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Chen CT, Wu MH, Huang TY, Li YY, Huang TJ, Lee CY, Lin CH, Lee CY. Anaerobic spondylodiscitis: a retrospective analysis. BMC Musculoskelet Disord 2022; 23:788. [PMID: 35978349 PMCID: PMC9382781 DOI: 10.1186/s12891-022-05749-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 08/09/2022] [Indexed: 11/20/2022] Open
Abstract
Background This retrospective study analyzed the clinical characteristics and outcomes of patients with anaerobic spondylodiscitis. Methods From a total of 382 patients with infectious spondylodiscitis, nine patients (2.4%; two male and seven female with an average age of 67 years) with anaerobic spondylodiscitis between March 2003 and March 2017 were analyzed. Results Most of the patients (77.8%) initially presented with afebrile back pain. Hematogenous spread occurred in seven patients and postoperative infection in two patients. Bacteroid fragilis was the most common pathogen isolated from three patients. Atypical radiographic characteristics, including a vertebral fracture with the preservation of disk height or coexisting spondylolytic spondylolisthesis, occurred in four patients with hematogenous anaerobic spondylodiscitis. The eradication rate of anaerobic infection was significantly higher in the patients with hematogenous infection than in those with postoperative infection (100% vs. 0%, p = 0.0476). Anaerobic spondylodiscitis accounted for 2.4% of cases of infectious spondylodiscitis and predominantly affected the female patients. Conclusions Diagnostic delay may occur because of atypical spinal radiographs if the patient reports only back pain but no fever. Anaerobic infection following elective spinal instrumentation has a higher recurrence rate.
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Affiliation(s)
- Chien-Ting Chen
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Meng-Huang Wu
- Department of Orthopedics, Taipei Medical University Hospital, No.252, Wu-hsing St., Taipei, 11031, Taiwan.,Department of Orthopaedics, School of Medicine, College of Medicine, Taipei Medical University, No.250, Wu-hsing St., Taipei, 11031, Taiwan
| | - Tsung-Yu Huang
- Division of Infectious Diseases, Department of Internal Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Yen-Yao Li
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Tsung-Jen Huang
- Department of Orthopedics, Taipei Medical University Hospital, No.252, Wu-hsing St., Taipei, 11031, Taiwan.,Department of Orthopaedics, School of Medicine, College of Medicine, Taipei Medical University, No.250, Wu-hsing St., Taipei, 11031, Taiwan
| | - Chien-Yin Lee
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Che-Han Lin
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Ching-Yu Lee
- Department of Orthopedics, Taipei Medical University Hospital, No.252, Wu-hsing St., Taipei, 11031, Taiwan. .,Department of Orthopaedics, School of Medicine, College of Medicine, Taipei Medical University, No.250, Wu-hsing St., Taipei, 11031, Taiwan. .,International Ph.D. Program for Cell Therapy and Regeneration Medicine, College of Medicine, Taipei Medical University, No.250, Wu-hsing St., Taipei, 11031, Taiwan.
