Complete thoracoscopic versus video-assisted thoracoscopic resection of congenital lung lesions

Minimally invasive surgery is recognized as a safe and feasible technique for resecting congenital lung lesions. In our hospital, video-assisted thoracoscopic surgery (VATS) was initially performed through a 5-6-cm incision with several trocars under differential lung ventilation (assisted-VATS). Complete thoracoscopic surgery (complete-VATS) with artificial pneumothorax was introduced in 2009 and allowed surgery in smaller infants. The aim of this study was to compare the outcomes of complete-VATS and assisted-VATS for congenital lung lesions.

Between January 2004 and October 2012, 22 children underwent pulmonary lobectomy by complete-VATS or assisted-VATS at our hospital. We retrospectively reviewed the intraoperative and early postoperative results of these patients.

Of the 22 children, 10 underwent assisted-VATS, and 12 underwent complete-VATS to treat various diseases, including congenital cystic adenomatous malformation, sequestration, and bronchial atresia. The age, body weight, and mean operative time were not significantly different between the two groups. Four patients in the complete-VATS group, but none in the assisted-VATS group, weighed <10 kg. Intraoperative bleeding was significantly less, and hospital stay was significantly shorter, in the complete-VATS group. One patient in the assisted-VATS group had intraoperative bleeding and required conversion to open surgery. Postoperative complications included transient paralysis of the affected arm and transient atelectasis in 1 patient each in the complete-VATS group.

Complete-VATS can be safely performed with less bleeding and shorter hospital stay than assisted-VATS. As differential lung ventilation is not essential during complete-VATS, complete-VATS can be performed in small infants.