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Huerta CT, Ramsey WA, Courel SC, Gilna GP, Saberi RA, Ribieras AJ, Perez EA, Sola JE, Thorson CM. Nationwide Outcomes After Thoracoscopic Versus Open Resection of Congenital Pulmonary Airway Malformations in Newborns. J Laparoendosc Adv Surg Tech A 2023; 33:897-903. [PMID: 37406288 DOI: 10.1089/lap.2023.0010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2023] Open
Abstract
Purpose: Elective resection of congenital pulmonary airway malformations (CPAM) has been debated for decades and varies significantly between individual surgeons. However, few studies have compared outcomes and costs associated with thoracoscopic and open thoracotomy approaches on a national level. This study sought to compare nationwide outcomes and resource utilization in infants undergoing elective lung resection for CPAM. Materials and Methods: The Nationwide Readmission Database was queried from 2010 to 2014 for newborns who underwent elective surgical resection of CPAM. Patients were stratified by operative approach (thoracoscopic versus open). Demographics, hospital characteristics, and outcomes were analyzed using standard statistical tests. Results: A total of 1716 newborns with CPAM were identified. Elective readmission for pulmonary resection was performed in 12% (n = 198), with 63% of resections completed at a different hospital than the newborn stay. Most resections were thoracoscopic (75%), compared to only 25% via thoracotomy. Infants treated with thoracoscopic resection were more often male (78% versus 62% open, P = .040) and were older at the time of resection. Patients who had an open thoracotomy experienced a higher rate of serious complications (40% versus 10% thoracoscopic, P < .001), including postoperative hemorrhage, tension pneumothorax, and pulmonary collapse. Readmission costs were higher for infants treated via thoracotomy (P < .001). Conclusion: Thoracoscopic lung resection for CPAM is associated with lower cost and fewer postoperative complications than thoracotomy. Most resections are performed at different hospitals than the place of birth, which may affect long-term outcomes from single institutional studies. These findings may be used to address costs and improve future evaluations of elective CPAM resections.
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Affiliation(s)
- Carlos Theodore Huerta
- Division of Pediatric Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Leonard M. Miller School of Medicine, Miami, Florida, USA
| | - Walter A Ramsey
- Division of Pediatric Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Leonard M. Miller School of Medicine, Miami, Florida, USA
| | - Steve C Courel
- University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Gareth P Gilna
- Division of Pediatric Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Leonard M. Miller School of Medicine, Miami, Florida, USA
| | - Rebecca A Saberi
- Division of Pediatric Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Leonard M. Miller School of Medicine, Miami, Florida, USA
| | - Antoine J Ribieras
- Division of Pediatric Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Leonard M. Miller School of Medicine, Miami, Florida, USA
| | - Eduardo A Perez
- Division of Pediatric Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Leonard M. Miller School of Medicine, Miami, Florida, USA
| | - Juan E Sola
- Division of Pediatric Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Leonard M. Miller School of Medicine, Miami, Florida, USA
| | - Chad M Thorson
- Division of Pediatric Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Leonard M. Miller School of Medicine, Miami, Florida, USA
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Joo S, Yun T, Kang CH, Na KJ, Park S, Park IK, Kim YT. Thoracoscopic segmentectomy in children with congenital lung malformation. Sci Rep 2023; 13:9640. [PMID: 37316608 DOI: 10.1038/s41598-023-36700-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 06/08/2023] [Indexed: 06/16/2023] Open
Abstract
Congenital lung malformations (CLM) are most commonly treated with a pulmonary lobectomy. However, due to technological advancement, video-assisted thoracoscopic surgery (VATS) segmentectomy is becoming an attractive alternative to VATS lobectomy. This study aimed to evaluate the safety, feasibility, and efficacy of VATS segmentectomy as a lung parenchyma-saving strategy in children with CLM. A retrospective analysis was performed on 85 children, for whom VATS segmentectomy was tried for CLM between January 2010 and July 2020. We compared the surgical outcomes of VATS segmentectomy with the outcomes of 465 patients who underwent VATS lobectomy. Eighty-four patients received VATS segmentectomy and thoracotomy conversion was necessary for one patient for CLM. The mean age was 3.2 ± 2.5 (range 1.2-11.6) years. The mean operative time was 91.4 ± 35.6 (range 40-200) minutes. The median duration of chest tube drainage was 1 (range 1-21) day, and the median length of postoperative hospital stay was 4 (range 3-23) days. There were no postoperative mortality and postoperative complications developed in 7 patients (8.2%), including persistent air leakage in 6 patients (7.1%) and postoperative pneumonia in 1 patient (1.2%). The median follow-up period was 33.5 (interquartile range 31-57) months and there were no patients requiring re-intervention or reoperation during the follow-up period. In the VATS segmentectomy group, the persistent air leakage rate was higher than in the VATS lobectomy group (7.1 vs. 1.1%, p = 0.003). Otherwise, postoperative outcomes were comparable between the two groups. VATS segmentectomy in children with CLM is a technically feasible alternative to VATS lobectomy with acceptable early and mid-term outcomes. However, the persistent air-leakage rate was higher in VATS segmentectomy.
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Affiliation(s)
- Seohee Joo
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
| | - Taeyoung Yun
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
| | - Chang Hyun Kang
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea.
| | - Kwon Joong Na
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
| | - Samina Park
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
| | - In Kyu Park
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
| | - Young Tae Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
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Kersten CM, Hermelijn SM, Dossche LWJ, Muthialu N, Losty PD, Schurink M, Rietman AB, Poley MJ, van Rosmalen J, Zanen-van den Adel TPL, Ciet P, von der Thüsen J, Brosens E, Ijsselstijn H, Tiddens HAWM, Wijnen RMH, Schnater JM. COllaborative Neonatal Network for the first European CPAM Trial (CONNECT): a study protocol for a randomised controlled trial. BMJ Open 2023; 13:e071989. [PMID: 36931672 PMCID: PMC10030930 DOI: 10.1136/bmjopen-2023-071989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/19/2023] Open
Abstract
INTRODUCTION Consensus is lacking on the optimal management of asymptomatic congenital pulmonary airway malformation (CPAM). For future studies, the CONNECT consortium (the COllaborative Neonatal Network for the first European CPAM Trial)-an international collaboration of specialised caregivers-has established consensus on a core outcome set of outcome parameters concerning respiratory insufficiency, surgical complications, mass effect and multifocal disease. These outcome parameters have been incorporated in the CONNECT trial, a randomised controlled trial which, in order to develop evidence-based practice, aims to compare conservative and surgical management of patients with an asymptomatic CPAM. METHODS AND ANALYSIS Children are eligible for inclusion after the CPAM diagnosis has been confirmed on postnatal chest CT scan and they remain asymptomatic. On inclusion, children are randomised to receive either conservative or surgical management. Subsequently, children in both groups are enrolled into a standardised, 5-year follow-up programme with three visits, including a repeat chest CT scan at 2.5 years and a standardised exercise tolerance test at 5 years.The primary outcome is exercise tolerance at age 5 years, measured according to the Bruce treadmill protocol. Secondary outcome measures are molecular genetic diagnostics, validated questionnaires-on parental anxiety, quality of life and healthcare consumption-, repeated imaging and pulmonary morbidity during follow-up, as well as surgical complications and histopathology. This trial aims to end the continuous debate surrounding the optimal management of asymptomatic CPAM. ETHICS AND DISSEMINATION This study is being conducted in accordance with the Declaration of Helsinki. The Medical Ethics Review Board of Erasmus University Medical Centre Rotterdam, The Netherlands, has approved this protocol (MEC-2022-0441). Results will be disseminated through peer-reviewed scientific journals and conference presentations. TRIAL REGISTRATION NUMBER NCT05701514.
