Operative Efficiency, Technical Workflow, and Perioperative Outcomes in Minimally Invasive Trans-Kambin Oblique Thoracic Interbody Fusion (MIS-OTIF): A Retrospective Clinical Analysis.

Background Thoracolumbar fusion surgery has historically been associated with prolonged operative duration, extensive posterior muscle dissection, elevated blood loss, prolonged hospitalization, and increased perioperative morbidity. Over the last decade, minimally invasive spinal surgery has evolved substantially with the goal of reducing tissue disruption while preserving biomechanical stabilization and neural decompression. Minimally invasive trans-Kambin oblique thoracic interbody fusion (MIS-OTIF) represents an extension of minimally invasive principles into the thoracic and thoracolumbar spine through an oblique trans-Kambin corridor that minimizes posterior soft tissue injury while facilitating efficient instrumentation and interbody reconstruction. Objective To evaluate operative efficiency, perioperative workflow characteristics, obesity-related technical considerations, and complication profiles in patients undergoing MIS-OTIF procedures. Methods A retrospective review of consecutive patients undergoing MIS-OTIF procedures between 2020 and 2026 was performed. Variables analyzed included operative time, body mass index (BMI), revision status, number of instrumented levels, hybrid versus pure minimally invasive technique, and complications. Results Twenty-five MIS-OTIF procedures were reviewed. Operative duration ranged from 30 to 171 minutes depending on procedural complexity, revision status, and the addition of posterior instrumentation or open components. Mean BMI across the cohort demonstrated that MIS-OTIF remained technically feasible even in obese and morbidly obese patients. Single-level thoracic MIS-OTIF procedures demonstrated the shortest operative duration, while hybrid constructs, multilevel fusion procedures, and revision surgeries required longer operative times. Elevated BMI alone did not significantly increase operative duration. Complication rates remained low, with isolated cases of persistent stenosis identified which were unrelated to surgical technique itself.  Conclusion MIS-OTIF demonstrates favorable operative efficiency with acceptable operative duration across a broad range of thoracic and thoracolumbar pathologies, including obese and revision patients. The minimally invasive trans-Kambin oblique corridor may reduce operative exposure time, tissue disruption, blood loss, and physiologic stress while maintaining efficient workflow and stabilization. Larger multicenter prospective studies are warranted to further validate the reproducibility and long-term outcomes of MIS-OTIF.