Video-assisted thoracoscopic surgery for respiratory disease in children.

Masahide Murasugi*, MD, PhD, Masato Kanzaki*, MD, PhD, Takuma Kikkawa*, MD, PhD, Tamami Isaka*, MD, PhD, Maeda Hideruki*, MD, Sakamoto Kei*, MD, Sayaka Katagiri*, MD, Junko Kawata*, MD, Kunihiro Oyama*, MD, PhD, Takamasa Onuki*, MD, PhD, Osamu Segawa**, MD, PhD. Department of Surgery, Division of Thoracic Surgery*, Division of Pediatric Surgery**, Tokyo Women’s Medical University, Tokyo, JAPAN..

Background: An operation case of children’s respiratory surgery increases by progress such as an imaging, prenatal diagnosis. A minimally invasive thoracoscopic surgery offers several options in diagnosis and surgical treatment in pediatric surgery. We would like to review our surgical experience during thoracoscopic surgery for children’s respiratory disease in our institute.

PATIENTS AND METHODS: From November 1993 to June 2013, 51 patients underwent thoracoscopic surgery for respiratory diseases, except pectus excavatum and pigeon chest. Age ranged from 3 months to 15 years old (an average of 10.8 years old). The patients were positioned in a modified prone or supine position, and single lung ventilation was performed on the contra lateral side. Video-assisted thorasoscopic surgery was performed through a small chest incision (minithoracotomy) with two or three trocar ports with 3 and 5-mm instrumentation. Thirty degrees thoracoscopy of 5 or 10-mm was used. Anomalous blood vessels were clipped, stapling, ultrasonic vessel sealing system and/or ligated.

RESULTS: There was no morbidity or mortality associated with the video assisted thoracoscopic surgical procedures. None of the patients required a conversion to standard thoracotomy. The thoracoscopic surgical procedures were feasible in 47 children with respiratory diseases including 29 spontaneous pneumothorax, 9 mediastinal tumors (including 4 Myasthenia Gravis), 4 congenital cystic adenomatoid malformation (CCAM), 1 pulmonary nodule, 2 pulmonary sequestration, 1 pulmonary A-V malformation (bilateral and two times), 1 hemopneumothorax and 3 empyema. Single lung ventilation was insufficient in 3 cases under 2 years old. Video-assisted thoracosopic surgery was effective in these cases.

CONCLUSIONS: We considered that video-assisted thoracosopic approach is surgical treatment of children. Cosmetic benefits were also obtained for girls. However, the most important consideration is the decision on a treatment strategy made by both pediatrician and thoracic surgeon.

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