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Video-assisted thoracic surgical procedures in children
1Division of Cardiothoracic Surgery, The Children's Hospital of Philadelphia, Philadelphia, PA.
Insights
Pediatric video-assisted cardiothoracic surgery (PVACTS) enhances surgical precision for various chest conditions. This minimally invasive approach is established for diagnosis and treatment of many pediatric thoracic diseases.
Area of Science:
- Thoracic Surgery
- Minimally Invasive Surgery
- Pediatric Surgery
Background:
- Pediatric video-assisted cardiothoracic surgery (PVACTS) has evolved significantly since the 1990s.
- It encompasses a range of pulmonary, mediastinal, and cardiac conditions in children.
Purpose of the Study:
- To review the principles and current applications of PVACTS.
- To highlight its role in improving surgical quality and precision for selected pediatric thoracic operations.
Main Methods:
- Utilizes a video camera, low-profile scope, and specialized instruments.
- Applied for diagnosis (biopsy) and treatment of various pediatric thoracic conditions.
Main Results:
- PVACTS is an accepted modality for diagnosing mediastinal/pleuropulmonary diseases and treating empyema, pneumothorax, and cysts.
- Successful applications include PDA ligation, vascular ring repair, diaphragmatic plication, and chylous leak repair.
- Indications for PVACTS lobectomy/pneumonectomy are less established, with anecdotal methods described.
Conclusions:
- PVACTS is a valuable tool for pediatric thoracic surgery, with established applications and emerging uses.
- Future advancements depend on surgeon adoption, industry innovation, and virtual imaging technologies.
Abstract:
The general principles and current applications of pediatric video-assisted cardiothoracic surgery (PVACTS) are reviewed. The purpose of PVACTS is to improve surgical quality and precision in selected operations. In the 1990s PVACTS has expanded to include the management of a variety of pulmonary, mediastinal, and cardiac lesions. Currently, PVACTS is carried out using a video camera connected to a low-profile scope and a specialized set of surgical instruments. PVACTS is an accepted modality for the diagnosis (by biopsy) of pleuropulmonary and mediastinal disease, and the treatment of pediatric empyema, spontaneous pneumothorax, and mediastinal cysts. Diaphragmatic plication, repair of chylous leak, and ligation of collateral vessels have all been done using PVACTS. PVACTS patent ductus arteriosus (PDA) ligation and vascular ring repair are being successfully carried out in several institutions. The technique at The Children's Hospital of Philadelphia is described. Indications and techniques for PVACTS lobectomy and pneumonectomy are less well established. Suggested anecdotal methods are described. Cardioscopy carries the hope of improving intracardiac repair, and has been applied to several lesions. The future of PVACTS depends on the surgeon's willingness to master it, industry's willingness to customize instruments for pediatric use, and developments in the fields of virtual imaging and augmented reality. Copyright 1998 by W.B. Saunders Company