Modified French-window thoracotomy for exposure of the anterior thoracic spine

Article · March 2011with2 Reads
DOI: 10.1510/icvts.2010.259564 · Source: PubMed
Due to the limited exposure, technical challenges, and postoperative pain of thoracic spine surgery, open thoracotomy and video-assisted thoracic surgery (VATS) are associated with significant morbidity and mortality. The modified French-window thoracotomy approach with the aid of a thoracoscope is a useful technique for approaching diseases of the anterior spinal. This approach allows for specific exposure of the spine with a reduction in postoperative pain, morbidity, and mortality and avoids the limitations of VATS.
  • [Show abstract] [Hide abstract] ABSTRACT: Thoracoscopy has been used worldwide for many years by thoracic surgeons. Despite a long learning curve and technical demands of the procedure, thoracoscopy has several advantages, including better cosmesis, adequate exposure to all levels of the thoracic spine from T2 to L 1, better illumination and magnification at the site of surgery, less damage to the tissue adjacent to the surgical field, less morbidity when compared with standard thoracotomy in terms of respiratory problems, pain, blood loss, muscle and chest wall damages, consequent shorter recovery time, less postoperative pulmonary function impairment, and shorter hospitalization. Good results at short- and medium-term follow-up need to be confirmed at long-term follow-up.
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  • [Show abstract] [Hide abstract] ABSTRACT: Video-assisted thoracic surgery is associated with less pain and shorter recovery than open procedures. Due to limited exposure, video-assisted thoracic surgery is not suitable for the management of all intrathoracic pathology. Muscle-sparing thoracotomies are smaller, but they are not associated with less pain or faster recovery. A modified French window is a useful approach to complex intrathoracic pathology and may result in less postoperative pain and shorter recovery than standard and muscle-sparring thoracotomies. This technique is suitable for the management of complex intrathoracic disease.
    Article · Sep 2009
  • [Show abstract] [Hide abstract] ABSTRACT: To consider optimal analgesic strategies for thoracic surgical patients. Recent studies have consistently suggested analgesic equivalence between paravertebral and thoracic epidural analgesia. Complications appear to be significantly less common with paravertebral analgesia. There is good evidence that paravertebral block can provide acceptable pain relief compared with thoracic epidural analgesia for thoracotomy. Important side-effects such as hypotension, urinary retention, nausea, and vomiting appear to be less frequent with paravertebral block than with thoracic epidural analgesia. Paravertebral block is associated with better pulmonary function and fewer pulmonary complications than thoracic epidural analgesia. Importantly, contraindications to thoracic epidural analgesia do not preclude paravertebral block, which can also be safely performed in anesthetized patients without an apparent increased risk of neurological injury. The place of paravertebral block in video-assisted thoracoscopic surgery is less clear.
    Article · Mar 2009
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    Full-text · Article · Feb 2008
  • [Show abstract] [Hide abstract] ABSTRACT: The pain of thoracotomy may be related to trauma to the intercostal nerves. This was a prospective randomized study of 160 patients. All patients had a functioning epidural, similar type and size thoracotomy, an intercostal muscle flap (ICM) harvested before rib spreading, inferior rib drilling, and postoperative pain management. In one group, the ICM was left intact distally and it dangled (D group); the ICM in the other was cut distally (C group). Pain was assessed using multiple pain scores. Outcomes assessed were qualitative and quantitative pain scores, number of ribs broken, spirometric values, analgesic use, and return to baseline activity for postoperative days 1 to 5 and weeks 2, 3, 4, 8, and 12. The D group had 85 patients and the C group, 75. The groups had similar demographics, types of procedures, and histology. Intrahospital pain scores were similar; however, at postoperative weeks 3, 4, 8, and 12, the D group had significantly lower mean numeric pain scores and was using fewer analgesics (p < 0.05 for all). At 12 weeks, patients in the D group were more likely to have returned to baseline activity (p = 0.002). An ICM flap reduces pain. Harvesting and then leaving the ICM flap intact instead of cutting it before rib spreading further reduced thoracotomy pain. This technique, when added to rib drilling, leads to reduced pain on postoperative weeks 3 to 12, to quicker return to baseline activity, and lessens the need for analgesics.
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