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Lu YA, Chen CY, Kuo G, Yen CL, Tian YC, Hsu HH. In-Hospital Outcomes and Recurrence of Infectious Spondylitis in Patients with and without Chronic Hemodialysis: A Nationwide Cohort Study. Int J Gen Med 2022; 15:2991-3001. [PMID: 35308570 PMCID: PMC8932927 DOI: 10.2147/ijgm.s348431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 03/07/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
- Yueh-An Lu
- Department of Nephrology, Kidney Research Center, Linkou Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taoyuan, Taiwan
| | - Chao-Yu Chen
- Department of Nephrology, Kidney Research Center, Linkou Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taoyuan, Taiwan
| | - George Kuo
- Department of Nephrology, Kidney Research Center, Linkou Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taoyuan, Taiwan
| | - Chieh-Li Yen
- Department of Nephrology, Kidney Research Center, Linkou Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taoyuan, Taiwan
| | - Ya-Chung Tian
- Department of Nephrology, Kidney Research Center, Linkou Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taoyuan, Taiwan
| | - Hsiang-Hao Hsu
- Department of Nephrology, Kidney Research Center, Linkou Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taoyuan, Taiwan
- Correspondence: Hsiang-Hao Hsu, Department of Nephrology, Kidney Research Center, Linkou Chang Gung Memorial Hospital, No. 5 Fu-Shin Street, Kweishan, Taoyuan, 333, Taiwan, Tel +886-3-328-1200 ext. 8181, Fax +886-3-3282173, Email
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Sebök M, Blum P, Sarnthein J, Fierstra J, Germans MR, Serra C, Krayenbühl N, Regli L, Esposito G. Validation of the Clavien-Dindo grading system of complications for microsurgical treatment of unruptured intracranial aneurysms. Neurosurg Focus 2021; 51:E10. [PMID: 34724644 DOI: 10.3171/2021.8.focus20892] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 08/20/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Microsurgery plays an essential role in managing unruptured intracranial aneurysms (UIAs). The Clavien-Dindo classification is a therapy-oriented grading system that rates any deviation from the normal postoperative course in five grades. In this study, the authors aimed to test the applicability of the Clavien-Dindo grade (CDG) in patients who underwent microsurgical treatment of UIAs. METHODS The records of patients who underwent microsurgery for UIAs (January 2013-November 2018) were retrieved from a prospective database. Complications at discharge and at short-term follow-up (3 months) were rated according to the Clavien-Dindo system. Patient outcomes were graded using the modified Rankin Scale (mRS) and the National Institutes of Health Stroke Scale (NIHSS). A descriptive statistic was used for data analysis. RESULTS Overall, 156 patients underwent 157 surgeries for 201 UIAs (size range 4-42 mm). Thirty-nine patients (25%) had complex UIAs. An adverse event (CDG ≥ I) occurred in 21 patients (13.5%) by the time of discharge. Among these, 10 patients (6.4%) presented with a new neurological deficit. Significant correlations existed between a CDG ≥ I and an increase in mRS and NIHSS scores (p < 0.001). Patients treated for complex aneurysms had a significantly higher risk of developing new neurological deficits (20.5% vs 1.7%, p = 0.007). At the 3-month follow-up, a CDG ≥ I was registered in 16 patients (10.3%); none presented with a new neurological deficit. A CDG ≥ I was associated with a longer hospital length of stay (LOS) (no complication vs CDG ≥ I, 6.2 ± 3.5 days vs 9.3 ± 7.7 days, p = 0.02). CONCLUSIONS The CDG was applicable to patients who received microsurgery of UIAs. A significant correlation existed between CDG and outcome scales, as well as LOS. The aneurysm complexity was significantly associated with a higher risk for new neurological deficit.
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Affiliation(s)
- Martina Sebök
- 1Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland; and.,2Clinical Neuroscience Center, University Hospital Zurich, Zurich, Switzerland
| | - Patricia Blum
- 1Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland; and.,2Clinical Neuroscience Center, University Hospital Zurich, Zurich, Switzerland
| | - Johannes Sarnthein
- 1Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland; and.,2Clinical Neuroscience Center, University Hospital Zurich, Zurich, Switzerland
| | - Jorn Fierstra
- 1Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland; and.,2Clinical Neuroscience Center, University Hospital Zurich, Zurich, Switzerland
| | - Menno R Germans
- 1Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland; and.,2Clinical Neuroscience Center, University Hospital Zurich, Zurich, Switzerland
| | - Carlo Serra
- 1Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland; and.,2Clinical Neuroscience Center, University Hospital Zurich, Zurich, Switzerland
| | - Niklaus Krayenbühl
- 1Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland; and.,2Clinical Neuroscience Center, University Hospital Zurich, Zurich, Switzerland
| | - Luca Regli
- 1Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland; and.,2Clinical Neuroscience Center, University Hospital Zurich, Zurich, Switzerland
| | - Giuseppe Esposito
