MISS THORASIC INFECTION
DIRECTOR GOVERNMENT SPINE INSTITUTE
HEAD OF ORTHOPEDIC DEPT.
CIVIL HOSPITAL AHMEDABAD
Anterior Spinal endoscopy
and Minimal access
Conventional Surgical Approach to spine
Conventional thoracotomy require large approach.
Rib resection cause post operative costal pain.
More blood loss
Post operative pleural adhesion and loss of lung
• Postoperative shoulder stiffness.
• Late recovery, late rehabilitation, longer hospital
stay and higher cost of treatment.
Conventional Surgical Approach to spine
• Conventional retroperitoneal and
laparotomy again need large exploration.
• More morbid cause of large dissection
trough abdominal musculature.
• Requires mobilization of big vessels.
• Complication like incisional hernia is
• Peritoneal adhesion causes post
• Infection and instrumentation failure is
• Late recovery, longer rehabilitation and
training is required.
Video assisted Minimal access
• Video assisted minimal access surgeries
is done through small incision with
special retractor system.
• Enhanced visualization with help of
telescope placed from same portal or
• Promising result with faster recovery.
• Less morbid approach.
• All possible spinal procedure can be
• Minimum-access techniques have
surgery, including Orthopaedics and
traumatology, where, since the early
80s, arthroscopy has revolutionized
the treatment of joint disorders.
• The first Thoraco-scopy was performed by H.C.
Jacbaeus in Stockholm in 1910 using cystoscope
for the division of tuberculous adhesions.
• Till early 1980’s laparoscopy was used extensively
to perform general surgical work.
• In early 1990’s VATS was used to treat various
pulmonary conditions like recurrent pleural
effusion, recurrent pneumothoraces, for lung
biopsy and evaluation of mediastinal adenopathy.
• Obenchain performed a laparoscopic L5-S1
discectomy, followed, in 1992, by Thomas
Zdeblick’s L5-S1 fusion by laparoscopic placement
of an interbody cage.
• In 1994, Rosenthal et al reported the first excision
of a herniated thoracic disc by thoracoscopic
• In 1994, Le Huec and Husson performed the first
endoscopic retroperitoneal approach to the lumbar
Together, these three techniques provide access to
the thoracic and lumbar spine in its entirety.
Advantages over conventional
• Minimal access to thorasic,
retroperitoneal, and abdominal cavity.
• Faster recovery
• Less post operative pain
• Less morbidity
• Less blood loss
• Less hospital stay
• Quick return to work
Requires higher skills and long learning
• VATS on the spine should be performed in a
standard operating room. Some modifications
from routine spinal procedures are needed.
• Double-lumen Endotracheal tube placement for
one lung anesthesia.
• Position: in the lateral decubitus position and
secured. The lower extremities are gently flexed
• The operating table should be capable of
Trendelenburg or reverse Trendelenburg
positions in order to allow the deflated lung to
fall away from the spine to increase visualization
and decrease inadvertent injury during the
• Both the Spine surgeon and Thoracic
surgeons stand on the same side of the
patient, the abdominal side, across from
the video monitor.
• The third assistant, if necessary, stands
on the back side of the patient and faces
an opposing second monitor.
• The thoracic surgeon usually obtains and
holds the exposure, the orthopaedic
surgeon controls the orthopaedic
instruments with both hands, and the
third assistant may hold the camera
and/or retract the lung.
• Usually 30 degree, 10mm DM
scope is used for all spinal
• Rigid scope had flexible claw
camera attachment at rear end
and light source on side.
• Trocar system are the portals to enter the
Thorasic, Retroperitoneal or Abdominal
• They come in size from 5 mm to 12 mm
• The Trocar it self is of different variety
like blunt tip, blade tip and dilating tip
according to the tissue to be approached.
• The cannula size also comes from 60
mm to 110 mm length.
• The first trocar inserted for
thoracoscopy is at the usual site in
5th or 6th intercostal space. According
to marker over spine.
• Usually blunt tip trocar to avoid
damage to lung.
• Other ports are taken in direct vision
to allow optimum placement for the
• Release of anterior scoliosis and other
• Herniated disc disease
• Vertebral fractures, decompression and
reconstruction of spinal column with or
with out anterior Instrumentation
• Abscess drainage and debridement in
tuberculous spine with reconstruction.
• Tumor biopsy and resection.
• Use of large approach for drainage of
spinal abscesses seems to be
unrealistic in modern era
• Small portal surgery or conventional
endoscopy can perform same work
with less morbidity
• Thoraco-scopy is reliable method
used for removal of adhesion of
lungs in pleurisy and fibrolysis so can
be used with adherent lung.