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Affiliation(s)
- Casper M Kersten
- Paediatric Surgery, Erasmus MC Sophia Children's Hospital, Rotterdam, Zuid-Holland, Netherlands
| | - Sergei M Hermelijn
- Paediatric Surgery, Erasmus MC Sophia Children's Hospital, Rotterdam, Zuid-Holland, Netherlands
| | - Louis W J Dossche
- Paediatric Surgery, Erasmus MC Sophia Children's Hospital, Rotterdam, Zuid-Holland, Netherlands
| | - Nagarajan Muthialu
- Tracheal Team, Department of Cardiothoracic Surgery, Great Ormond Street Hospital for Children, London, UK
| | - Paul D Losty
- Paediatric Surgery, Institute Of Life Course And Medical Sciences, University of Liverpool, Liverpool, UK
- Paediatric Surgery, Ramathibodi Hospital Mahidol University, Bangkok, Thailand
| | - Maarten Schurink
- Paediatric Surgery, Radboud University Medical Centre Amalia Children's Hospital, Nijmegen, the Netherlands, Nijmegen, Netherlands
| | - André B Rietman
- Child and Adolescent Psychiatry, Erasmus MC Sophia Children Hospital, Rotterdam, Zuid-Holland, Netherlands
| | - Marten J Poley
- Paediatric Surgery, Erasmus MC Sophia Children's Hospital, Rotterdam, Zuid-Holland, Netherlands
- Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - Joost van Rosmalen
- Biostatistics, Erasmus MC, Rotterdam, Zuid-Holland, Netherlands
- Epidemiology, Erasmus MC, Rotterdam, Zuid-Holland, Netherlands
| | | | - Pierluigi Ciet
- Radiology and Nuclear Medicine, Erasmus MC Sophia Children's Hospital, Rotterdam, Zuid-Holland, Netherlands
- Paediatric Pulmonology, Erasmus MC Sophia Children's Hospital, Rotterdam, Zuid-Holland, Netherlands
- Radiology and Medical Sciences, University of Cagliari, Cagliari, Italy
| | | | - Erwin Brosens
- Clinical Genetics, Erasmus MC Sophia Children's Hospital, Rotterdam, Zuid-Holland, Netherlands
- Erasmus MC Cancer Centre, Rotterdam, Zuid-Holland, Netherlands
| | - Hanneke Ijsselstijn
- Paediatric Surgery, Erasmus MC Sophia Children's Hospital, Rotterdam, Zuid-Holland, Netherlands
| | - Harm A W M Tiddens
- Radiology and Nuclear Medicine, Erasmus MC Sophia Children's Hospital, Rotterdam, Zuid-Holland, Netherlands
- Paediatric Pulmonology, Erasmus MC Sophia Children's Hospital, Rotterdam, Zuid-Holland, Netherlands
| | - Rene M H Wijnen
- Paediatric Surgery, Erasmus MC Sophia Children's Hospital, Rotterdam, Zuid-Holland, Netherlands
| | - J Marco Schnater
- Paediatric Surgery, Erasmus MC Sophia Children's Hospital, Rotterdam, Zuid-Holland, Netherlands
- Tracheal Team, Department of Cardiothoracic Surgery, Great Ormond Street Hospital for Children, London, UK
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4
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Weller JH, Peter SDS, Fallat ME, Saito JM, Burns CR, Deans KJ, Fraser JD, Gadepalli SK, Helmrath MA, Hirschl RB, Kabre R, Lal DR, Landman MP, Leys CM, Mak GZ, Minneci PC, Wright TN, Kunisaki SM. Thoracoscopic versus open lobectomy in infants with congenital lung malformations: A multi-institutional propensity score analysis. J Pediatr Surg 2021; 56:2148-2156. [PMID: 34030879 DOI: 10.1016/j.jpedsurg.2021.04.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 03/18/2021] [Accepted: 04/15/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE The impact of thoracoscopic surgery on outcomes in children with congenital lung malformations (CLM) remains controversial. The purpose of this study was to determine the effect of operative approach on perioperative outcomes in infants undergoing lobectomy for an asymptomatic CLM. METHODS After IRB approval, a retrospective cohort study was conducted on 506 children with a CLM resected at one of eleven children's hospitals over a seven-year period. Infants undergoing elective lobectomy were identified, and covariates were balanced based on operative approach using propensity scores with full matching. Outcomes were analyzed based on intention to treat with weighted conditional regression. RESULTS One hundred seventy-five infants met inclusion criteria. There were 67 (38.3%) open, 89 (50.9%) thoracoscopic, and 19 (10.9%) thoracoscopic-converted-to-open lobectomies. Thoracoscopic lobectomy was associated with significantly longer operative times (26 min, 95% CI 6-47 min, p = 0.012) but used less epidural anesthesia (OR 0.02, 95% CI 0.004-0.11, p<0.001) when compared to open lobectomy. There were no significant differences in intraoperative blood loss, postoperative complications, chest tube duration, or length of stay. CONCLUSIONS Thoracoscopy has become the most common operative approach for elective lobectomy in infants with asymptomatic CLMs. The non-inferiority of thoracoscopic lobectomy in postoperative outcomes supports its continued use as an alternative to open lobectomy. LEVEL OF EVIDENCE Treatment study, Level III.
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Affiliation(s)
- Jennine H Weller
- Division of General Pediatric Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Johns Hopkins Children's Center, Baltimore, MD, United States
| | | | - Mary E Fallat
- Division of Pediatric Surgery, Hiram C. Polk, Jr., M.D. Department of Surgery, University of Louisville, Norton Children's Hospital, Louisville, KY, United States
| | - Jacqueline M Saito
- Division of Pediatric Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO, United States
| | - Cartland R Burns
- Division of Pediatric Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Katherine J Deans
- Center for Surgical Outcomes Research, the Research Institute and Department of Surgery, Nationwide Children's Hospital, Ohio State University College of Medicine, Columbus, OH, United States
| | - Jason D Fraser
- Children's Mercy Hospital, Kansas City, MO, United States
| | - Samir K Gadepalli
- University of Michigan and Michigan Medicine, C.S. Mott Children's Hospital, Ann Arbor, MI, United States
| | - Michael A Helmrath
- Division of Pediatric Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Ronald B Hirschl
- University of Michigan and Michigan Medicine, C.S. Mott Children's Hospital, Ann Arbor, MI, United States
| | - Rashmi Kabre
- Division of Pediatric Surgery, Department of Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Dave R Lal
- Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Matthew P Landman
- Division of Pediatric Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Charles M Leys
- Division of Pediatric Surgery, Department of Surgery, University of Wisconsin, Madison, WI, United States
| | - Grace Z Mak
- Section of Pediatric Surgery, Department of Surgery, Comer Children's Hospital, University of Chicago Medicine and Biological Sciences, Chicago, IL, United States
| | - Peter C Minneci
- Center for Surgical Outcomes Research, the Research Institute and Department of Surgery, Nationwide Children's Hospital, Ohio State University College of Medicine, Columbus, OH, United States
| | - Tiffany N Wright
- Division of Pediatric Surgery, Hiram C. Polk, Jr., M.D. Department of Surgery, University of Louisville, Norton Children's Hospital, Louisville, KY, United States
| | - Shaun M Kunisaki
- Division of General Pediatric Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Johns Hopkins Children's Center, Baltimore, MD, United States.
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5
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Murray-Torres TM, Winch PD, Naguib AN, Tobias JD. Anesthesia for thoracic surgery in infants and children. Saudi J Anaesth 2021; 15:283-299. [PMID: 34764836 PMCID: PMC8579498 DOI: 10.4103/sja.sja_350_20] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 04/21/2020] [Indexed: 11/19/2022] Open
Abstract
The management of infants and children presenting for thoracic surgery poses a variety of challenges for anesthesiologists. A thorough understanding of the implications of developmental changes in cardiopulmonary anatomy and physiology, associated comorbid conditions, and the proposed surgical intervention is essential in order to provide safe and effective clinical care. This narrative review discusses the perioperative anesthetic management of pediatric patients undergoing noncardiac thoracic surgery, beginning with the preoperative assessment. The considerations for the implementation and management of one-lung ventilation (OLV) will be reviewed, and as will the anesthetic implications of different surgical procedures including bronchoscopy, mediastinoscopy, thoracotomy, and thoracoscopy. We will also discuss pediatric-specific disease processes presenting in neonates, infants, and children, with an emphasis on those with unique impact on anesthetic management.
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Affiliation(s)
- Teresa M Murray-Torres
- Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio, Missouri, USA.,Department of Anesthesiology, St. Louis Children's Hospital, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Peter D Winch
- Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio, Missouri, USA.,Department of Anesthesiology and Pain Medicine, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Aymen N Naguib
- Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio, Missouri, USA.,Department of Anesthesiology and Pain Medicine, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Joseph D Tobias
- Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio, Missouri, USA.,Department of Anesthesiology and Pain Medicine, The Ohio State University College of Medicine, Columbus, Ohio, USA
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Elhattab A, Elsaied A, Wafa T, Jugie M, Delacourt C, Sarnacki S, Aly K, Khen-Dunlop N. Thoracoscopic surgery for congenital lung malformations: Does previous infection really matter? J Pediatr Surg 2021; 56:1982-1987. [PMID: 33573805 DOI: 10.1016/j.jpedsurg.2021.01.036] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 01/13/2021] [Accepted: 01/19/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND/ PURPOSE Elective resection of congenital lung malformations (CLMs) is still debatable. The two main risks are malignant transformation and recurrent pulmonary infections. Our study aimed to assess the effect of previous pulmonary infection on the intraoperative and postoperative courses of thoracoscopic surgery for CLMs. METHODS This is a retrospective study including all thoracoscopic lung resections for CLMs between 2010 and 2019. Ninety patients were included. There was a history of previous pulmonary infection in 28 patients (group A) and no such history in 62 patients (group B). RESULTS The median age at operation for group A was 20.4 months (IQR:14.9-41.4) versus 15.1 months (IQR:9.7-20.8) in group B (p = 0.006). There were 10 conversions (35.7%) in group A and 8 (12.9%) in group B (p = 0.02). The operative time was significantly shorter in group B (p<0.002). In group A, 32.1% of patients experienced postoperative fever versus 11.3% of group B (p = 0.03), with higher antibiotics requirement (28.6% versus 6.5% respectively, p = 0.007). However, no significant differences were found in terms of postoperative complications (p = 0.99). CONCLUSION Earlier intervention for CLMs before the development of pulmonary infection carries higher chances for the success of the thoracoscopic approach with shorter operative time and more uneventful postoperative courses.
