Thoracoscopic removal with fluoroscopic radiographic guidance of thoracoamniotic shunting catheters in newborns

Case report: Minimally invasive removal of a dislodged thoracoamniotic shunt with an integral cystoscope in a preterm infant

“…As previously reported, severe intrathoracic adhesions can make it challenging to locate dislodged TAS in certain cases ( 10 ). Although we did not encounter this situation, the use of fluoroscopic radiography during surgery to detect the position of the TAS catheter could be beneficial, as described by Muta et al These authors suggest that thoracoscopic removal with fluoroscopic radiography can help to reduce the operation time and wound length ( 10 ).…”

“…Some studies have advocated for a conservative approach to the management of intrathoracic fetal chest shunts without surgical removal, as their follow-up did not reveal significant complications ( 9 , 15 ). However, others have recommended early elective removal to minimize the risks of infection, the shunt’s proximity to mediastinal structures, and fibrous change that may complicate shunt removal ( 8 , 10 – 12 ). There was a case reported by Blanch et al where an abnormal position of a retained TAS led to strangulation of the pulmonary hilum, resulting in neonatal death ( 16 ).…”

“…Regarding the ideal timing of intervention for intrathoracic dislodged shunts, most authors suggest removing them sooner rather than later, once the patient’s condition has stabilized ( 8 , 10 – 12 ). A similar strategy was applied in our patient, in which the operation was performed on day 17 of life for initial stabilization.…”

“…However, traditional thoracoscopy necessitates at least two incisions, measured 3–5 mm in length, for a camera port and a working port. Muta et al reported their experience of removing TAS catheters with a 2.7-mm scope inserted into a 5-mm trocar to observe the thoracic cavity ( 10 ). Once the catheter was identified, a 3-mm forceps was inserted into the 5-mm trocar from the side of the scope to grasp the catheter.…”

“…Some previous studies suggested early elective removal of the shunt, primarily due to concerns regarding the risk of infection. In most cases, these shunts are extracted via thoracoscopy or a small skin incision ( 8 , 10 – 12 ). Here, we detail our experience of removing a dislodged TAS from the chest using an “all in one” pediatric cystoscope via a 3-mm thoracic incision within 5 min.…”