Evolution of Video Assisted Thoracoscopic Surgery for Thoracic Disc Herniation: Towards Biportal Thoracoscopic Approach.

Abstract

This work aims to describe the evolution of the video-assisted Thoracoscopic Surgery (VATS) approach from a multiportal access to a biportal access for thoracic herniated disc surgery. Thoracic disc herniation remains a challenging pathology for spine surgeons. VATS of the thoracic spine was described in the 90s and represented an important technical leap by including minimally invasive options for thoracic pathology. Nowadays, VATS in thoracic surgery tends to evolve towards an even less invasive technique, from a multiportal approach to a biportal one. We describe the adoption of this approach for our spinal pathology in 3 patients. We use a two-port VATS. The largest (approximately 5 cm) with an Alexis retractor and a second port (1.5 cm) just for the camera. The 3 patients started walking in less than 24 hours and none suffered any complications related to the approach. All of them reported tolerable pain at the surgical site. Changing our previous VATS system from 3 to 5 ports was relatively easy regarding the surgical technique. This access allows the surgeon to manipulate the instrumentation confidently and the camera does not fog up as often. Extracting a piece of rib is unnecessary and theoretically, we only manipulate 1 or at most 2 intercostal nerves, so the patient's recovery is favorable.