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Affiliation(s)
- Ahmad Elhattab
- Department of Pediatric Surgery, AP-HP, Necker-Enfants malades Hospital, Paris, France; Department of Pediatric Surgery, Mansoura University Children's Hospital, Mansoura, Egypt
| | - Adham Elsaied
- Department of Pediatric Surgery, Mansoura University Children's Hospital, Mansoura, Egypt
| | - Tamer Wafa
- Department of Pediatric Surgery, Mansoura University Children's Hospital, Mansoura, Egypt
| | - Myriam Jugie
- Intensive care Unit, AP-HP, Necker-Enfants malades Hospital, Paris, France
| | - Christophe Delacourt
- Department of Pediatric Pulmonology, AP-HP, Necker-Enfants malades Hospital, Paris, France; Université de Paris, Paris, France
| | - Sabine Sarnacki
- Department of Pediatric Surgery, AP-HP, Necker-Enfants malades Hospital, Paris, France; Université de Paris, Paris, France
| | - Kamal Aly
- Department of Pediatric Surgery, Mansoura University Children's Hospital, Mansoura, Egypt
| | - Naziha Khen-Dunlop
- Department of Pediatric Surgery, AP-HP, Necker-Enfants malades Hospital, Paris, France; Université de Paris, Paris, France
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Ojha S, Srivastava P, Poonia A, Bansal R. Thoracoscopic excision of double-pulmonary sequestration in left haemithorax, without anomalous blood supply (supply from pulmonary artery) in a neonate: First case. J Minim Access Surg 2021; 17:556-558. [PMID: 34558432 PMCID: PMC8486054 DOI: 10.4103/jmas.jmas_218_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 10/30/2020] [Accepted: 11/24/2020] [Indexed: 12/04/2022] Open
Abstract
Pulmonary sequestration (PS) is a rare anomaly. PS is a mass of abnormal pulmonary tissue that does not communicate with the tracheobronchial tree and is supplied by an anomalous systemic artery. Although aberrant systemic arterial supply is considered the key element to diagnose PS, rarely it can have arterial supply from the pulmonary artery as a spectrum of sequestration. Here, we present an unusual case of double (upper and lower) extralobar sequestration, present unilaterally (left haemithorax) in a neonate, without anomalous blood supply (supply from the left pulmonary artery and drainage into the superior and inferior pulmonary veins), not reported in literature earlier, to the best of our knowledge. In the present case, a child presented with respiratory discomfort at birth, requiring surgery due to inability to wean off respiratory support. It is important to be aware of this variant of sequestration spectrum. In a 18 days old child, both pulmonary sequestrations were resected thoracoscopically, making it a rare case, not described earlier in literature.
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Affiliation(s)
- Sunita Ojha
- Department of Neonatal and Pediatric Surgery, Santokba Durlabhji Memorial Hospital and Research Institute, Jaipur, Rajasthan, India
| | - Prabhar Srivastava
- Department of Pediatric, Santokba Durlabhji Memorial Hospital and Research Institute, Jaipur, Rajasthan, India
| | - Anil Poonia
- Department of Pediatric, Santokba Durlabhji Memorial Hospital and Research Institute, Jaipur, Rajasthan, India
| | - Rajiv Bansal
- Department of Neonatal and Pediatric Surgery, Santokba Durlabhji Memorial Hospital and Research Institute, Jaipur, Rajasthan, India
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8
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Huang D, Habuding A, Yuan M, Yang G, Cheng K, Luo D, Xu C. The clinical management of extralobar pulmonary sequestration in children. Pediatr Pulmonol 2021; 56:2322-2327. [PMID: 33930250 DOI: 10.1002/ppul.25433] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 04/12/2021] [Accepted: 04/12/2021] [Indexed: 02/05/2023]
Abstract
INTRODUCTION The treatment of extralobar pulmonary sequestration (ELS) remains divergent. This study aims to demonstrate the characters of ELS in children for optimal clinical management in the future. MATERIAL AND METHODS A retrospective analysis was conducted for ELS patients' treatment in our center from January 2013 to April 2020. RESULTS In total, 85 patients were included, containing 70 upper-diaphragmatic, 7 intra-diaphragmatic, and 8 infra-diaphragmatic ELS. Eight patients' pathology results showing inflammation without symptoms preoperation and two patients had chest pain for torsion. All the upper-diaphragmatic and intra-diaphragmatic ELS patients accepted thoracoscopic surgery resection. The intraoperative operation time and blood loss volume of intra-diaphragmatic ELS were significantly more than that of the upper-diaphragmatic (40.14 ± 9.92 vs. 23.07 ± 6.79 min; 9.29 ± 3.45 vs. 3.18 ± 4.94 ml; all p < .05). No chest tubes were inserted in both subgroups. No complications were found in the postoperative follow-up of operative ELS patients at least 3 months. A total of eight infra-diaphragmatic ELS patients except for one (7/8) had conservative therapy and follow-up by the outpatient clinic or phone call eventually. There were no symptoms occurring and no size increasing of observation infra-diaphragmatic ELS. CONCLUSIONS The ELS has the potential risk of infection and torsion in this study. Thoracoscopic surgery might be optimal management of upper-diaphragmatic ELS for its minimal invasion and low perioperative risks, which could be developed into a day operation with safe and quick recovery. The intra-diaphragmatic and infra-diaphragmatic ELS need a larger sample size and multiple center data to get a better management approach.
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Affiliation(s)
- Dongmei Huang
- Department of Pediatric Thoracic Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Aerxin Habuding
- Department of Pediatric Surgery, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang, China
| | - Miao Yuan
- Department of Pediatric Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Gang Yang
- Department of Pediatric Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Kaisheng Cheng
- Department of Pediatric Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Dengke Luo
- Department of Pediatric Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Chang Xu
- Department of Pediatric Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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9
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Uniportal video-assisted thoracoscopic lobectomy for pulmonary mucormycosis in a pediatric patient. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2021. [DOI: 10.1016/j.epsc.2020.101769] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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10
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Clark RA, Perez EA, Chung DH, Pandya SR. Predictive Factors and Outcomes for Successful Thoracoscopic Lung Resection in Pediatric Patients. J Am Coll Surg 2021; 232:551-558. [PMID: 33359619 DOI: 10.1016/j.jamcollsurg.2020.12.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 12/01/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Less than 50% of children with congenital lung lesions are treated thoracoscopically. There are variable data regarding the benefits and limited information on factors contributing to successful thoracoscopic lobectomies in pediatric patients. We sought to identify predictive factors leading to safe and efficient thoracoscopic lung resection. STUDY DESIGN We performed a single-center, retrospective chart review of patients (age <18 y) who underwent lung resection between June 2009 and July 2020. Pulmonary wedge resection was excluded. Data collected included demographics, perioperative findings, such as symptoms or infection, and postoperative outcomes. Univariate, multivariate, and sensitivity analyses were performed. RESULTS Ninety-six patients were identified. Sixty-nine patients (72%) underwent initial thoracoscopy, with 15 (22%) converting to open thoracotomy (CTO). Forty-one (43%) patients had preoperative symptoms and 15 (15.6%) had an active infection. Among symptomatic patients, 18 (43.9%) underwent thoracotomy and 23 (56%) were attempted thoracoscopically, 13 (31%) of whom were completed thoracoscopically. On univariate analysis, age >1 year, infection, preoperative symptoms, and intraoperative adhesions were associated with CTO. Older age (odds ratio [OR] = 1.041) and estimated blood loss (EBL) (OR = 2.398) were significant prognostic factors of CTO on logistic regression. Thoracoscopy was significantly associated with decreased length of stay, opioid use, chest tube duration, blood loss and need for blood transfusion. There was no difference in operative time, 30-day readmission, or mortality. CONCLUSIONS Thoracoscopy has become a standard approach for pediatric lung resection. Our findings indicate that age < 1 year and the absence of active respiratory infection and preoperative symptoms may be predictive of successful completion of the thoracoscopic approach. Thoracoscopy offers significant advantages over the traditional open thoracotomy with regard to blood loss and opioid requirements, LOS, and chest tube duration.
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Affiliation(s)
- Rachael A Clark
- Department of Surgery, Division of Pediatric Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Eduardo A Perez
- Department of Pediatric Surgery, University of Miami Health System, Miami, FL
| | - Dai H Chung
- Department of Surgery, Division of Pediatric Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Samir R Pandya
- Department of Surgery, Division of Pediatric Surgery, University of Texas Southwestern Medical Center, Dallas, TX.
