15 years (interquartile range [IQR], 14-19 years). Three patients (20%) required conversion to thoracotomy. There were 2 serious (13.3%) and 3 minor complications (20%). They all resolved satisfactorily and there was no perioperative mortality. The median Cobb angle was 71 degrees (IQR, 63.75 degrees -75.25 degrees ) before surgery and 41 degrees (IQR, 30 degrees -50 degrees ) after surgery. Median duration of surgery was 360 minutes (IQR, 300-360 minutes), duration of postoperative recovery unit stay was 1.5 days (IQR, 1-2.75 days), and total hospital stay was 11.5 days (IQR, 8.25-14 days).


CONCLUSIONS
Despite the complexity of video-assisted thoracic surgical procedures, we believe they will become the standard approach to treating spinal deformities in the near future. By working together in general hospital settings, orthopedic and thoracic surgeons can help to overcome the steep yet manageable learning curve.
Rivo Vázquez
José Eduardo
JE
Servicio de Cirugía Torácica. Hospital Xeral, Complexo Hospitalario Universitario de Vigo, Vigo, Pontevedra, Spain. eduardorivo@yahoo.es
Cañizares Carretero
Miguel Angel
MA
García Fontán
Eva
E
Blanco Ramos
Montserrat
M
Varela Ares
Ermitas
E
Justo Tarrazo
César
C
D000293:Adolescent; D000328:Adult; D004724:Endoscopy / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007858:Learning; D008297:Male; D009985:Orthopedics / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D013122:Spinal Diseases / Q000453:epidemiology* / Q000601:surgery*; D013903:Thoracic Surgery / Q000706:statistics & numerical data; D020775:Thoracic Surgery, Video-Assisted / Q000706:statistics & numerical data*