HOJ-2003 v7

Dr. M. Timothy Hresko Department of Orthopaedic Surgery Children’s Hospital 300 Longwood Avenue, Hunnewell 2 Boston, MA 02115 617-355-6617 [email protected] INTRODUCTION Video-assisted thoracoscopic (VAT) spinal surgery has become a popular approach to the anterior thoracic spine. VAT spinal surgery has benefits over the traditional open thoracotomy approach in that the scar is less unsightly, there is less postoperative morbidity, and there is better visualization at the ends of the fusion. VAT spinal surgery is performed either in the lateral position with single lung ventilation via a double lumen endotracheal intubation or prone with single lumen endotracheal technique. The single lumen technique is particularly useful in the child less than thirty kilograms, as single lung ventilation is difficult in the small child. Access from the T-2 to L1 vertebral body and disc can be obtained with retraction of the relevant structures. The indications for VAT spinal surgery are similar to the indications for open surgery and include: