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New technique of En bloc vertebral resection in the thoracolumbar region assisted by retroperitoneal laparoscopy in a single prone position: first results

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Abstract

Purpose

To describe the technique and review the oncological and surgical results of the En Bloc resection assisted by retroperitoneal laparoscopy in a single prone position for tumors in the thoracolumbar region.

Methods

Monocentric retrospective case study. Procedure was performed in a single prone position by a dual team of spine and thoracovascular surgeons. An endoscopic balloon was inflated in the right retroperitoneal cavity. A plan was developed between the anterior spine and vena cava as well as abdominal aorta with segmental vessels ligation. Structures at risk were safely protected under endoscopy during horizontal or sagittal osteotomies.

Results

From 2021, seven patients aged a median 52 years old (range, 34–67) were included. Involved spinal segments went from T11 to L3. Surgery was aborted in one case due to massive bleeding and ventilating difficulties. There were two partial and four total vertebral resections. Median operating duration and estimated blood loss were 405 min (range, 360–540) and 2.1 L (range, 1.2–19), respectively. Postoperative complications consisted of 1 urinary infection; 1 transient urinary retention; 1 posterior wound infection; 1 pneumothorax; 1 persistent partial motor deficit; 1 transient confusion; 1 pulmonary embolism; 1 CSF leak; 1 subdural hematoma; 1 retroperitoneal lymphocele. All margins were uncontaminated. All patients were alive and ambulatory at last follow-up.

Conclusion

Early results suggest En Bloc resection assisted by retroperitoneal videoscopy in tumors from T11 to L3/4 disk space is feasible, less invasive and safe. Careful surgical planning and experience in endoscopic vascular surgery are mandatory.

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Funding

No funding was associated to this study.

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Authors and Affiliations

  1. Orthopedic and Trauma Surgery Department. Spine and Tumor Surgery Unit. Hôpital Bicêtre. Assistance Publique Hôpitaux de Paris, Université Paris Saclay, 78 rue du Général Leclerc, 94270, Le Kremlin Bicêtre, France

    Charles Court, Barthelemy Valteau, Gilles Missenard & Charlie Bouthors

  2. Cardiothoracic Surgery Department, Center Chirurgical Marie Lannelongue, Université Paris Saclay, 133 avenue de la Résistance, 92350, Le Plessis Robinson, France

    Antoine Girault, Olaf Mercier & Elie Fadel

Authors
  1. Charles Court
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  2. Antoine Girault
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  3. Barthelemy Valteau
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  4. Olaf Mercier
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  5. Gilles Missenard
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  6. Elie Fadel
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  7. Charlie Bouthors
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Correspondence to Charlie Bouthors.

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Charles Court, Antoine Girault, Barthelemy Valteau, Olaf Mercier, Gilles Missenard, Elie Fadel, Charlie Bouthors declare that they have no conflicts of interest.

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Court, C., Girault, A., Valteau, B. et al. New technique of En bloc vertebral resection in the thoracolumbar region assisted by retroperitoneal laparoscopy in a single prone position: first results. Eur Spine J (2024). https://doi.org/10.1007/s00586-023-08121-5

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