- 1Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland; and.,2Clinical Neuroscience Center, University Hospital Zurich, Zurich, Switzerland
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Fiani B, Siddiqi I, Reardon T, Sarhadi K, Newhouse A, Gilliland B, Davati C, Villait A. Thoracic Endoscopic Spine Surgery: A Comprehensive Review. Int J Spine Surg 2020; 14:762-771. [PMID: 33046537 DOI: 10.14444/7109] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND From the 1990s, there has been growth in the literature demonstrating the feasibility of minimally invasive approaches for treating diverse spinal disorders. There is still much work to be done in circumnavigating the technical challenges and elucidating relative advantages of endoscopic techniques in spine surgery. In this comprehensive literature review, we discuss the history, advantages, disadvantages, approaches, and technology of, and critically examine peer-reviewed studies specifically addressing, endoscopic thoracic spinal surgery. METHODS Literature review was conducted with the key words "endoscopic," "minimally invasive," and "thoracic spinal surgery," using PubMed, Web of Science, and Google Scholar. RESULTS Review of 241 thorascopic procedures showed a success rate of 98% to 100%, low morbidity, and favorable complication profile. Review of 115 thoracic fixation procedures demonstrated high success rate, and 87% of screw positions were rated "good." Review of 55 full endoscopic uniportal decompressions showed sufficient decompression in most patients. Match pair analysis of 34 patients comparing video-assisted thoracoscopy surgery (VATS) or posterior spinal fusion reported the VATS group had increased operative duration but reduced blood loss. CONCLUSIONS Based on our literature review, there is a high rate of positive outcomes with endoscopic thoracic spine surgery, which reduces tissue dissection, intraoperative blood loss, and epidural fibrosis. However, the technical challenge highlights the importance of further training and innovation in this rapidly evolving field. LEVEL OF EVIDENCE 3. CLINICAL RELEVANCE There is growing evidence demonstrating the success of endoscopic thoracic spinal surgery. Populations that could be helped include the elderly and immunocompromised, who would benefit from decreased hospital stay and enhanced recovery time.
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Affiliation(s)
- Brian Fiani
- Desert Regional Medical Center, Palm Springs, California
| | - Imran Siddiqi
- Western University of Health Sciences College of Osteopathic Medicine, Pomona, California
| | - Taylor Reardon
- University of Pikeville, Kentucky College of Osteopathic Medicine, Pikeville, Kentucky
| | - Kasra Sarhadi
- Miller School of Medicine, University of Miami, Miami, Florida
| | | | | | - Cyrus Davati
- New York Institute of Technology College of Osteopathic Medicine, Glen Head, New York
| | - Akash Villait
- Midwestern University, Arizona College of Osteopathic Medicine, Glendale, Arizona
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Klineberg EO, Passias PG, Poorman GW, Jalai CM, Atanda A, Worley N, Horn S, Sciubba DM, Hamilton DK, Burton DC, Gupta MC, Smith JS, Soroceanu A, Hart RA, Neuman B, Ames CP, Schwab FJ, Lafage V. Classifying Complications: Assessing Adult Spinal Deformity 2-Year Surgical Outcomes. Global Spine J 2020; 10:896-907. [PMID: 32730730 PMCID: PMC7485066 DOI: 10.1177/2192568220937473] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
STUDY DESIGN Retrospective review of prospective database. OBJECTIVE Complication rates for adult spinal deformity (ASD) surgery vary widely because there is no accepted system for categorization. Our objective was to identify the impact of complication occurrence, minor-major complication, and Clavien-Dindo complication classification (Cc) on clinical variables and patient-reported outcomes. METHODS Complications in surgical ASD patients with complete baseline and 2-year data were considered intraoperatively, perioperatively (<6 weeks), and postoperatively (>6 weeks). Primary outcome measures were complication timing and severity according to 3 scales: complication presence (yes/no), minor-major, and Cc score. Secondary outcomes were surgical outcomes (estimated blood loss [EBL], length of stay [LOS], reoperation) and health-related quality of life (HRQL) scores. Univariate analyses determined complication presence, type, and Cc grade impact on operative variables and on HRQL scores. RESULTS Of 167 patients, 30.5% (n = 51) had intraoperative, 48.5% (n = 81) had perioperative, and 58.7% (n = 98) had postoperative complications. Major intraoperative complications were associated with increased EBL (P < .001) and LOS (P = .0092). Postoperative complication presence and major postoperative complication were associated with reoperation (P < .001). At 2 years, major perioperative complications were associated with worse ODI, SF-36, and SRS activity and appearance scores (P < .02). Increasing perioperative Cc score and postoperative complication presence were the best predictors of worse HRQL outcomes (P < .05). CONCLUSION The Cc Scale was most useful in predicting changes in patient outcomes; at 2 years, patients with raised perioperative Cc scores and postoperative complications saw reduced HRQL improvement. Intraoperative and perioperative complications were associated with worse short-term surgical and inpatient outcomes.
