Thoracoscopic lobectomy for congenital cystic lung diseases in neonates and small infants

Abstract

Thoracoscopic lobectomy for congenital cystic lung diseases in neonates was practicable, with good esthetic results. Dissection was easier with significantly less blood loss in patients without adhesions, even in neonates. However, this procedure necessitated highly skilled endoscopic maneuvers within a small working space.

Two Decades of Experience with Thoracoscopic Lobectomy in Infants and Children: Standardizing Techniques for Advanced Thoracoscopic Surgery

“…11 Others have clearly documented the issues involved with trying to operate on these lung lesions using thoracoscopy once the infant has already had a clinical chest infection. Kanenko et al 12 documented a higher complication rate in those patients who were diagnosed after a chest infection and underwent a thoracoscopic lobectomy compared with those diagnosed prenatally and operated on prior to any clinical infections. Garrett-Cox et al 13 found that 83% of patients converted to open surgery had had a previous chest infection.…”

Surgical management of bronchopulmonary malformations

“…The "steep learning curve" for such procedures is inherent in the three technical difficulties accompanying pediatric thoracoscopy as follows: achieving single lung ventilation, maintaining vasculature control, and operating with minimal work space [15,16,20]. Following Rothenberg's descriptions of pediatric thoracoscopic pulmonary resections [14], a number of studies have deemed this procedure safe and feasible [12,18,25,28,29]. Furthermore, advocates of thoracoscopic management of BPM cite many salient advantages.…”

Hilar closure using staplers or Hem-o-lok clips in a rabbit model

“…Most surgeons performing pediatric VATS lobectomy have avoided the use of surgical staplers in smaller infants due to the large dimensions of the applicator and cartridge that limit their applicability. Combinations described in the literature include the use of manual intracorporeal suturing for bronchial closure along with vessel-sealing of the pulmonary vasculature [1,3] or the use of 5 mm endoscopic clips on the bronchus [2,3]. Although intracorporeal suturing techniques have been demonstrated to have similar leak pressures to endoscopic stapling devices, the increased surgical time may result in increased morbidity and cost associated with surgery [12,13].…”