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Updated: Aug 13, 2026
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Non-Intubated Video-Assisted Thoracoscopic Surgery
Published on: May 26, 2023
The Konakondla-Telfeian-Shen (KTS) Pyramid: a safe entry zone for ventral thoracic pathologies
Sanjay Konakondla1, Shailen G Sampath2, Isaac Lee2
1The Endoscopic Spine Institute of New York (ESINY), New York, NY, USA.
Journal of Spine Surgery (Hong Kong)
|August 12, 2026
Summary
A new Konakondla-Telfeian-Shen (KTS) Thoracic Pyramid framework enhances transforaminal (TF) endoscopic spine surgery planning. This standardized approach improves safety and communication for accessing ventral thoracic pathology.
Area of Science:
- Neurosurgery
- Spine Surgery
- Minimally Invasive Procedures
Background:
- Traditional Kambin's triangle is inadequate for thoracic transforaminal (TF) endoscopic spine surgery due to unique thoracic anatomy.
- Thoracic anatomy presents challenges like smaller foraminal dimensions and spinal cord proximity, unlike lumbar anatomy.
Purpose of the Study:
- To define a standardized, three-dimensional thoracic TF working corridor: the Konakondla-Telfeian-Shen (KTS) Thoracic Pyramid.
- To establish a framework for preoperative planning and standardized anatomic language for thoracic endoscopic access.
Main Methods:
- Conceptualized the thoracic TF corridor as a six-faced, three-dimensional volume.
- Incorporated level-dependent anatomic constraints including the rib head-costovertebral complex and pedicle morphology.
- Discussed variations related to degeneration, fusion, prior surgery, and vascular anatomy within the geometric framework.
Main Results:
- The KTS Pyramid defines a reproducible, level-specific posterolateral access corridor to the ventral thoracic canal.
- The corridor's dimensions narrow predictably from T12 to T1 due to anatomical changes.
- Identified specific anatomical structures limiting access at each thoracic level within the pyramid framework.
Conclusions:
- The KTS Pyramid offers a formal geometric and anatomic description for thoracic TF working corridors.
- Standardizing thoracic endoscopic planning with the KTS Pyramid enhances safety and communication.
- This framework aims to shorten the learning curve and facilitate future research in thoracic endoscopic spine surgery.
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