THORACOSCOPIC

SCOLIOSIS

CORRECTION

Dr. Libin Thomas Manathara

Dr. Scott Chacko John

AMALA SPINE & JOINT CENTRE

AMALA INSTITUTE OF MEDICAL SCIENCES

MINIMAL INCISION

/

MINIMALLY INVASIVE

?

MISS

IS REALLY

MINIMALLY INVASIVE

SPINE SURGERY

Not only the incision, but also techniques

of spine surgery have

been changed

THORACOSCOPIC SPINE

SURGERY

• SCOLIOSIS

• TUMOURS

• FRACTURES

SINGLE LUNG VENTILATION

SINGLE LUNG VENTILATION

SINGLE LUNG VENTILATION

THORACOSCOPIC SPINE

SURGERY• ADVANTAGE

THORACOSCOPIC THORACOTOMY

LESS INVASIVE INVASIVE

EARLY RETURN TO WORK LONG POST OPERATIVE

STAY

LESS MORBIDITY MORE MORBIDITY

RIBS ARE INTACT RIBS ARE

FRACTURED/CUT

PORTS

• WORKING PORT 15-30mm

• THORACO SCOPIC PORT 11mm

• FAN RETRACTOR 11mm

• SUCTION IRRIGATION 5mm

Position

LEFT LATERAL

Special instruments required• 30 degree thoracoscope

• Sharp narrow osteotome

• 11mm trochar

• 5mm trochar

• Fan retractor

• Long Cobbs elevator, Rongers

• Good camera with twin monitor

• Light source –LED

• HARMONIC SCALPEL

62

44

15

18

THORACOSCOPIC SCOLIOSIS CORRECTION

WITHOUT SCAR ON THE BACK

• 14yr old female

• Right thoracic

curve of 59o T4-

L1

• Thoracoscopic

instrumented

correction

• Post OP- 15o

Delta Baby, 11yrs, female,

OP. NO. 2553530Date of surgery- 10 May 2016

Presentation• Low back ache for 2 weeks duration

• Cough for 2 weeks with associated posttussive

emesis

• No associated fever

• A K/C/O Kyphoscoliosis now progressive

• K/C/O ventricular septal defect for which she

underwent no surgery

• All developmenatl milestones attained to age

• No other significant family history

Clinical Examination

• Vitals stable

• Systems Normal

• Spine, Inspection- Visible thoracic scoliosis with

convexity to right

• Palpation- Kyphoscolios with thoracic scoliosis

with right convexity and compensatory lumbar

scoliosis with left convexity

• Normal neurological examination

Pre surgical work up

• Pre anaesthetic, cardiology and pulmonology work

up was done, no contraindication to surgery

• History of congenital heart disease- small sub

aortic VSD was noted

• PFT done- moderate restriction noted (FVC 52%),

No BDR (Bronchodilator responsiveness)

Surgical Procedure

• Video – Assisted Thoracoscopic Spine

Surgery (VATS) for Scoliosis

• Anteriorly approached via 5 ports under C-

arm control

• Adequate reduction was obtained

Right thoracic convexity of 90 degrees and

left lumbar convexity of 37 degrees- pre op

Post op xray

Discussion

• The word “scoliosis” is derived from the Greek

word meaning “crooked”

• Scoliosis is defined as a lateral deviation of the

normal vertical line of the spine

• The lateral curvature of the spine also is associated

with rotation of the vertebrae

• This produces a three-dimensional deformity of

the spine that occurs in the sagittal, frontal, and

coronal planes

Discussion

• Surgery for scoliosis has seen dramatic progress in

the methods of treatment

• The surgical incision is most commonly

performed posteriorly, on the back of the spine,

but there are specific circumstances when an

incision is needed to approach the front of the

spine (anterior approach)

Discussion

• Historically, anterior surgery was performed

through an open thoracotomy

• This required a large incision through the

chest wall and chest cavity

• Technological advances have allowed spine

surgeons to perform these same procedures

through small incisions in the chest wall

using endoscopic instruments

THORACOSCOPIC SPINE SURGERY

DISADVANTAGE

STEEP LEARNING CURVE

AMALA SPINE & JOINT CENTRE