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Xie J, Wu Y, Wu C. Is thoracoscopy superior to thoracotomy in the treatment of congenital lung malformations? An updated meta-analysis. Ther Adv Respir Dis 2020; 14:1753466620980267. [PMID: 33308023 PMCID: PMC7739138 DOI: 10.1177/1753466620980267] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background: A meta-analysis was performed for a comparison of outcomes between video-assisted thoracoscopic surgery (VATS) and thoracotomy for congenital lung malformations (CLM). Methods: Electronic databases, including PubMed, Scopus, Embase, and the Cochrane Library were searched systematically for literature aimed mainly at reporting the therapeutic effects for CLM administrated by VATS and thoracotomy. Results: A total of 40 studies meeting the inclusion criteria were included, involving 2896 subjects. VATS was associated with fewer complications [odds ratio (OR) 0.54; 95% confidence interval (CI), 0.42–0.69], less use of epidural anesthesia (OR, 0.08; 95% CI, 0.03–0.23), shorter length of hospital stay [standard mean difference (SMD) −0.98; 95% CI, −1.4 to −0.55] and chest drainage (SMD, −0.43; 95% CI, −0.7 to −0.17), as compared with thoracotomy. However, thoracotomy showed superiority in reduced operative time (SMD, 0.44; 95% CI, 0.04–0.84). Pearson analysis (Pearson r = 0.85, 95% CI, 0.28 to 0.98, p = 0.01) and linear regression (R square 0.73) confirmed a positive correlation between percentage of symptomatic cases and conversion in patients using VATS. Conclusion: VATS is associated with fewer complications, less use of epidural anesthesia, shorter length of stay and length of chest drainage, but longer operative time, as compared with thoracotomy. Symptomatic patients with CLM using VATS may be prone to conversion to thoracotomy. The reviews of this paper are available via the supplemental material section.
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12
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Feasibility and safety of reduced-port video-assisted thoracoscopic surgery using a needle scope for pulmonary lobectomy- retrospective study. Ann Med Surg (Lond) 2019; 45:70-74. [PMID: 31388418 PMCID: PMC6677861 DOI: 10.1016/j.amsu.2019.07.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 07/17/2019] [Accepted: 07/23/2019] [Indexed: 11/22/2022] Open
Abstract
Background This study aimed to determine the usefulness and limitations of videoassisted thoracoscopic (VATS) lobectomy using one-window and puncture method (1WPM). Methods This study involved 14 patients who underwent lobectomy using the 1WPM at our institute from 2008 to 2017. Results The study patients comprised of 3 men and 11 women with a median age of 10.5 years (range, 0-72 years). There were eight cases in children younger than 18 years old and the youngest patient was 9 days old. The diagnoses were congenital pulmonary cystic disease (n = 7), primary lung cancer (n = 4), metastatic lung tumor (n = 1), and others (n = 2). The 1WPM was successful in 9 of 14 patients (64.3%) and, in 5 cases (35.7%), needed conversion to either two-window method (TWM) using additional port (n = 3) or open thoracotomy (n = 2). The causes for conversion were need for additional bronchoplasty or lymph node dissection (n = 3), failure of one-lung ventilation (n = 1), and presence of a small thoracic cavity that made the procedure extremely difficult (n = 1). In the group that was successfully treated with 1WPM, the median values were as follows: operation time, 193 min (range, 112-480 min); blood loss, 0 ml (range, 0-90 ml); drainage duration, 1 day (range, 1-4 days); and postoperative hospital stay, 7 days (range, 4-13 days). Conclusions Lobectomy by 1WPM can be safely performed and has good postoperative course and this procedure can be applicable and effective in small infants. This study describes the novel VATS lobectomy method: the one-window and puncture method (1WPM). 1WPM is performed using 2–3 cm single incisions and a needle scope for intrathoracic access from other points. This retrospective study involved 14 patients who underwent lobectomy using the 1WPM. VATS lobectomy using 1WPM can be safely applied from adult cases to new born cases.
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13
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Zhou H, Tang S, Fu Q, Yu L, Liu L. Hybrid surgery in treatment of pulmonary sequestration with abdominal aorta feeding vessel: a case report. J Cardiothorac Surg 2018; 13:44. [PMID: 29776376 PMCID: PMC5960101 DOI: 10.1186/s13019-018-0733-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Accepted: 05/09/2018] [Indexed: 02/05/2023] Open
Abstract
Background Pulmonary sequestration is a rare congenital pulmonary dysplasia, which requires surgical resection (either via open thoracotomy or video-assisted thoracoscopic surgery [VATS] or via endoluminal occlusion of the abnormal feeding vessel). Case presentation We described a 51-year-old female patient with a history of recurrent cough and repeated pneumonia. She was referred to our hospital for further work-up of pulmonary sequestration. We performed a hybrid surgery (i.e., embolization of the aberrant feeding vessel of the sequestration combined with wedge resection of the left lower lobe lesion through VATS). The patient was discharged on the sixth postoperative day in good condition and without complications. Conclusions We believe that a hybrid operation is safer, more feasible, and more comprehensive than other treatments.
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Affiliation(s)
- Haining Zhou
- Department of Thoracic surgery, West China Hospital, Sichuan University, Chengdu, 610000, China.,Department of Thoracic surgery, Suining Central Hospital, Suining, 629000, China
| | - Shoujun Tang
- Department of Thoracic surgery, Suining Central Hospital, Suining, 629000, China.,Shehong People's Hospital, Suining, 629000, China
| | - Quanshui Fu
- Department of Thoracic surgery, Suining Central Hospital, Suining, 629000, China
| | - Li Yu
- Department of Thoracic surgery, Suining Central Hospital, Suining, 629000, China
| | - Lunxu Liu
- Department of Thoracic surgery, West China Hospital, Sichuan University, Chengdu, 610000, China.
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14
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Yasmin R, Stærk DR, Kalhauge A, Hansen HJ, Olsen TE, Maroun LL. Role of CT angiography in bilateral pulmonary sequestration: a case report. Acta Radiol Open 2018. [PMID: 29531794 PMCID: PMC5843107 DOI: 10.1177/2058460118757577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Bilateral pulmonary sequestration (PS) is a very rare congenital malformation. We describe a case of bilateral intralobar pulmonary sequestration (ILS) in a newborn. Both sequestrations received arterial supply from separate branches of the descending aorta and venous drainage was into ipsilateral inferior pulmonary veins. Prenatal ultrasonography showed cystic changes in the lungs. Computed tomography angiography (CTA) with supplemental two-dimensional (2D) and three-dimensional (3D) images was performed to clearly define the pathology and revealed bilateral intralobar pulmonary sequestration with aberrant blood supply. The child underwent successful video-assisted thoracoscopic surgical (VATS) lobectomy on the left side and thoracoscopic wedge resection on the right side. There were no complications. CTA with supplemental 2D and 3D images plays a vital role in revealing the exact pathology in congenital pulmonary malformations associated with anomalous vasculature.
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Affiliation(s)
- Rizwana Yasmin
- 1Department of Radiology, Rigshospitalet, Copenhagen, Denmark
| | - Dorte R Stærk
- 1Department of Radiology, Rigshospitalet, Copenhagen, Denmark
| | - Anna Kalhauge
- 1Department of Radiology, Rigshospitalet, Copenhagen, Denmark
| | - Henrik J Hansen
- 2Department of Cardiothoracic Surgery, Rigshospitalet, Copenhagen, Denmark
| | - Tina E Olsen
- 3Department of Pathology, Rigshospitalet, Copenhagen, Denmark
| | - Lisa L Maroun
- 3Department of Pathology, Rigshospitalet, Copenhagen, Denmark
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15
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Khen-Dunlop N, Farmakis K, Berteloot L, Gobbo F, Stirnemann J, De Blic J, Brunelle F, Delacourt C, Revillon Y. Bronchopulmonary sequestrations in a paediatric centre: ongoing practices and debated management. Eur J Cardiothorac Surg 2018; 54:246-251. [DOI: 10.1093/ejcts/ezy049] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 01/14/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- Naziha Khen-Dunlop
- Deparmtent of Pediatric Surgery, AP-HP, Hopital Necker-Enfants malades, Paris, France
- Université Paris Descartes, Sorbonne Paris Cite, Paris, France
- EA FETUS, Paris, France
| | - Konstantinos Farmakis
- Deparmtent of Pediatric Surgery, AP-HP, Hopital Necker-Enfants malades, Paris, France
| | - Laureline Berteloot
- Deparmtent of Pediatric Radilogy, AP-HP, Hopital Necker-Enfants malades, Paris, France
| | - Francesca Gobbo
- Deparmtent of Pediatric Surgery, AP-HP, Hopital Necker-Enfants malades, Paris, France
| | - Julien Stirnemann
- Université Paris Descartes, Sorbonne Paris Cite, Paris, France
- EA FETUS, Paris, France
- Department of Obstetrics, AP-HP, Hopital Necker-Enfants malades, Paris, France
| | - Jacques De Blic
- Université Paris Descartes, Sorbonne Paris Cite, Paris, France
- Department of Pediatric Pulmunology, AP-HP, Hopital Necker-Enfants malades, Paris, France
| | - Francis Brunelle
- Université Paris Descartes, Sorbonne Paris Cite, Paris, France
- Deparmtent of Pediatric Radilogy, AP-HP, Hopital Necker-Enfants malades, Paris, France
| | - Christophe Delacourt
- Université Paris Descartes, Sorbonne Paris Cite, Paris, France
- Department of Pediatric Pulmunology, AP-HP, Hopital Necker-Enfants malades, Paris, France
| | - Yann Revillon
- Deparmtent of Pediatric Surgery, AP-HP, Hopital Necker-Enfants malades, Paris, France
- Université Paris Descartes, Sorbonne Paris Cite, Paris, France
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16
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Miyagi H, Honda S, Hamada H, Minato M, Ara MW, Taketomi A. One-Stage Laparoscopic Surgery for Pulmonary Sequestration and Hiatal Hernia in a 2-Year-Old Girl. European J Pediatr Surg Rep 2018; 6:e11-e14. [PMID: 29318104 PMCID: PMC5758358 DOI: 10.1055/s-0037-1612611] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 11/02/2017] [Indexed: 11/30/2022] Open
Abstract
We herein report a case of one-stage laparoscopic surgery for extralobar pulmonary sequestration (EPS) and hiatal hernia. Our patient was a 2-year-old girl who was diagnosed as a mediastinal mass lesion. Postnatal computed tomography revealed that the mediastinal mass was an EPS. Two weeks after birth, the patient developed gastroesophageal reflux (GER), and esophagography showed a hiatal hernia. At 2 years of age, she underwent one-stage laparoscopic Nissen's fundoplication for GER with resection of the EPS in the posterior mediastinum. The sequestrated lung was grasped via the esophageal hiatus; three aberrant blood vessels were dissected to allow removal of the sequestration through the umbilical port site. The esophageal hiatus was repaired and Nissen's fundoplication was performed laparoscopically. The patient's postoperative course was uneventful, with no recurrence of GER symptoms for 1 year. We conclude that one-stage laparoscopic surgery is useful for patients with EPS and hiatal hernia.
