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Thoracoscopic versus open resection of congenital lung lesions: a case-matched study
Ivan R Diamond1, Patricio Herrera, Jacob C Langer
1Division of General Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada M5G 1X8.
Insights
Thoracoscopic resection of congenital lung lesions in children is a safe alternative to open surgery. This minimally invasive approach shows similar early outcomes and may offer long-term benefits.
Area of Science:
- Pediatric Surgery
- Thoracic Surgery
- Minimally Invasive Surgery
Background:
- Congenital lung lesions require surgical intervention in pediatric patients.
- Traditional open resection carries risks of morbidity and long-term complications.
- Minimally invasive techniques are increasingly explored for pediatric thoracic procedures.
Purpose of the Study:
- To compare the perioperative outcomes of thoracoscopic resection versus open thoracotomy for congenital lung lesions in children.
- To evaluate the safety and feasibility of the thoracoscopic approach in this patient population.
Main Methods:
- Retrospective review of 12 children (<3 years) undergoing thoracoscopic resection (2004-2005).
- Comparison with 24 age- and sex-matched controls undergoing thoracotomy (2000-2005).
- Analysis of intraoperative and early postoperative outcomes.
Main Results:
- No major intraoperative complications; 2 thoracoscopic cases converted to thoracotomy.
- Similar operative time, length of stay, chest tube drainage, and opioid requirements between groups.
- Thoracoscopic group less likely to receive regional anesthesia (OR=0.07).
- Overall morbidity: 33% thoracoscopic vs. 25% open (P=.70).
Conclusions:
- Thoracoscopic resection is a safe and feasible alternative for pediatric congenital lung lesions.
- Longer follow-up is needed to confirm long-term advantages like reduced chest wall deformity and improved cosmesis.
Purpose:
The purpose of the study was to compare the outcomes in children undergoing thoracoscopic versus open resection of congenital lung lesions.
Methods:
Retrospective review of 12 consecutive children (<3 years of age) undergoing thoracoscopic resection of a congenital lung lesion between 2004 and 2005 was performed. Intraoperative and early postoperative results were compared with randomly selected age- and sex-matched (2:1) patients undergoing thoracotomy between 2000 and 2005.
Results:
Twelve children underwent thoracoscopic resection and were compared with 24 that underwent thoracotomy. Seventy five percent of the lesions in both groups were congenital cystic adenomatoid malformations. There were no major intraoperative complications. Two thoracoscopic procedures were converted to a thoracotomy. Perioperative outcomes including operative time, length of stay, duration and volume of chest tube drainage, and dose and duration of intravenous opioids were similar for the procedures. However, children undergoing thoracoscopic procedures were less likely (odds ratio = 0.07) to have received adjunctive regional anesthesia. Overall morbidity was 33% thoracoscopic and 25% open (P = .70).
Conclusion:
Thoracoscopic resection is a safe and feasible alternative to open resection of congenital lung lesions. Examination of long-term advantages of the thoracoscopic approach such as decreased risk of chest wall deformity and scoliosis and improved cosmesis will require longer follow-up.