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Affiliation(s)
| | - Peter G. Passias
- NYU Hospital for Joint Diseases, New York, NY, USA,Peter G. Passias, Department of Orthopaedic Surgery, NYU Medical Center—Hospital for Joint Diseases, New York Spine Institute, 301 East 17th St, New York, NY, 10003, USA.
| | | | | | | | - Nancy Worley
- NYU Hospital for Joint Diseases, New York, NY, USA
| | | | | | | | | | - Munish Chandra Gupta
- Department of Orthopedic Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Justin S. Smith
- University of Virginia Health System, Charlottesville, VA, USA
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Yang X, Luo C, Liu L, Song Y, Li T, Zhou Z, Hu B, Zhou Q, Xiu P. Minimally invasive lateral lumbar intervertebral fusion versus traditional anterior approach for localized lumbar tuberculosis: a matched-pair case control study. Spine J 2020; 20:426-434. [PMID: 31669614 DOI: 10.1016/j.spinee.2019.10.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 10/19/2019] [Accepted: 10/21/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND CONTEXT Minimally invasive lateral lumbar intervertebral fusion (LLIF) procedure has been reported as a feasible alternative to the traditional anterior approach for patients with lumbar tuberculosis. However, there is still no study in the existing literature comparing LLIF to traditional surgeries in the treatment of such patients. PURPOSE To evaluate the clinical, radiological, and functional outcomes of LLIF versus the traditional anterior approach for treating localized lumbar tuberculosis. STUDY DESIGN Retrospective case-control study. PATIENT SAMPLE A total of 60 patients with single-level localized lumbar tuberculosis. OUTCOME MEASURES The outcome parameters included incision length, operation time, blood loss, complications, segmental lordosis, fusion status, Frankel grade, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), visual analog scale (VAS), and Oswestry Disability Index (ODI). METHODS We matched 20 patients treated by LLIF with 40 patients undergoing traditional anterior surgery (ratio, 1:2) by age, sex, lesion level, and radiographic features. The LLIF group consisted of 12 men and eight women with a mean age of 42.2±11.1 years, while the traditional group consisted of 22 men and 18 women with a mean age of 40.0±14.5 years. Both the demographics and radiographic data were reviewed. Pre- and postoperative segmental lordosis Cobb angle was measured on lateral X-ray films, while fusion status was assessed on computed tomography scans. The VAS and ODI were used to evaluate functional outcomes. RESULTS The average follow-up was 24 months in the LLIF group and 39 months in the traditional group. Incision length, operation time, and blood loss were significantly less in the LLIF group than in the traditional group. A similar improvement in segmental lordosis after operation was found in both groups. There was no significant difference between the two groups in neurological recovery, blood infection markers (ESR, CRP), functional outcome, or fusion rate, except for the postoperative VAS score, which was significantly lower in the LLIF group than in the traditional group (2.7±1.0 vs. 3.6±1.0, p=.003). Four patients in the traditional group received a transfusion and 4 patients had a superficial wound infection, while no patient in the LLIF group received a transfusion or experienced any infection; however, the difference between the two groups was not statistically significant (p=.291). CONCLUSIONS Both LLIF and traditional anterior surgery are sufficient for treating patients with localized lumbar tuberculosis, but the LLIF approach results in significantly shorter operation time and less blood loss.