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Affiliation(s)
- Hisayuki Miyagi
- Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, Kita-ku, Kita 15, Nishi 7, Sapporo, Japan
| | - Shohei Honda
- Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, Kita-ku, Kita 15, Nishi 7, Sapporo, Japan
| | - Hiromi Hamada
- Department of Pediatric Surgery, Hokkaido Medical Center for Child Health and Rehabilitation, Teine-ku, Kanayama 1-1, Sapporo, Japan
| | - Masashi Minato
- Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, Kita-ku, Kita 15, Nishi 7, Sapporo, Japan
| | - Momoko W Ara
- Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, Kita-ku, Kita 15, Nishi 7, Sapporo, Japan
| | - Akinobu Taketomi
- Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, Kita-ku, Kita 15, Nishi 7, Sapporo, Japan
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17
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Abstract
Congenital lung lesions (CLLs) comprise a heterogeneous group of developmental and histologic entities often diagnosed on screening prenatal ultrasound. Most fetuses with CLL are asymptomatic at birth; however, the risk of malignancy and infection drives the decision to prophylactically resect these lesions. The authors describe their approach to minimally invasive lobectomy in children with CLLs, postoperative care, and management of procedure-specific complications.
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Affiliation(s)
- Jarrett Moyer
- Department of Surgery, University of CA - San Francisco, 513 Parnassus Avenue, S-321, San Francisco, CA 94143, USA.
| | - Hanmin Lee
- Professor of Surgery, Division of Pediatric Surgery, Dept of Surgery, Universty of CA - San Francisco, San Francisco, CA
| | - Lan Vu
- Assistant Professor of Surgery, Division of Pediatric Surgery, Dept of Surgery, University of CA - San Francisco, San Francisco, CA
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18
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Serial improvement of quality metrics in pediatric thoracoscopic lobectomy for congenital lung malformation: an analysis of learning curve. Surg Endosc 2017; 31:3932-3938. [PMID: 28205035 DOI: 10.1007/s00464-017-5425-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2016] [Accepted: 01/20/2017] [Indexed: 10/20/2022]
Abstract
BACKGROUND Video-assisted thoracic surgery (VATS) pulmonary resection in children is a technically demanding procedure that requires a relatively long learning period. This study aimed to evaluate the serial improvement of quality metrics according to case volume experience in pediatric VATS pulmonary resection of congenital lung malformation (CLM). Methods VATS anatomical resection in CLM was attempted in 200 consecutive patients. The learning curve for the operative time was modeled by cumulative sum analysis. Quality metrics were used to measure technical achievement and efficiency outcomes. Results The median operative time was 95 min. The median length of hospital stay and chest tube indwelling time was 4 and 2 days, respectively. The improvement of operation time was observed persistently until 200 cases. However, two cut-off points, the 50th case and 110th case, were identified in the learning curve for operative time, and the 110th case was the turning point for stable outcomes with short operation time. Significant reduction of length of hospital stay and chest tube indwelling time was observed after 50 cases (p = .002 and p = .021, respectively). The complication rate decreased but continued at a low rate for entire study period and the interval decrease was not statistically significant. Conversion rate decreased significantly (p = .001), and technically challenging procedures were performed more frequently in later cases. Conclusions Improvements of quality metrics in operation time, conversion rate, length of hospital stay, and chest tube indwelling time were observed in proportion to case volume. Minimum experience of 50 is necessary for stable outcomes of pediatric VATS pulmonary resection.
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19
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Does thoracoscopy have advantages over open surgery for asymptomatic congenital lung malformations? An analysis of 1626 resections. J Pediatr Surg 2017; 52:247-251. [PMID: 27889066 DOI: 10.1016/j.jpedsurg.2016.11.014] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 11/08/2016] [Indexed: 11/23/2022]
Abstract
AIM The apparent incidence of antenatally diagnosed congenital lung malformations (CLM) is rising (1 in 3000), and the majority undergo elective resection even if asymptomatic. Thoracoscopy has been popularized, but early series report high conversion rates and significant complications. We aimed to perform systematic review/meta-analysis of outcomes of thoracoscopic vs open excision of asymptomatic CLMs. METHODS A systematic review according to PRISMA guidelines was performed. Data were extracted for all relevant studies (2004-2015) and Rangel quality scores calculated. Analysis was on 'intention to treat' basis for thoracoscopy and asymptomatic lung lesions. Meta-analysis was performed using the addon package METAN of the statistical package STATA14™; p<0.05 was considered significant. RESULTS 36 studies were eligible, describing 1626 CLM resections (904 thoracoscopic, 722 open). There were no randomized controlled trials. Median quality score was 14/45 (IQR 6.5) 'poor'. 92/904 (10%) thoracoscopic procedures were converted to open. No deaths were reported. Meta-analysis showed that regarding thoracoscopic procedures, the total number of complications was significantly less (OR 0.63, 95% CI 0.43, 0.92; p<0.02, 12 eligible series, 912 patients, 404 thoracoscopic). Length of stay was 1.4days shorter (95%CI 2.40, 0.37;p<0.01). Length of operation was 37 min longer (95% CI 18.96, 54.99; p<0.01). Age, weight, and number of chest tube days were similar. There was heterogeneity (I2 30%, p=0.15) and no publication bias seen. CONCLUSIONS A reduced total complication rate favors thoracoscopic excision over thoracotomy for asymptomatic antenatally diagnosed CLMs. Although operative time was longer, and open conversion may be anticipated in 1/10, the overall length of hospital stay was reduced by more than 1day. LEVEL OF EVIDENCE 4 (based on lowest level of article analyzed in meta-analysis/systematic review).
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20
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Varela P, Pio L, Brandigi E, Paraboschi I, Khen-Dunlop N, Hervieux E, Muller C, Mattioli G, Sarnacki S, Torre M. Tracheal and bronchial tumors. J Thorac Dis 2016; 8:3781-3786. [PMID: 28149577 PMCID: PMC5227203 DOI: 10.21037/jtd.2016.12.67] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 12/05/2016] [Indexed: 11/06/2022]
Abstract
Although primary tracheobronchial tumors are extremely rare in children, recurrent respiratory symptoms resistant to conventional therapy require further investigations to exclude possible malignant obstructive causes. As the matter of fact, early diagnosis may allow minimally invasive surgeries, improving the standard of living and the globally survival rate. The aim of this article is to provide an overview of diagnosis and management of tracheobronchial tumors in the early age, since only few reports are reported in the worldwide literature.
