[Thoracoscopy versus thoracotomy in spinal surgery: comparison of 2 paired series]

This study was carried out to compare the intraoperative and postoperative results of conventional surgery of the thoracic spine by thoracotomy with those of the thoracoscopic technique to determine the advantages of this new approach.

A series of twenty-nine patients operated by thoracoscopy for a spinal disorder was matched regarding the etiology of spine disease and type of surgical procedure with twenty-four patients operated by thoracotomy. This matching procedure yielded two similar groups of twenty patients. The criteria used for evaluation were the duration of the procedure, blood loss, intraoperative complications, the duration of stay in postoperative intensive care, the duration and yield of pleural drainage, the time until return to the upright position, duration of use of WHO grade-three analgesics (morphine derivatives), the postoperative complications, and the length of hospitalization.

There was a significant difference in three parameters: the duration of the procedure (thoracotomy, 172 min; thoracoscopy, 246 min; p < 0.006), intraoperative bleeding (thoracotomy, 837 mL; thoracoscopy, 447 mL; p < 0.0009), and duration of use of WHO grade-three analgesics (thoracotomy, 4.5 days; thoracoscopy, 2.3 days; p = 0.011). There was no difference in the intra- or postoperative complication rates of the two methods.

The better view provided by thoracoscopy and its preservation of the wall structures probably explain why there was less bleeding and postoperative pain with this technique. The insufficiency of the current thoracoscopic instrumentation and the learning curve account for the longer duration of these interventions.

These data confirm the usefulness of thoracoscopy which is less traumatizing, less hemorrhagic, and causes no more complications than thoracotomy. The longer operative duration is currently a minor drawback, and should shorten with experience and the development of specific instrumentation.