Thoracoscopy in children

In the past four and one-half years we have used thoracoscopy as the primary technique for pulmonary biopsy in children. During that interval, over 80 thoracoscopic procedures have been performed with no mortality and minimal morbidity. The ages of the patients have ranged between 2 weeks and 20 years. The procedure is carried out in the general operating room under regional and intravenous anesthesia, avoiding the need for endotracheal intubation. Fourty-two of the procedures have been performed in immunosuppressed patients, attempting to determine the presence of Pneumocystis carinii pneumonia. Twenty-four of the procedures have been performed for the diagnosis of intrathoracic tumors while 15 procedures have been performed for the diagnosis of localized pulmonary infiltrates. The diagnostic accuracy in immunosuppressed patients has been 100 persons and in the tumor patients has been 92 percent. The complications of this technique have been minimal. Four patients developed pneumothoraces which responded to manipulation of the chest tube and 3 patients have had sufficient postoperatoire bleeding to require transfusion, while none have required re-exploration. The technique of thoracoscopy has provided a safe and rapid method of pulmonary diagnosis in this aged patient.