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Affiliation(s)
- Patricio Varela
- Department of Pediatric Surgery, Clinica Las Condes Medical Center, Hospital de Niños Calvo Mackenna, University of Chile, Santiago, Chile
| | - Luca Pio
- Department of Pediatric Surgery, Necker Enfants-Malades Hospital-Université Paris Descartes, Sorbonne Paris Cite, Paris, France
| | - Elisa Brandigi
- Department of Medical Sciences, Surgery and Neurosciences, Clinic Pediatric Surgery, University of Siena, Siena, Italy
| | - Irene Paraboschi
- DINOGMI University of Genoa, Genoa, Italy
- Pediatric Surgery Unit, Istituto Giannina Gaslini, Genoa, Italy
| | - Nazhia Khen-Dunlop
- Department of Pediatric Surgery, Necker Enfants-Malades Hospital-Université Paris Descartes, Sorbonne Paris Cite, Paris, France
| | - Erik Hervieux
- Department of Pediatric Surgery, Necker Enfants-Malades Hospital-Université Paris Descartes, Sorbonne Paris Cite, Paris, France
| | - Cecile Muller
- Department of Pediatric Surgery, Necker Enfants-Malades Hospital-Université Paris Descartes, Sorbonne Paris Cite, Paris, France
| | - Girolamo Mattioli
- DINOGMI University of Genoa, Genoa, Italy
- Pediatric Surgery Unit, Istituto Giannina Gaslini, Genoa, Italy
| | - Sabine Sarnacki
- Department of Pediatric Surgery, Necker Enfants-Malades Hospital-Université Paris Descartes, Sorbonne Paris Cite, Paris, France
| | - Michele Torre
- Pediatric Surgery Unit, Istituto Giannina Gaslini, Genoa, Italy
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21
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Mattioli G, Pio L, Disma NM, Torre M, Sacco O, Pistorio A, Zanaboni C, Montobbio G, Barra F, Ramenghi LA. Congenital Lung Malformations: Shifting from Open to Thoracoscopic Surgery. Pediatr Neonatol 2016; 57:463-466. [PMID: 27036100 DOI: 10.1016/j.pedneo.2015.10.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Revised: 10/01/2015] [Accepted: 10/29/2015] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND Over the years the need for surgical treatment, timing of intervention, and the type of surgical approach have been discussed, but the treatment of congenital lung malformations remains controversial. The aim of this study was to compare the thoracotomy approach with the thoracoscopic technique by evaluating different surgical outcomes (duration of surgery, postoperative hospital stay, and complications). METHODS All patients operated from January 2011 to March 2015 for suspected congenital cystic lung were included in the study. Patients treated for congenital lobar emphysema and tracheobronchial neoplasms were excluded from the study. RESULTS In the analyzed period, 31 asymptomatic patients were treated: 18 lung resections were performed with thoracotomy (Group A) and 13 with the thoracoscopic approach (Group B). No significant differences were observed between the age and weight at surgery, length of the procedures, complications, and the need for postoperative intensive care between the two groups. The postoperative hospital stay in Group A was twice that for Group 2 (p = 0.0009). CONCLUSION Comparing thoracoscopic surgery with the traditional open approach, we confirmed the superiority of minimally invasive treatment in terms of postoperative hospital stay. Common technical recommendations can help pediatric centers to develop the thoracoscopic approach for the treatment of congenital pulmonary malformations.
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Affiliation(s)
- Girolamo Mattioli
- Pediatric Surgery Unit, Istituto Giannina Gaslini, Genoa, Italy; DINOGMI, University of Genoa, Genoa, Italy
| | - Luca Pio
- Pediatric Surgery Unit, Istituto Giannina Gaslini, Genoa, Italy; DINOGMI, University of Genoa, Genoa, Italy.
| | | | - Michele Torre
- Pediatric Surgery Unit, Istituto Giannina Gaslini, Genoa, Italy
| | - Oliviero Sacco
- Pediatric Pulmonology Unit, Istituto Giannina Gaslini, Genoa, Italy
| | - Angela Pistorio
- Epidemiology and Biostatistics Service, Istituto Giannina Gaslini, Genoa, Italy
| | - Clelia Zanaboni
- Pediatric Anesthesia Unit, Istituto Giannina Gaslini, Genoa, Italy
| | | | - Fabio Barra
- Pediatric Surgery Unit, Istituto Giannina Gaslini, Genoa, Italy
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Wagenaar AE, Tashiro J, Satahoo SS, Sola JE, Neville HL, Hogan AR, Perez EA. Resection of pediatric lung malformations: National trends in resource utilization & outcomes. J Pediatr Surg 2016; 51:1414-20. [PMID: 27292597 DOI: 10.1016/j.jpedsurg.2016.04.020] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 04/24/2016] [Accepted: 04/28/2016] [Indexed: 12/24/2022]
Abstract
PURPOSE We sought to determine factors influencing survival and resource utilization in patients undergoing surgical resection of congenital lung malformations (CLM). Additionally, we used propensity score-matched analysis (PSMA) to compare these outcomes for thoracoscopic versus open surgical approaches. METHODS Kids' Inpatient Database (1997-2009) was used to identify congenital pulmonary airway malformation (CPAM) and pulmonary sequestration (PS) patients undergoing resection. Open and thoracoscopic CPAM resections were compared using PSMA. RESULTS 1547 cases comprised the cohort. In-hospital survival was 97%. Mortality was higher in small vs. large hospitals, p<0.005. Survival, pneumothorax (PTX), and thoracoscopic procedure rates were higher, while transfusion rates and length of stay (LOS) were lower, in children ≥3 vs. <3months (p<0.001). Multivariate analysis demonstrated longer LOS for older patients and Medicaid patients (all p<0.005). Total charges (TC) were higher for Western U.S., older children, and Medicaid patients (p<0.02). PSMA for thoracoscopy vs. thoracotomy in CPAM patients showed no difference in outcomes. CONCLUSION CLM resections have high associated survival. Children <3months of age had higher rates of thoracotomy, transfusion, and mortality. Socioeconomic status, age, and region were independent indicators for resource utilization. Extent of resection was an independent prognostic indicator for in-hospital survival. On PSMA, thoracoscopic resection does not affect outcomes.
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Affiliation(s)
- Amy E Wagenaar
- Division of Pediatric Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Jun Tashiro
- Division of Pediatric Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Shevonne S Satahoo
- Division of Pediatric Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Juan E Sola
- Division of Pediatric Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Holly L Neville
- Division of Pediatric Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Anthony R Hogan
- Division of Pediatric Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Eduardo A Perez
- Division of Pediatric Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA.
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23
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Abstract
Primary tracheobronchial tumors are rare lesions that can be benign or malignant, with different location along the airway tree. Symptoms may include wheezing, chronic pneumonia, asthma, chest pain, recurrent cough, atelectasis, haemoptysis, and weight loss. Due to the heterogeneity of symptoms, diagnosis can be difficult and the airway involvement can lead progressively to a bronchial or tracheal obstruction. Due to the rarity of primary tracheobronchial tumors in children, there are not any oncological guidelines on pre-operative work-up, treatment, and follow-up. Only few reports and multicentric studies are reported. In most cases, surgical resection seems to be the treatment of choice. Brachytherapy, endoscopic treatment, and chemotherapy are rarely described. In this article we present an overview on these rare tumors, including pathological aspects, clinical presentation, imaging assessment, and endoscopic or open surgical treatments. We discuss different surgical approaches, according with tumor location.
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Affiliation(s)
- Patricio Varela
- Department of Pediatric Surgery, Clinica Las Condes Medical Center, Hospital de Niños Calvo Mackenna, University of Chile, Camino el tucuquere 4080, Santiago, Chile.
| | - Luca Pio
- DINOGMI, University of Genoa, Genova, Italy; Airway Team and Pediatric Surgery Unit, Istituto Giannina Gaslini, Genova, Italy
| | - Michele Torre
- Airway Team and Pediatric Surgery Unit, Istituto Giannina Gaslini, Genova, Italy
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Laje P, Pearson EG, Simpao AF, Rehman MA, Sinclair T, Hedrick HL, Adzick NS, Flake AW. The first 100 infant thoracoscopic lobectomies: Observations through the learning curve and comparison to open lobectomy. J Pediatr Surg 2015; 50:1811-6. [PMID: 26100691 DOI: 10.1016/j.jpedsurg.2015.05.015] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Revised: 05/22/2015] [Accepted: 05/26/2015] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The objective of the study is to describe our initial 100 attempted infant thoracoscopic lobectomies for asymptomatic, prenatally diagnosed lung lesions, and compare the results to contemporaneous age-matched patients undergoing open lobectomy. BACKGROUND Infant thoracoscopic lobectomy is a technically challenging procedure, which has only gained acceptance worldwide in recent years. METHODS This is a retrospective review of all patients undergoing thoracoscopic or open lung lobectomy between March 2005 and January 2014. Included were all asymptomatic infants younger than 4months. Excluded were patients undergoing emergent lobectomy and patients with isolated extralobar bronchopulmonary sequestrations. RESULTS A total of 100 attempted thoracoscopic lobectomies were compared with 188 open lobectomies. In the thoracoscopic group, mean age and weight at surgery were 7.3weeks and 4.8kg, mean operative time was 185minutes, and mean hospital stay was 3days. Twelve cases were converted to open (12%). Ten conversions occurred within the first third of the series and none in the last third. There were no mortalities. There were no differences between the thoracoscopic and open groups in perioperative complications or hospital stay. There was a significant difference in the operative time: 111minutes vs. 185minutes (open vs. thoracoscopic; p<0.001). There was a higher mean end-tidal carbon dioxide (ETCO2) and lower mean peripheral capillary oxygen saturation (SpO2) in the thoracoscopic group versus the open group (51.7 versus 38.6mmHg and 97.5 versus 99.1%, respectively). CONCLUSION In high volume centers, the learning curve of thoracoscopic lobectomy can be overcome and the procedure can be performed with equivalent outcomes and, in our opinion, superior cosmetic results to open lobectomy.
