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Video-Assisted Thoracic Surgery to Treat Spinal Deformities: Climbing the Learning Curve
José Eduardo Rivo Vázqueza,
, Miguel Ángel Cañizares Carreteroa, Eva García Fontána, Montserrat Blanco Ramosa, Ermitas Varela Aresb, César Justo Tarrazob
Corresponding author
eduardorivo@yahoo.es
Correspondence: Dr. J.E. Rivo Vázquez. Servicio de Cirugía Torácica. Hospital Xeral. CHUVI. Pizarro, 22. 36204 Vigo. Pontevedra. España
Correspondence: Dr. J.E. Rivo Vázquez. Servicio de Cirugía Torácica. Hospital Xeral. CHUVI. Pizarro, 22. 36204 Vigo. Pontevedra. España
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] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Cirugía Torácica, Hospital Xeral, Complexo Hospitalario Universitario de Vigo, Vigo, Pontevedra, Spain" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff1" ] 1 => array:3 [ "entidad" => "Servicio de Cirugía Ortopédica y Traumatología, Hospital Xeral, Complexo Hospitalario Universitario de Vigo, Vigo, Pontevedra, Spain" "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff2" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor1" "etiqueta" => "*" "correspondencia" => "Correspondence: Dr. J.E. Rivo Vázquez. Servicio de Cirugía Torácica. Hospital Xeral. CHUVI. Pizarro, 22. 36204 Vigo. Pontevedra. España" ] ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2005-12-18" "fechaAceptado" => "2006-10-10" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Key words" "identificador" => "xpalclavsec154837" "palabras" => array:6 [ 0 => "Diskectomy" 1 => "Spinal fusion" 2 => "Scoliosis" 3 => "Thoracoscopy" 4 => "Video-assisted thoracic surgery" 5 => "Endoscopic treatment of scoliosis" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec154836" "palabras" => array:6 [ 0 => "Discectomía" 1 => "Fusión espinal" 2 => "Escoliosis" 3 => "Toracoscopia" 4 => "Cirugía torácica videoasistida" 5 => "Tratamiento endoscópico de la escoliosis" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:1 [ "resumen" => "<span class="elsevierStyleSectionTitle">Objective</span><p class="elsevierStyleSimplePara elsevierViewall">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.</p> <span class="elsevierStyleSectionTitle">Patients and methods</span><p class="elsevierStyleSimplePara elsevierViewall">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.</p> <span class="elsevierStyleSectionTitle">Results</span><p class="elsevierStyleSimplePara elsevierViewall">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).</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p class="elsevierStyleSimplePara elsevierViewall">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.</p>" ] "es" => array:1 [ "resumen" => "<span class="elsevierStyleSectionTitle">Objetivo</span><p class="elsevierStyleSimplePara elsevierViewall">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.</p> <span class="elsevierStyleSectionTitle">Pacientes y métodos</span><p class="elsevierStyleSimplePara elsevierViewall">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.</p> <span class="elsevierStyleSectionTitle">Resultados</span><p class="elsevierStyleSimplePara elsevierViewall">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 perioperato ria 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).</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p class="elsevierStyleSimplePara elsevierViewall">La aplicación de la cirugía torácica video-asistida 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 con-junta por cirujanos ortopédicos y torácicos.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:26 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Thoracoscopic techniques for the treatment of scoliosis: early results in procedure development" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "GD Picetti III" 1 => "D Pang" 2 => "HU Bueff" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Neurosurgery" "fecha" => "2002" "volumen" => "51" "paginaInicial" => "978" "paginaFinal" => "984" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12234406" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib2" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Thoracoscopic spine surgery: current indications and techniques" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "TR Kuklo" 1 => "LG Lenke" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Orthop Nurs" "fecha" => "2000" "volumen" => "19" "paginaInicial" => "15" "paginaFinal" => "22" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11899304" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib3" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Minimally invasive spine instrumentation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "DH Kim" 1 => "S Jaikumar" 2 => "AC Kam" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Neurosurgery" "fecha" => "2002" "volumen" => "51" "paginaInicial" => "S15" "paginaFinal" => "S25" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12234426" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib4" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "American Orthopaedic Association. