Thoracoscopy, laparoscopy and endoscopy are all terms used to describe a range of "minimally invasive" approaches to surgery. The endoscope allows the surgeon to have a magnified and illuminated view of the site of the operation without making a large incision. Early uses of endoscopic procedures were for biopsy, removal of thoracic disc herniations and releasing or mobilizing the anterior spine for scoliosis and kyphosis.
Currently, a relatively small number of spinal surgeries can be performed utilizing an endoscopic approach, which requires that all instruments and implants are available to perform the surgery endoscopically, i.e. through the “keyhole”. The incisions for endoscopic surgery are usually a centimetre in length, through which a portal is established to maintain cavity space for passage of surgical instruments to the site of disc damage.
In the thoracic spine the space to operate through is provided by deflating the lung. The anaesthetist performs this by placing a special breathing tube down the trachea into the large airway of each lung. Once in place the patient is asleep and breathing with only one lung, which is very safe and commonly done. This allows the opposite lung to deflate and falls out of the way of the spine.
The portals are placed and the procedure to be performed on the spine is begun. Endoscopic surgical procedure is no less than a formal open procedure, but the incision and tissue dissection to the spine may be less, improving postoperative recovery, with less pain and faster return to activities