Video-assisted thoracoscopic lobectomy in infants

Area of Science:

• Pediatric Surgery
• Thoracic Surgery
• Minimally Invasive Procedures

Background:

• Congenital lung malformations are often detected prenatally and may be asymptomatic.
• Management of these lesions, such as congenital cystic adenomatoid malformation and pulmonary sequestration, remains controversial.
• Traditional thoracotomy for lung resection in infants is associated with significant morbidity.

Purpose of the Study:

• To evaluate the safety and efficacy of video-assisted thoracoscopic (VATS) lobectomy in infants and small children.
• To assess VATS lobectomy for asymptomatic, prenatally diagnosed lung lesions.
• To compare VATS lobectomy outcomes with traditional open surgery in pediatric patients.

Main Methods:

• Six infants (mean age 10 months) with congenital lung lesions underwent elective VATS lobectomy without mini-thoracotomy.
• Procedures utilized 3-4 small ports, single lung ventilation, and controlled pneumothorax.
• Vessel ligation was performed with a bipolar sealing device, and bronchi were closed with sutures.

Main Results:

• All six VATS lobectomies were completed successfully without intraoperative complications.
• Mean operative time was 130 minutes, with chest tubes in place for 1-4 days.
• Hospital stay averaged 7 days, with two cases of spontaneous hemothorax postoperatively.

Conclusions:

• Video-assisted thoracoscopic (VATS) lobectomy is a feasible and safe surgical technique for infants and small children.
• VATS lobectomy offers advantages including decreased postoperative pain, shorter hospital stays, and improved cosmetic outcomes.
• This minimally invasive approach avoids the long-term morbidity associated with major thoracotomy incisions in pediatric patients.