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 4 | 3 | 7 |
| 2024 October | 32 | 23 | 55 |
| 2024 September | 26 | 14 | 40 |
| 2024 August | 45 | 38 | 83 |
| 2024 July | 28 | 23 | 51 |
| 2024 June | 23 | 20 | 43 |
| 2024 May | 36 | 29 | 65 |
| 2024 April | 24 | 29 | 53 |
| 2024 March | 20 | 17 | 37 |
| 2024 February | 16 | 19 | 35 |
| 2023 March | 3 | 3 | 6 |
| 2023 February | 19 | 15 | 34 |
| 2023 January | 15 | 25 | 40 |
| 2022 December | 25 | 24 | 49 |
| 2022 November | 17 | 23 | 40 |
| 2022 October | 22 | 41 | 63 |
| 2022 September | 15 | 21 | 36 |
| 2022 August | 17 | 36 | 53 |
| 2022 July | 20 | 39 | 59 |
| 2022 June | 20 | 36 | 56 |
| 2022 May | 18 | 32 | 50 |
| 2022 April | 18 | 35 | 53 |
| 2022 March | 16 | 46 | 62 |
| 2022 February | 21 | 30 | 51 |
| 2022 January | 13 | 22 | 35 |
| 2021 December | 13 | 53 | 66 |
| 2021 November | 14 | 43 | 57 |
| 2021 October | 13 | 31 | 44 |
| 2021 September | 15 | 59 | 74 |
| 2021 August | 13 | 32 | 45 |
| 2021 July | 9 | 25 | 34 |
| 2021 June | 11 | 28 | 39 |
| 2021 May | 10 | 23 | 33 |
| 2021 April | 9 | 41 | 50 |
| 2021 March | 24 | 35 | 59 |
| 2021 February | 10 | 10 | 20 |
| 2021 January | 11 | 10 | 21 |
| 2020 December | 11 | 11 | 22 |
| 2020 November | 6 | 27 | 33 |
| 2020 October | 9 | 2 | 11 |
| 2020 September | 9 | 1 | 10 |
| 2020 August | 6 | 7 | 13 |
| 2020 July | 12 | 18 | 30 |
| 2020 June | 12 | 9 | 21 |
| 2020 May | 10 | 10 | 20 |
| 2020 April | 17 | 11 | 28 |
| 2020 March | 9 | 7 | 16 |
| 2020 February | 16 | 10 | 26 |
| 2020 January | 17 | 13 | 30 |
| 2019 December | 16 | 8 | 24 |
| 2019 November | 12 | 4 | 16 |
| 2019 October | 6 | 9 | 15 |
| 2019 September | 8 | 9 | 17 |
| 2019 August | 10 | 6 | 16 |
| 2019 July | 17 | 18 | 35 |
| 2019 June | 6 | 14 | 20 |
| 2019 May | 11 | 10 | 21 |
| 2019 April | 13 | 23 | 36 |
| 2019 March | 11 | 20 | 31 |
| 2019 February | 11 | 7 | 18 |
| 2019 January | 8 | 9 | 17 |
| 2018 December | 7 | 6 | 13 |
| 2018 November | 15 | 11 | 26 |
| 2018 October | 17 | 11 | 28 |
| 2018 September | 13 | 10 | 23 |
| 2018 May | 7 | 0 | 7 |
| 2018 April | 8 | 5 | 13 |
| 2018 March | 9 | 5 | 14 |
| 2018 February | 9 | 7 | 16 |
| 2018 January | 4 | 4 | 8 |
| 2017 December | 7 | 4 | 11 |
| 2017 November | 4 | 3 | 7 |
| 2017 October | 5 | 5 | 10 |
| 2017 September | 1 | 8 | 9 |
| 2017 August | 7 | 12 | 19 |
| 2017 July | 3 | 2 | 5 |
| 2017 June | 9 | 13 | 22 |
| 2017 May | 7 | 11 | 18 |
| 2017 April | 1 | 2 | 3 |
| 2017 March | 2 | 11 | 13 |
| 2017 February | 2 | 5 | 7 |
| 2017 January | 3 | 1 | 4 |
| 2016 December | 7 | 10 | 17 |
| 2016 November | 13 | 4 | 17 |
| 2016 October | 11 | 14 | 25 |
| 2016 September | 17 | 12 | 29 |
| 2016 August | 15 | 3 | 18 |
| 2016 July | 4 | 2 | 6 |
| 2016 March | 1 | 0 | 1 |
| 2016 February | 1 | 0 | 1 |
| 2015 December | 2 | 0 | 2 |
| 2015 October | 44 | 11 | 55 |
| 2015 September | 36 | 3 | 39 |
| 2015 August | 42 | 9 | 51 |
| 2015 July | 50 | 5 | 55 |
| 2015 June | 35 | 8 | 43 |
| 2015 May | 54 | 6 | 60 |
| 2015 April | 32 | 6 | 38 |
| 2015 March | 39 | 7 | 46 |
| 2015 February | 31 | 4 | 35 |
| 2015 January | 27 | 5 | 32 |
| 2014 December | 39 | 4 | 43 |
| 2014 November | 43 | 5 | 48 |
| 2014 October | 39 | 7 | 46 |
| 2014 September | 28 | 9 | 37 |
| 2014 August | 35 | 7 | 42 |
| 2014 July | 30 | 8 | 38 |
| 2014 June | 40 | 4 | 44 |
| 2014 May | 52 | 10 | 62 |
| 2014 April | 45 | 3 | 48 |
| 2014 March | 59 | 9 | 68 |
| 2014 February | 53 | 12 | 65 |
| 2014 January | 46 | 8 | 54 |
| 2013 December | 47 | 5 | 52 |
| 2013 November | 34 | 10 | 44 |
| 2013 October | 41 | 7 | 48 |
| 2013 September | 38 | 9 | 47 |
| 2013 August | 28 | 8 | 36 |
| 2013 July | 54 | 19 | 73 |
| 2013 June | 28 | 3 | 31 |
| 2013 May | 35 | 5 | 40 |
| 2013 April | 23 | 3 | 26 |
| 2013 March | 7 | 1 | 8 |
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