Gemcitabine side effects Given the impossibility to realize a completely percutaneous approach, an OPCA was carried out with the specific aim to reduce to the least the morbidity of the surgery in highly debilitated patients. Although palliative, the operation allowed a good general recovery and a strong support of the spine. Completely percutaneous approach in two cases of multiple fractures showed good clinical recovery of the patients with very fast discharge from the hospital 3 days after the operation. In two cases, we utilized an OPCA procedure limiting the proximal opening only to the segments chosen for pedicle screwing. In one case, the proximal approach was limited to the lower cervical spine and to the first two thoracic segments to allow the screwing of the cervical lateral masses and placement of the screws in the pedicles of T1 and T2.
In the other case, the incision was prolonged to the fracture site to allow bone grafting. The need of posterior arthrodesis in the treatment of fractures is still a matter of discussion . However, an OPCA can allow local bone grafting by distal extension of the proximal open approach. In conclusion, although a higher number of series with long-term outcome are needed to prove the reliability of the mininvasive techniques in the treatment of thoracic spine diseases, our series showed promising results at one-year follow-up with no complications technique-related. Conflict of Interests The authors declare that there is no conflict of interests regarding the publication of this paper.
The first successful cardiac operation was performed on September 7, 1896, in Frankfurt, Germany, by Rehn .
The first successful cardiac valve operation was performed in 1912 by Tuffier  and the first successful mitral valve (MV) operation in 1923 by Cutler and Levine . In 1956, Lillehei et al. repaired multiple valvular lesions through a right thoracotomy using cardiopulmonary bypass (CPB) . The subsequent years have seen a glorious phase of mitral valve surgery with full sternotomy and use of conventional cardiopulmonary bypass techniques. This phase also witnessed the development of various valvular prostheses Anacetrapib and mitral valve repair techniques. In the 1990s, the success of laparoscopic operations in general surgery renewed an interest in minimally invasive approaches for cardiac surgery. Navia and Cosgrove  and Cohn et al.  performed the first minimally invasive valve operations (via the right parasternal and transsternal approaches). These authors have shown that small incision mitral valve surgery can be conducted safely with equivalent outcomes. Carpentier et al.  in February of 1996 performed the first video-assisted mitral valve repair (MVR) through a mini thoracotomy using ventricular fibrillation.