Three-Dimensional Thoracoscopic Surgery for Spine Fractures: A Technical Report With First Results and Experiences

Study Design: Technical report. Objectives: Conventional 2-dimensional (2D) video-assisted thoracoscopy (VATS) is a technical procedure mainly performed by experienced surgeons. The technique may, however, come with difficulties in hand-eye coordination and estimation of depth. Three-dimensional thoracoscopy can help overcome these difficulties by providing a stereoscopic 3D view. The objective of this study is to report the first experience and results with 3D thoracoscopy for spine surgery in trauma patients. Methods: The first 4 patients treated with anterior stabilization for traumatic spine fractures using 3D thoracoscopy in an academic hospital are described. Baseline characteristics, operative time, and blood loss were retrospectively collected. This data is compared with a cohort of patients treated in the same center with the conventional 2D technique. Additionally, the treating surgeons' and residents' experience with the technique is described. Surgical equipment consists of 3D compatible video monitors, a videoscope with 2 cameras, and special glasses to be worn by the personnel. Results: Four patients were successfully treated using 3D thoracoscopy. Operative time was comparable to that of the conventional 2D technique and less blood loss occurred. No per-or postoperative complications or problems occurred. Peroperative views were of very high quality and provided improved depth perception. Surgeons and residents deemed the technique helpful, especially during technically demanding aspects of the procedure. Conclusions: While a shorter learning curve, decreased surgery time, and blood loss have to be proven in future prospective studies, the first experience with 3D-VATS for spine surgery is positive, and future use in minimally invasive spine surgery seems feasible.