APSA papers
First decade's experience with thoracoscopic lobectomy in infants and children

https://doi.org/10.1016/j.jpedsurg.2007.09.015Get rights and content

Abstract

Purpose

This study evaluates the safety and efficacy of thoracoscopic lobectomy in infants and children.

Methods

From January 1995 to March 2007, 97 patients underwent video-assisted thoracoscopic lobe resection. Ages ranged from 2 days to 18 years and weights from 2.8 to 78 kg. Preoperative diagnosis included sequestration/congenital adenomatoid malformation (65), severe bronchiectasis (21), congenital lobar emphysema (9), and malignancy (2).

Results

Of 97 procedures, 93 were completed thoracoscopically. Operative times ranged from 35 minutes to 210 minutes (average, 115 minutes). There were 19 upper, 11 middle, and 67 lower lobe resections. There were 3 intraoperative complications (3.1%) requiring conversion to an open thoracotomy. Chest tubes were left in 88 of 97 procedures for 1 to 3 days (average, 2.1 days). Hospital stay ranged from 1 to 12 days (average, 2.4 days).

Conclusions

Thoracoscopic lung resection is a safe and efficacious technique. It avoids the inherent morbidity of a major thoracotomy incision and is associated with the same decrease in postoperative pain, recovery, and hospital stay as seen in minimally invasive procedures.

Section snippets

Patients and methods

From January 1995 to March 2007, all patients with lung pathology requiring resection were considered for a video-assisted thoracoscopic approach. The only patients excluded were those with solid mass lesions occupying more than 50% of the chest or those with extreme respiratory compromise suggesting they would not tolerate any length of single lung ventilation. Ages ranged from 2 days to 18 years of age (mean, 3.8 years) and weight from 2.8 to 78 kg (mean, 16.7 kg). Preoperative evaluation

Results

Of 97 lobectomies, 93 were completed endoscopically. Operative times ranged from 35 to 210 minutes (average, 115 minutes). There were 19 upper, 11 middle, and 67 lower lobectomies. Nine of the lobectomies, 8 lower and 1 upper, were extralobar sequestrations. One additional patient had a CAM, which involved the apical segment of the left lower lobe and the posterior segment of the left upper lobe with no fissure separating the two. This patient had a bi-segmentectomy. Pathology of the other

Discussion

Over the last decade, thoracoscopy has become an increasingly important tool in the armamentarium of the pediatric surgeon. The limited explorations, biopsies, and debridements described by Rodgers in the mid- to late-1970s have become replaced by extensive, technically demanding resections and reconstructive procedures. Thoracoscopic lung biopsy, decortication, and bleb resection for pneumothorax have been shown to be so safe and effective that in many centers, it has completely replaced open

Discussion

Paper No. APSA-D-08-00008, “First Decade's Experience with Thoracoscopic Lobectomy in Infants and Children.” Presented by Steven Rothenberg, MD, Denver, Colo.

(Applause.)

Discussion by (unidentified speaker)

    Doctor

    Steve, that is a very nice series. I have had some experience with this now and my biggest problem is dealing with fused fissures, and I wonder if you have any special tricks with the truly fused fissure where you do not have lobar anatomy.

    Dr Rothenberg (response)

    I just did a case a

References (13)

There are more references available in the full text version of this article.

Cited by (134)

  • Congenital lung malformations

    2023, Nature Reviews Disease Primers
View all citing articles on Scopus

Presented at the 38th annual meeting of the American Pediatric Surgical Association, Orlando, Florida, May 24-27, 2007

View full text