Experience with thoracoscopic tracheal surgery in infants and children

Complex thoracoscopic procedures in infants and children, such as tracheoesophageal fistula (TEF) repair and lung resection, have already been shown to be safe and efficacious in infants and children. This study evaluated the application of thoracoscopic techniques in more complex, unusual tracheal anomalies.

From January 2002 to October 2008, 9 patients with more rare anatomic tracheal anomalies, between the thoracic inlet and the carina, were treated by thoracoscopy. Ages ranged from 5 months to 8 years and weights ranged from 5.4 to 8 years and from 5.9 to 42 kg. Pathology included 3 H-type TEFs, 2 recurrent TEFs following previous open repair of an esophageal atresia with fistula, resection of a giant tracheal pouch, and 3 tracheobronchi with associated abnormal lung parenchyma.

All procedures were successfully completed thoracoscopically. Operative times ranged from 60 to 130 minutes. Procedures included division and closure of the 3 H-type fistulas and 2 recurrent fistulas, resection of the tracheal pouch, 2 upper lobectomies, and resection of an aberrant upper lobe segment by segmentectomy. There were no operative or postoperative complications. Chest tubes were left in for an average of 1 day, and hospital stay averaged 2.2 days.

Thoracoscopy provides an excellent technique for approaching tracheal pathology from the level of the thoracic inlet to the carina. A thoracoscopic approach avoids the morbidity of a major thoracotomy and virigule or a major neck exploration while providing greater exposure, especially in the upper thorax.