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Affiliation(s)
- Pablo Laje
- Department of General, Thoracic, and Fetal Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Erik G Pearson
- Department of General, Thoracic, and Fetal Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Allan F Simpao
- Department of General, Thoracic, and Fetal Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Mohammed A Rehman
- Department of General, Thoracic, and Fetal Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Tiffany Sinclair
- Department of General, Thoracic, and Fetal Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Holly L Hedrick
- Department of General, Thoracic, and Fetal Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - N Scott Adzick
- Department of General, Thoracic, and Fetal Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Alan W Flake
- Department of General, Thoracic, and Fetal Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
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25
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Kulaylat AN, Engbrecht BW, Hollenbeak CS, Safford SD, Cilley RE, Dillon PW. Comparing 30-day outcomes between thoracoscopic and open approaches for resection of pediatric congenital lung malformations: Evidence from NSQIP. J Pediatr Surg 2015; 50:1716-21. [PMID: 26144284 DOI: 10.1016/j.jpedsurg.2015.06.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Revised: 06/04/2015] [Accepted: 06/08/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND/PURPOSE Thoracoscopic surgery has been increasingly utilized in treating pediatric congenital lung malformations (CLM). Comparative studies evaluating 30-day outcomes between thoracoscopic and open resection of CLM are lacking. METHODS There were 258 patients identified in pediatric NSQIP with a CLM and pulmonary resection in 2012-2013. Comparisons of patient characteristics and outcomes between surgical approaches were made using standard univariate statistics. In addition, a propensity score match was performed to evaluate outcomes in similar patient cohorts. RESULTS One-hundred twelve patients (43.4%) received thoracoscopic resections and 146 patients (56.6%) received open resections. Patients undergoing open resections were more likely to be less than 5 months of age and have a comorbidity/preoperative condition (47.3% vs. 25.0%, p<0.001). The extent of resection was a lobectomy in 84.8% of thoracoscopic and 92.5% of open resection patients. Median operative time was similar between both groups (thoracoscopic 172 vs. open 153.5 minutes). On univariate analysis, thoracoscopic resection was associated with decreased postoperative complications (9.8% vs. 25.3%, p=0.001) and LOS (3 vs. 4 days, p<0.001). However, after adjusting for similar patient and operative characteristics, no significant differences were encountered between techniques. CONCLUSIONS Thoracoscopic and open resection provide comparable 30-day outcomes and safety in the management of congenital lung malformations.
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Affiliation(s)
- Afif N Kulaylat
- Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, PA, United States
| | - Brett W Engbrecht
- Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, PA, United States
| | - Christopher S Hollenbeak
- Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, PA, United States; Department of Public Health Sciences, College of Medicine, The Pennsylvania State University, Hershey, PA, United States
| | - Shawn D Safford
- Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, PA, United States
| | - Robert E Cilley
- Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, PA, United States
| | - Peter W Dillon
- Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, PA, United States.
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26
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Nagar R, Bütter A, Brahm G, Price A. Pulmonary sequestration causing severe cardiac failure requiring lobectomy in an extreme preterm infant. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2015. [DOI: 10.1016/j.epsc.2015.08.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
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27
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Abstract
The controversy surrounding the management of congenital lung malformations (CLMs) centre on how best to manage the increasing population of asymptomatic antenatally detected infants. Should elective surgery be offered? Or is a "watch-and-wait" policy safe? This will be addressed in this review by examining the reported complications of surgery, the risk of symptom development if lesions are left in situ and whether this may alter surgical outcomes, and importantly whether there is any long-term risk of malignancy that can be negated by surgical resection in infancy.
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Affiliation(s)
- Michael Stanton
- Department of Paediatric Surgery, University Hospital Southampton, Tremona Road, Southampton SO16 6YD, UK.
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28
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Mahida JB, Asti L, Pepper VK, Deans KJ, Minneci PC, Diefenbach KA. Comparison of 30-Day Outcomes Between Thoracoscopic and Open Lobectomy for Congenital Pulmonary Lesions. J Laparoendosc Adv Surg Tech A 2015; 25:435-40. [DOI: 10.1089/lap.2014.0298] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Affiliation(s)
- Justin B. Mahida
- Center for Surgical Outcomes Research, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio
- Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, Ohio
| | - Lindsey Asti
- Center for Surgical Outcomes Research, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio
| | - Victoria K. Pepper
- Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, Ohio
| | - Katherine J. Deans
- Center for Surgical Outcomes Research, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio
- Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, Ohio
| | - Peter C. Minneci
- Center for Surgical Outcomes Research, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio
- Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, Ohio
| | - Karen A. Diefenbach
- Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, Ohio
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29
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Barsness KA, Rooney DM, Davis LM, O'Brien E. Preliminary evaluation of a novel thoracoscopic infant lobectomy simulator. J Laparoendosc Adv Surg Tech A 2014; 25:429-34. [PMID: 25536146 DOI: 10.1089/lap.2014.0364] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
PURPOSE Thoracoscopic lobectomy in infants requires advanced minimally invasive skills. Simulation-based education has the potential to improve complex procedural skills without exposing the patient to undue risks. The study purposes were (1) to create a size-appropriate infant lobectomy simulator and (2) to evaluate validity evidence to support or refute its use in surgical education. MATERIALS AND METHODS In this Institutional Review Board-exempt study, a size-appropriate rib cage for a 3-month-old infant was created. Fetal bovine tissue completed the simulator. Thirty-three participants performed the simulated thoracoscopic lobectomy. Participants completed a self-report, 26-item instrument consisting of 25 4-point rating scales (from 1=not realistic to 4=highly realistic) and a one 4-point Global Rating Scale. Validity evidence relevant to test content and response processes was evaluated using the many-facet Rasch model, and evidence of internal structure (inter-item consistency) was estimated using Cronbach's alpha. RESULTS Experienced surgeons (observed average=3.6) had slightly higher overall rating than novice surgeons (observed average=3.4, P=.001). The highest combined observed averages were for the domain Physical Attributes (3.7), whereas the lowest ratings were for the domains Realism of Experience and Ability to Perform Tasks (3.4). The global rating was 2.9, consistent with "this simulator can be considered for use in infant lobectomy training, but could be improved slightly." Inter-item consistency for items used to evaluate the simulator's quality was high (α=0.90). CONCLUSIONS With ratings consistent with high physical attributes and realism, we successfully created an infant lobectomy simulator, and preliminary evidence relevant to test content, response processes, and internal structure was supported. Participants rated the model as realistic, relevant to clinical practice, and valuable as a learning tool. Minor improvements were suggested prior to its full implementation as an educational and testing tool.
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Affiliation(s)
- Katherine A Barsness
- 1 Division of Pediatric Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago , Chicago, Illinois
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30
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Barnet L, Mittaine M, Heitz F, Amadieu R, Acar P, Dulac Y, Hascoet S. [Embolization of pulmonary arteriovenous malformation causing hypoxemia in a 7-year-old child]. Arch Pediatr 2014; 22:75-80. [PMID: 25435273 DOI: 10.1016/j.arcped.2014.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2014] [Revised: 05/22/2014] [Accepted: 10/07/2014] [Indexed: 10/24/2022]
Abstract
Pulmonary arteriovenous fistulas are abnormal vessels joining the right pulmonary artery to the pulmonary veins. They lead to an extracardiac right-to-left shunt with refractory hypoxemia. We report the case of a 7-year-old girl with a large pulmonary arteriovenous fistula discovered with refractory hypoxemia diagnosed during general anesthesia for adenoidectomy. Radio-opacity was observed on the upper lobe of the right lung. The diagnosis was made using thoracic angiotomography. The proximal arterial vessel arose from the lobar pulmonary artery. The fistula had developed in the entire right upper lobe and drained into two veins flowing into the right superior pulmonary artery. Given the marked hypoxemia, the potential risks of pulmonary hemorrhage and pulmonary infection, an occlusion of the fistula was indicated. After discussion between surgeons and interventional cardiologists, catheterization was indicated. The occlusion of the fistula was successful at the second attempt after release of a vascular plug in the main proximal vessel. This case illustrates the clinical circumstances of diagnosis of arteriovenous fistula, the diagnostic algorithm for refractory hypoxemia and the therapeutic options, with discussion of the benefits and drawbacks of a catheterization procedure.
