Endosurgical Technologies for Treatment of Bronchopulmonary Sequestration in Children

Abstract

The study systematized the long-term experience of thoracoscopic and laparoscopic treatment of intra- and extrapleural forms of bronchopulmonary sequestration (BPS). Materials and methods of research: a retrospective study analysed clinical data of 20 patients with BPS who have underwent thoracoscopic and laparoscopic surgeries for 15 years, starting from 2005. The main surgical methods included thoracoscopic lobectomy, thoracoscopic sequestrectomy, laparoscopic sequestrectomy and combined thoracoscopic transdiaphragmatic access in a patient with multiple forms of BPS. Results: a total of 20 patients with BPS had an intralobar form, 5 had an extralobar form, 4 had an extrapleural type, and 1 had a combined (extralobar + extrapleural) form. Intralobar form of BPS was found in the left lower lobe in 6 patients, in the right lower lobe – in 4. Extralobar BPS was found near the left lower lobe in 3 patients, near the lower right lobe – in 2. Extrapleural BPS was observed in the abdominal cavity under the diaphragm in 3 patients, in one patient – in the thickness of the diaphragmatic muscle. One patient had a combined form of BPS in the form of an association of extralobaric and intra-abdominal types. Thoracoscopy was performed in 16 patients, laparoscopy in 4 patients. The mean operative time was 60 min (range: 40–100 min). Intraoperative blood loss was not observed. A drainage tube was installed in 10 patients with intralobaric BPS. In all other cases, the pleural and abdominal cavity was not drained. A histological examination of all resected pulmonary sequesters showed that in half of the cases (10/20) the anomaly was associated with other malformations of the lungs (cystoadenomatous malformation of the lungs, bronchogenic cyst or intestinal duplication). During the 5 year average observation period after surgery (range: 1–15 years), musculoskeletal deformities of the chest and adhesive intestinal obstruction were not recorded. Conclusion: the series of minimally invasive treatment of patients with BPS presented in this study demonstrates the effectiveness and safety of this approach, especially for the surgical correction of those forms of pulmonary sequestration when they are located in hard-to-reach anatomical spaces of the body.