Scoliosis & Spinal Deformity Surgery
What Is Video-Assisted Thoracoscopic Surgery (VATS)?
VATS is a minimally invasive procedure that doctors use to gain entry to the spine from the front (or anterior) side. Although most forms of scoliosis surgery adopt a posterior approach, certain types of thoracic scoliosis will require a different port of entry.
More specifically, the VATS procedure utilizes a tiny video scope (aka a thoracoscope), small incisions, and special implements to prevent collateral damage to nearby tissues. In fact, sometimes, doctors alternatively refer to this procedure as a thoracoscopy.
Thoracoscopes are not unlike the cameras used in tubular retractors. Both tiny cameras stream live video to a nearby monitor, which allows the surgeon to guide their instruments. Usually, the surgeon inserts the camera into the chest cavity via small incisions in the chest wall.
The biggest upside to this procedure is its minimally invasive nature, which means a couple of things for the patient. First of all, the recovery period is much shorter than with traditional open procedures (known as thoracotomies). Secondly, it is much less likely that nearby tissues (such as muscle) will be damaged during VATS. This is why the recovery period is also quicker, as muscle, in particular, takes an eternity to heal.
Patient Selection for VATS & Alternative Uses
Scoliosis doctors use VATS to treat very specific kinds of scoliosis in children. For example, your doctor may recommend VATS if your child meets the following criteria:
- A doctor has diagnosed your child with severe idiopathic scoliosis (>80 degrees of thoracic curvature)
- The curvature in question is rigid instead of flexible in nature
- Your child has yet to reach skeletal maturity, maximizing the effectiveness of this intervention
- Your child would otherwise require a thoracotomy (a much more invasive form of correction) to reverse their curvature
However, certain types of patients are less likely than others to tolerate VATS. For instance, your doctor will not recommend VATS if your child has a condition that prevents him or her from undergoing single-lung ventilation (a key step in most of these procedures). Likewise, your child might not qualify for VATS if he or she has significant lung scarring from a previous procedure; or if his or her scoliotic curvature juts out into the chest wall.
Outside of the scoliosis world, surgeons use VATS to treat and diagnose a wide range of conditions that affect the thorax, heart, and lungs. One of the most common reasons that doctors perform VATS, for instance, involves removing a portion of lung affected by cancer. Of course, the applications of this procedure don’t just end there. Your doctor may use VATS to biopsy the lung, lymph nodes, surrounding respiratory or cardiovascular tissues, or the esophagus.
Likewise, heart procedures, like pacemaker lead placement or mitral valve repair, may also use VATS. In addition, your surgeon may use VATS to:
- Drain fluid from a lung (infection) or cardiovascular system (infection/inflammation)
- Drain an abscess
- Prevent pleural effusions
- Treat gastroesophageal disease associated with surgery
- Remove restrictive fibrous tissue surrounding the respiratory system
- Repair congenital chest wall conditions
- Treat diaphragm paralysis
How is VATS Performed?
The answer to this question depends on the application of VATS. For brevity, we will examine one of the most common minimally invasive procedures that uses VATS: a thoracoscopy.
A thoracoscopy is essentially an endoscopy that allows for access to the chest/thoracic spine region. Using thoracoscopic guidance, surgeons can achieve access to the thoracic spine through a series of lateral entry points on the chest wall. Sometimes, the surgeon must also deflate a single lung (known as single-lung ventilation) to achieve optimal access to the spine.
In the past, surgical treatment for thoracic scoliosis inevitably meant an open procedure for the patient. These leave large scars and take much longer to heal when compared to minimally invasive procedures. Instead of making a large incision, the surgeon uses a series of small incisions to access the affected area. Then, the surgeon uses these small access points as entryways for their endoscopic instruments.
In most cases, scoliotic curve reduction usually results in the removal of a number of intervertebral discs. Additionally, many of these scenarios also involved fusion as well as spinal instrumentation. More specifically, surgeons use the latter two to correct the abnormality in the spine, as well as to provide spinal stability.
In short, several incisions are made on the side of the body to allow endoscopic access to the affected area. The surgeon then uses these instruments to navigate through the procedure. Typically, scoliotic curve correction means that a number of intervertebral discs and end plates will be removed. Once the surgeon performs the necessary steps for the patient’s specific needs, the instruments are removed and the incisions are closed.
How Do I Prepare For a VATS Procedure?
Always consult with your doctor about the steps that you will need to take before undergoing any surgical procedure. He or she will provide you with both useful and mandatory advice to consider before your procedure date.
Some patients may need to stop taking certain medicines before they have a VATS procedure. In adults, this list is pretty much comprised of blood thinners, but there are other substances you should stop taking as well. Make sure to disclose all medications that your child is currently taking to your doctor. This list should include any OTC medications, as well as any vitamins or supplements.
Engaging in daily exercise is also important when it comes to preparing for any surgery. Of course, the most appropriate exercises for you will depend on your condition and the nature of your procedure. Consult with your doctor for insights. For example, some doctors may require that their patients perform breathing exercises with a spirometer to strengthen the lungs in preparation for VATS. Your doctor will let you know if this applies to your child.
Lastly, your doctor may perform additional tests to determine whether or not VATS is a good fit for you or your child. These tests may include:
- Chest X-rays
- CT Scans
- Positron emission tomography
- Blood tests
- Pulmonary function tests
Risks Associated With VATS Procedures
Any surgery comes with complications, even those that are minimally invasive. The biggest concern with minimally invasive procedures is whether or not they will effectively address the problem. Most patients do relatively well with VATS procedures, but rare complications do occur. These include:
- Air leakage
- Atelectasis (partial lung collapse)
- Surgery-associated pneumonia
- Adverse reaction to anesthesia
As you might have noticed, most of these risks ride along the coattails of any surgical procedure, save a few. Your level of risk will depend on a variety of factors, such as your age, pre-existing medical conditions, and the reason for the procedure. However, as a general rule of thumb, children undergoing VATS tend to be more resilient than adults.
After a VATS Procedure
Most patients wake up after a VATS procedure in around 2 or 3 hours. Your child will likely be connected to several machines that monitor vitals, such as heart rate. In addition, patients who undergo single-lung ventilation will be given oxygen via small tubes placed in the nasal cavity. Your child will likely experience a moderate level of soreness after the procedure, but it should not be severe. Your medical team will provide your child with intravenous pain medications to help cope with any discomfort.
In addition, your child will likely be assigned a team of experts who help him or her reacclimate to performing daily tasks after surgery. This may involve teaching your child strategies to walk, rise from bed, or climb the stairs safely.
If you believe that your child needs scoliosis surgery, please contact us at (855) 220-5966. Dr. Jason Lowenstein is a leading expert in the field of minimally invasive surgical treatments and a winner of the NJ Favorite Kids’ Doc award for pediatric spine doctors. He will work tirelessly to ensure that every child receives the best treatment for their specific needs. Whether this involves conservative treatments like scoliosis bracing or minimally invasive surgeries, like spinal fusion, Dr. Lowenstein is passionate about finding solutions for his patients.