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Affiliation(s)
- Xi Yang
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, No. 37 GuoXue Rd, Chengdu, Sichuan, China
| | - Chao Luo
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, No. 37 GuoXue Rd, Chengdu, Sichuan, China
| | - Limin Liu
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, No. 37 GuoXue Rd, Chengdu, Sichuan, China.
| | - Yueming Song
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, No. 37 GuoXue Rd, Chengdu, Sichuan, China
| | - Tao Li
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, No. 37 GuoXue Rd, Chengdu, Sichuan, China
| | - Zhongjie Zhou
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, No. 37 GuoXue Rd, Chengdu, Sichuan, China
| | - Bowen Hu
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, No. 37 GuoXue Rd, Chengdu, Sichuan, China
| | - Quan Zhou
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, No. 37 GuoXue Rd, Chengdu, Sichuan, China
| | - Peng Xiu
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, No. 37 GuoXue Rd, Chengdu, Sichuan, China
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Validating a therapy-oriented complication grading system in lumbar spine surgery: a prospective population-based study. Sci Rep 2017; 7:11752. [PMID: 28924249 PMCID: PMC5603580 DOI: 10.1038/s41598-017-12038-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 08/30/2017] [Indexed: 11/30/2022] Open
Abstract
The aim of the present study was to validate a therapy-oriented complication grading system in a well-defined neurosurgical patient population in which complications may entrain neurological deficits, which are severe but not treated. The prospective patient registry of the Department of Neurosurgery, University of Zurich provides extensive population-based data. In this study we focused on complications after lumbar spine surgeries and rated their severity by Clavien-Dindo grade (CDG). Analyzing 138 consecutive surgeries we noted 44 complications. As to treatment, CDG correlated with the length of hospital stay and treatment cost. As to patient outcome, CDG correlated with performance and outcome (McCormick). The present study demonstrates the correlation between outcome scales and the CDG. While the high correlation of CDG with costs seems self-evident, the present study shows this correlation for the first time. Furthermore, the study validates the CDG for a surgical subspecialty. As a further advantage, CDG registers any deviation from the normal postoperative course and allows comparison between surgical specialties.
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Video-Assisted Thoracoscopic Surgery and Minimal Access Spinal Surgery Compared in Anterior Thoracic or Thoracolumbar Junctional Spinal Reconstruction: A Case-Control Study and Review of the Literature. BIOMED RESEARCH INTERNATIONAL 2016; 2016:6808507. [PMID: 28101511 PMCID: PMC5215450 DOI: 10.1155/2016/6808507] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Revised: 11/16/2016] [Accepted: 12/01/2016] [Indexed: 12/01/2022]
Abstract
There are no published reports that compare the outcomes of video-assisted thoracoscopic surgery (VATS) and minimal access spinal surgery (MASS) in anterior spinal reconstruction. We conducted a retrospective case-control study in a single center and systematically reviewed the literature to compare the efficacy and safety of VATS and MASS in anterior thoracic (T) and thoracolumbar junctional (TLJ) spinal reconstruction. From 1995 to 2012, there were 111 VATS patients and 76 MASS patients treated at our hospital. VATS patients had significantly (p < 0.001) longer operating times and significantly (p < 0.022) higher thoracotomy conversion rates. We reviewed 6 VATS articles and 10 MASS articles, in which there were 625 VATS patients and 399 MASS patients. We recorded clinical complications and a thoracotomy conversion rate from our cases and the selected articles. The incidence of approach-related complications was significantly (p = 0.021) higher in VATS patients. The conversion rate was 2% in VATS patients and 0% in MASS patients (p = 0.001). In conclusion, MASS is associated with reduction in operating time, approach-related complications, and the thoracotomy conversion rate.
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