Minimally invasive chest wall stabilization: a novel surgical approach to video-assisted rib plating (VARP)

Abstract

The current morbidity of rib plating is due to the size of the incision required to perform an open procedure. We describe a minimally invasive laparoscopic approach to rib plating. A cadaver model was used to develop the surgical technique by performing both left and right posterior-lateral rib plating. A small incision was made over the auscultatory triangle. The potential working space is developed under the posterior shoulder girdle and the scapula. A table-based retractor was used to elevate the scapula and the muscles. Two separate ports were placed: one camera port and one working port. In three cadaver models, 12 rib fractures were plated and the surgical technique is described. This novel technique will likely allow for faster recovery and was especially useful in the subscapular space.Level of evidence II.

Nonintubated Minimally Invasive Chest Wall Stabilization for Multiple Rib Fractures: a Prospective, Single-arm Study

“…VARP is a new technique for CWS that allows for an extrathoracic approach using standard plating assisted by laparoscopy, which likely allows for a faster recovery. A previous study reported their experience with performing the VARP technique and concluded that it was feasible in a cadaver model [11]. Our study is the rst to report our experience using the VARP technique in patients with multiple rib fractures with satisfactory results, which supports its application in the general patient population to further de ne patient indications.…”

Non-intubated Minimally Invasive Chest Wall Stabilization for Multiple Rib Fractures: a Prospective, Single-arm Study

“…VARP is a new technique for CWS allows for an extrathoracic approach using standard plating assisted by laparoscopy, which is likely allow for faster recovery. Previous study reported their experience of performing VARP technique and concluded that it was feasible in the cadaver model [11]. Our study rstly reported our experience of using VARP technique in patients with multiple rib fractures with satisfactory results, which supports application in the general patient population to further de ne the patient indications.…”

“…To further reduce surgical trauma of CWS, some experienced thoracic surgeons adopted muscle sparing incisions in CWS to minimize the soft tissue injury. Since the major morbidity of CWS is the size of the incisions required to perform an open procedure, some surgeons tried to perform minimally invasive video-assisted rib plating (VARP) in CWS [11]. Compared with traditional CWS, minimally invasive CWS using above techniques can obviously minimize the soft tissue injury and reduce the size of incisions.…”

Nonintubated minimally invasive chest wall stabilization for multiple rib fractures: a prospective, single-arm study

“…VARP is a new technique for CWS that allows for an extrathoracic approach using standard plating assisted by laparoscopy, which likely allows for a faster recovery. A previous study reported their experience with performing the VARP technique and concluded that it was feasible in a cadaver model [ 11 ]. Our study is the first to report our experience using the VARP technique in patients with multiple rib fractures with satisfactory results, which supports its application in the general patient population to further define patient indications.…”

“…To further reduce the surgical trauma associated with CWS, some experienced thoracic surgeons have adopted muscle-sparing incisions in CWS to minimize soft tissue injury. Since the major morbidity of CWS is the size of the incision required to perform an open procedure, some surgeons have tried to perform minimally invasive video-assisted rib plating (VARP) in CWS [ 11 ]. Compared with traditional CWS, minimally invasive CWS using the techniques described above can obviously minimize soft tissue injury and reduce the size of incisions.…”