FEMALE SPEAKER: So we have now prepped and draped the patient. Typically, we are looking for a flexible curve pattern, and we try to achieve approximately 50% correction interoperatively, both from the tensioning and from the positioning of the patient on the table. Our first step is to obtain access to the right hemithorax, and Dr. Potter will take us through this.
It's important that this arm is prepped and draped out of the way, because you'll see the thoracoscope will come pretty close to the arm. In addition, we've prepped in the spinous processes, because we'll place a navigated stealth reference frame on the spinous process and that will help us navigate the position of the screws as we place them later in the case.
DR POTTER: OK, so the landmark for a thoracoscopy is the tip of the scapula, there, and then the 12th rib, which is down here. We try to stay anterior to the latissimus muscle or at least not divide it, so more towards the auscultatory triangle.
So we use selective intubation. So our lungs should not be ventilated on this side. So we use a VATS approach. And then our lower port will be somewhere about there. We'll double-check that on the inside once we have thoracoscopic visualization.
The pleura is opened using the harmonic scalpel. And each segmental artery and vein is identified and coagulated using the harmonic scalpel.
Finding the landmark on the anterior chest wall, using the camera, and then a port is then placed through the chest to obtain access to each of these vertebral levels.
The navigated pointer is placed into the chest so that the screw's starting point can be identified. A navigated awl is then placed on the vertebral body and then inserted followed by the bone tap itself.
Once this has been placed, a feeler is used to ensure that bicortical purchase has been obtained. A staple is then placed into the vertebral body using a mallet. This allows for extra fixation in the vertebral body itself.
Another tap is placed to make room for the screw. You can see the hydroxyappetite-coated component of the screw.
The tether is then placed from superior to inferior using the ports. It is locked at the top using the port and a set screw.
These levels are then tensioned using an external tensioner. You can see the tension being applied across the vertebral bodies. A set screw is then placed with pressure on the wall.
End result is a corrected spine. Postoperatively the patient is given a chest tube but has no restrictions on range of motion. In-hospital time is approximately three days. Final postoperative radiographs can be compared to the preoperative radiographs, showing significant correction of the scoliosis.