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Affiliation(s)
- L Barnet
- Service de cardiopédiatrie, hôpital des enfants, CHU de Purpan, 31000 Toulouse cedex 9, France.
| | - M Mittaine
- Service de pneumopédiatrie, hôpital des enfants, CHU de Purpan, 31000 Toulouse, France
| | - F Heitz
- Service de cardiopédiatrie, hôpital des enfants, CHU de Purpan, 31000 Toulouse cedex 9, France
| | - R Amadieu
- Service de cardiopédiatrie, hôpital des enfants, CHU de Purpan, 31000 Toulouse cedex 9, France
| | - P Acar
- Service de cardiopédiatrie, hôpital des enfants, CHU de Purpan, 31000 Toulouse cedex 9, France
| | - Y Dulac
- Service de cardiopédiatrie, hôpital des enfants, CHU de Purpan, 31000 Toulouse cedex 9, France
| | - S Hascoet
- Service de cardiopédiatrie, hôpital des enfants, CHU de Purpan, 31000 Toulouse cedex 9, France
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31
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Pilot study of pulmonary arterial branch sealing using energy devices in an ex vivo model. J Thorac Cardiovasc Surg 2014; 148:3219-23. [DOI: 10.1016/j.jtcvs.2014.05.089] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Revised: 05/14/2014] [Accepted: 05/23/2014] [Indexed: 11/22/2022]
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32
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Acker SN, Staulcup S, Partrick DA, Sømme S. Evolution of Minimally Invasive Techniques Within an Academic Surgical Practice at a Single Institution. J Laparoendosc Adv Surg Tech A 2014; 24:806-10. [DOI: 10.1089/lap.2014.0239] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Affiliation(s)
- Shannon N. Acker
- Department of Pediatric Surgery, Children's Hospital Colorado, Aurora, Colorado
| | - Susan Staulcup
- Children's Outcome Research, University of Colorado School of Medicine, Aurora, Colorado
| | - David A. Partrick
- Department of Pediatric Surgery, Children's Hospital Colorado, Aurora, Colorado
| | - Stig Sømme
- Department of Pediatric Surgery, Children's Hospital Colorado, Aurora, Colorado
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33
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Wang A, D'Amico TA, Berry MF. Surgical Management of Congenital Pulmonary Malformations After the First Decade of Life. Ann Thorac Surg 2014; 97:1933-8. [DOI: 10.1016/j.athoracsur.2014.01.053] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Revised: 01/09/2014] [Accepted: 01/17/2014] [Indexed: 10/25/2022]
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Bagrodia N, Cassel S, Liao J, Pitcher G, Shilyansky J. Segmental resection for the treatment of congenital pulmonary malformations. J Pediatr Surg 2014; 49:905-9. [PMID: 24888832 DOI: 10.1016/j.jpedsurg.2014.01.021] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Accepted: 01/27/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE The purpose of this study was to compare clinical outcomes of segmental resection to lobectomy as increasing antenatal diagnosis of congenital pulmonary malformations has led to a shift in surgical management. METHODS A retrospective institutional review for patients undergoing surgical excision of congenital pulmonary malformations was performed. RESULTS Sixty-two patients with congenital pulmonary malformations were reviewed between 2001 and 2012. Forty-five were included for analysis. Malformations were subdivided into two groups, including congenital lobar emphysema (CLE) (n=11, 24%) and intrapulmonary (IP) lesions (n=34, 76%). Nineteen (56%) IP patients underwent segmental resection, and 15 (79%) were performed thoracoscopically without conversion to thoracotomy. None of these patients had recurrent disease. Lobectomy was performed in 11 (100%) CLE and 15 (44%) IP patients, and the majority were by thoracotomy. Median hospital stay was longer for the lobectomy group at 7days when compared to the segmentectomy group at 2days (p<0.001). There was not a difference in complication rate (21% vs. 19%, p=1.000) or in median number of chest tube days (2 vs. 3days, p=0.079) for segmentectomy versus lobectomy patients. CONCLUSIONS Segmental resections of congenital pulmonary malformations can be performed safely while conserving healthy lung tissue.
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Affiliation(s)
- Naina Bagrodia
- Department of Surgery, Division of Pediatric Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA
| | - Shannon Cassel
- Department of Surgery, Division of Pediatric Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA
| | - Junlin Liao
- Department of Surgery, Division of Pediatric Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA
| | - Graeme Pitcher
- Department of Surgery, Division of Pediatric Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA
| | - Joel Shilyansky
- Department of Surgery, Division of Pediatric Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA.
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Abstract
AIM To review the outcome of all antenatally diagnosed conservatively managed congenital lung malformations (CLMs) managed at our centre. METHODS All patients diagnosed antenatally with cystic lung malformations from 2001 to 2011, at a tertiary referral paediatric surgical centre practising a policy of conservative management of asymptomatic cases, were retrospectively reviewed. Data were collected from medical case notes and radiology reports. Ethical approval was obtained from our institutional research and development department. RESULTS The complete records of 74 fetuses antenatally diagnosed with CLM were reviewed. There were 72 live births, at a median gestation of 39.6 weeks. Emergency lobectomy was performed in one symptomatic neonate. Elective lobectomies were performed at parental request in three asymptomatic infants, one of whom had a family history of synovial sarcoma. Two patients developed pneumonia in the affected lobe during early childhood and proceeded to lobectomy at the age of 3 years. One patient with a bronchopulmonary sequestration required embolisation for cyanotic episodes. The remaining 65 patients have been conservatively managed to date, and none have required hospital admission. Less than a quarter report mild respiratory symptoms such as cough or wheeze. Median follow-up is 5 years. CONCLUSIONS This retrospective cohort study of 74 consecutive CLMs diagnosed antenatally over a 10-year period demonstrates that most of these lesions will remain asymptomatic throughout childhood. Although the natural history of CLMs in later years remains to be elucidated, we hope that this report on medium-term outcomes will be useful to clinicians who undertake antenatal counselling and may inform the discussion on how best to manage these children.
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Affiliation(s)
- Christabella Ng
- Department of Paediatric Surgery, University Hospital Southampton NHS Foundation Trust, , Southampton, UK
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36
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Chouikh T, Berteloot L, Revillon Y, Delacourt C, Khen-Dunlop N. Extralobar pulmonary sequestration with combined gastric and intradiaphragmatic locations. Pediatr Pulmonol 2014; 49:512-4. [PMID: 24022880 DOI: 10.1002/ppul.22891] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2013] [Accepted: 07/21/2013] [Indexed: 11/09/2022]
Abstract
Extralobar pulmonary sequestration is a congenital lung malformation characterized by a non-functional lung segment with systemic feeding vessel. Over 90% of sequestrations are found in the thorax with less than 10% located in the abdomen. We present an unusual case of intra abdominal pulmonary sequestration, located suprarenally, adherent to both the stomach and the diaphragm. The malformation was surgically excised via laparoscopy in the second year of life, when no evidence of regression was found on follow up imaging. On the occasion of this description, the spectrum of bronchopulmonary foregut malformation is discussed.
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Affiliation(s)
- Taieb Chouikh
- AP-HP, Pediatric Surgery Department, Necker-Enfants Malades Hospital, Paris, France
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37
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Thoracoscopic vs open lobectomy in infants and young children with congenital lung malformations. J Am Coll Surg 2013; 218:261-70. [PMID: 24315887 DOI: 10.1016/j.jamcollsurg.2013.10.010] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Revised: 10/21/2013] [Accepted: 10/23/2013] [Indexed: 11/23/2022]
Abstract
BACKGROUND Although thoracoscopic lobectomy is a widely accepted surgical procedure in adult thoracic surgery, its role in small children remains controversial. The purpose of this study was to evaluate perioperative outcomes after thoracoscopic and open lobectomy in infants and young children with congenital lung malformations at a single academic referral center. STUDY DESIGN A cohort study of 62 consecutive children who underwent elective pulmonary lobectomy for a congenital lung lesion between 2001 and 2013 was performed. Patient demographics and perioperative outcomes were evaluated in univariate and logistic regression analyses. RESULTS Forty-nine patients underwent thoracoscopy and 13 had a thoracotomy. Six children undergoing thoracoscopy required conversion to thoracotomy (conversion 12.2%). Perioperative outcomes, including median blood loss (2.0 vs 1.1 mL/kg; p = 0.34), chest tube duration (3 vs 3 days; p = 0.33), hospital length of stay (3 vs 3 days; p = 0.42), and morbidity as defined by the Accordion Grading Scale (30.6% vs 30.8%; p = 0.73), were similar between thoracoscopy and thoracotomy, respectively. Although thoracoscopy was associated with increased operative duration compared with thoracotomy (239.9 vs 181.2 minutes, respectively; p = 0.03), thoracoscopy operative times decreased with increasing institutional experience (p = 0.048). Thoracoscopic lobectomy infants younger than 5 months of age had a 2.5-fold higher rate of perioperative adverse outcomes compared with older children (p = 0.048). CONCLUSIONS In small children undergoing pulmonary lobectomy, both thoracoscopy and thoracotomy are associated with similar perioperative outcomes. The cosmetic and musculoskeletal benefits of the thoracoscopic approach must be balanced against institutional expertise and a potentially higher risk for complications in younger patients.
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Minimally invasive thoracic surgery in pediatric patients: the Taiwan experience. BIOMED RESEARCH INTERNATIONAL 2013; 2013:850840. [PMID: 23819123 PMCID: PMC3683426 DOI: 10.1155/2013/850840] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/07/2012] [Revised: 05/06/2013] [Accepted: 05/07/2013] [Indexed: 11/17/2022]
Abstract
Minimally invasive technology or laparoscopic surgery underwent a major breakthrough over the past two decades. The first experience of thoracoscopy in children was reported around 1980 for diagnosis of intrathoracic pathology and neoplasia. Up until the middle of the 1990s, the surgical community in Taiwan was still not well prepared to accept the coming era of minimally invasive surgery. In the beginning, laparoscopy was performed in only a few specialties and only relatively short or simple surgeries were considered. But now, the Taiwan's experiences over the several different clinical scenarios were dramatically increased. Therefore, we elaborated on the experience about pectus excavatum: Nuss procedure, primary spontaneous hemopneumothorax, thoracoscopic thymectomy, and empyema in Taiwan.
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