[Video-assisted thoracic surgery to treat spinal deformities: climbing the learning curve]. / Cirugía torácica videoasistida de las deformidades espinales: afrontando la curva de aprendizaje.

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. PATIENTS AND 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.

Cirugía torácica videoasistida de las deformidades espinales: afrontando la curva de aprendizaje / Video-assisted thoracic surgery to treat spinal deformities: climbing the learning curve

Objetivo: Analizar el impacto de la curva de aprendizaje sobre los resultados iniciales de la cirugía torácica videoasistida de las deformidades espinales realizada en un hospital general. Pacientes y métodos: Se revisaron de forma retrospectiva los registros clínicos de 15 pacientes intervenidos de deformidades espinales mediante cirugía torácica videoasistida por un equipo multidisciplinario formado por cirujanos ortopédicos y torácicos. El procedimiento consistió en la liberación y fusión anteriores endoscópicas, seguidas de una instrumentación posterior en el mismo acto. Se compararon los datos demográficos, ortopédicos y de morbimortalidad con los de otras series publicadas. Resultados: Se indicó el abordaje endoscópico en 15 pacientes ­11 (73,3%) mujeres y 4 (26,7%) varones­, con una edad mediana de 15 años (rango intercuartílico [RIQ]: 14-19). En 3 casos (20%) fue necesario convertir el procedimiento en una toracotomía. Se registraron complicaciones graves en 2 pacientes (13,3%) y leves en 3 (20%). Todas se resolvieron satisfactoriamente y la mortalidad perioperatoria fue nula. La mediana de los ángulos de Cobb preoperatorios era de 71º (RIQ: 63,75-75,25) y pasó a ser de 41° (RIQ: 30-50) tras la corrección. Las intervenciones duraron una mediana de 360 min (RIQ: 300-360). Los pacientes permanecieron ingresados en la unidad de reanimación una mediana de 1,5 días (RIQ: 1-2,75) y la estancia hospitalaria total fue de 11,5 días (RIQ: 8,25-14). Conclusiones: La aplicación de la cirugía torácica videoasistida a la enfermedad deformativa del raquis torácico resulta técnicamente compleja pero ineludible en un futuro inmediato, con una curva de aprendizaje dilatada pero abordable en un hospital general si se hace de forma conjunta por cirujanos ortopédicos y torácicos

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. Patients and 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° (IQR, 63.75°-75.25°) before surgery and 41° (IQR, 30°-50°) 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