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Video-Assisted Thoracoscopic Surgery (VATS) in a 20-Day-Old Newborn With Empyema Thoracis. Indian Pediatr 2021. [DOI: 10.1007/s13312-021-2174-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Koga H, Ochi T, Hirayama S, Watanabe Y, Ueno H, Imashimizu K, Suzuki K, Kuwatsuru R, Nishimura K, Lane GJ, Suzuki K, Yamataka A. Congenital Pulmonary Airway Malformation in Children: Advantages of an Additional Trocar in the Lower Thorax for Pulmonary Lobectomy. Front Pediatr 2021; 9:722428. [PMID: 34926336 PMCID: PMC8678478 DOI: 10.3389/fped.2021.722428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 10/14/2021] [Indexed: 11/16/2022] Open
Abstract
Aim: To present the use of an additional trocar (AT) in the lower thorax during thoracoscopic pulmonary lobectomy (TPL) in children with congenital pulmonary airway malformation. Methods: For a lower lobe TPL (LL), an AT is inserted in the 10th intercostal space (IS) in the posterior axillary line after trocars for a 5-mm 30° scope, and the surgeon's left and right hands are inserted conventionally in the 6th, 4th, and 8th IS in the anterior axillary line, respectively. For an upper lobe TPL (UL), the AT is inserted in the 9th IS, and trocars are inserted in the 5th, 3rd, and 7th IS, respectively. By switching between trocars (6th↔8th for the scope, 4th↔6th for the left hand, and 8th↔10th for the right hand during LL and 5th↔7th, 3rd↔5th, and 7th↔9th during UL, respectively), vital anatomic landmarks (pulmonary veins, bronchi, and feeding arteries) can be viewed posteriorly. The value of AT was assessed from blood loss, operative time, duration of chest tube insertion, requirement for post-operative analgesia, and incidence of perioperative complications. Results: On comparing AT+ (n = 28) and AT- (n = 27), mean intraoperative blood loss (5.6 vs. 13.0 ml), operative time (3.9 vs. 5.1 h), and duration of chest tube insertion (2.2 vs. 3.4 days) were significantly decreased with AT (p < 0.05, respectively). Differences in post-operative analgesia were not significant. There were three complications requiring conversion to open/mini-thoracotomy: AT- (n = 2; bleeding), AT+: (n = 1; erroneous stapling). Conclusions: An AT and switching facilitated posterior dissection during TPL in children with congenital pulmonary airway malformation enhancing safety and efficiency.
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Affiliation(s)
- Hiroyuki Koga
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Takanori Ochi
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Shunki Hirayama
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Yukio Watanabe
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Hiroyasu Ueno
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Kota Imashimizu
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Kazuhiro Suzuki
- Department of Radiology, Juntendo University School of Medicine, Tokyo, Japan
| | - Ryohei Kuwatsuru
- Department of Radiology, Juntendo University School of Medicine, Tokyo, Japan
| | - Kinya Nishimura
- Department of Anesthesiology and Pain Medicine, Juntendo University School of Medicine, Tokyo, Japan
| | - Geoffrey J Lane
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Kenji Suzuki
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Atsuyuki Yamataka
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo, Japan
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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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Sueyoshi R, Koga H, Suzuki K, Miyano G, Okawada M, Doi T, Lane GJ, Yamataka A. Surgical intervention for congenital pulmonary airway malformation (CPAM) patients with preoperative pneumonia and abscess formation: "open versus thoracoscopic lobectomy". Pediatr Surg Int 2016; 32:347-51. [PMID: 26661941 DOI: 10.1007/s00383-015-3848-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/03/2015] [Indexed: 11/24/2022]
Abstract
AIM Thoracoscopic lobectomy (TL) and open lobectomy (OL) were compared for treating congenital pulmonary airway malformation (CPAM) with preoperative complications, specifically pneumonia/abscess formation (PA). METHODS The medical records of 46 CPAM patients treated by lobectomy at our institution from 1990 to 2014 were reviewed retrospectively. Four groups, TL for patients without PA (n = 17; TL-), TL for patients with PA (n = 8; TL+), OL for patients without PA (n = 16; OL-), and OL for patients with PA (n = 5; OL+) were compared for operative time, intra/postoperative complications, blood loss, duration of chest tube insertion, postoperative analgesia, pre: postoperative white blood cell (WBC) ratio, and duration of hospitalization. RESULTS Operative time for TL+ was longest, but not statistically significant. Incidences of intra/postoperative complications were similar in all groups. Blood loss was significantly less for TL+ versus OL+ (p < .05). WBC ratio was significantly lower in TL+ versus OL+ (p < .05), similar for TL+ and TL-, and significantly higher in OL+ versus OL- (p < .01). Chest tube insertion was significantly longer in OL- versus TL- (p < .01). CONCLUSION PA would not appear to be a contraindication to perform TL in CPAM. TL is associated with less surgical stress than OL despite longer operative time.
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Affiliation(s)
- Ryo Sueyoshi
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo, 113-8421, Japan.
| | - Hiroyuki Koga
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo, 113-8421, Japan
| | - Kenji Suzuki
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Go Miyano
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo, 113-8421, Japan
| | - Manabu Okawada
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo, 113-8421, Japan
| | - Takashi Doi
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo, 113-8421, Japan
| | - Geoffrey J Lane
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo, 113-8421, Japan
| | - Atsuyuki Yamataka
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo, 113-8421, Japan
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Inflammatory myofibroblastic tumour in a 5-year-old child - a case report and review of the literature. Wideochir Inne Tech Maloinwazyjne 2015; 9:658-61. [PMID: 25562011 PMCID: PMC4280424 DOI: 10.5114/wiitm.2014.45885] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Revised: 06/11/2014] [Accepted: 09/01/2014] [Indexed: 11/17/2022] Open
Abstract
Inflammatory myofibroblastic tumour is an uncommon tumour of intermediate malignant potential. Its aetiology is still unclear. It occurs predominantly in children and young adults. This report presents a case of pulmonary inflammatory myofibroblastic tumour in a 5-year-old girl. The patient had a history of recurrent respiratory tract infections. A chest radiograph and computed tomography chest scan showed a round mass in the lower lobe of her left lung. Thoracoscopic marginal excision of the tumour with an Endo-GIA stapler device (TYCO healthcare) was performed. Histological examination confirmed the final diagnosis of inflammatory myofibroblastic tumour. Postoperative recovery was uncomplicated and the patient was discharged 6 days after surgery. Round masses located in the lungs are very rare in children and the possibility of myofibroblastic tumour as well as metastatic lesions should be taken into consideration in such cases. Thoracoscopic excision is the best option in distally located lesions.
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Koga H, Suzuki K, Nishimura K, Okawada M, Doi T, Lane GJ, Inada E, Okazaki T, Yamataka A. Comparison of the value of tissue-sealing devices for thoracoscopic pulmonary lobectomy in small children: a first report. Pediatr Surg Int 2014; 30:937-40. [PMID: 25074733 DOI: 10.1007/s00383-014-3567-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/15/2014] [Indexed: 10/25/2022]
Abstract
Accurate division and sealing of lung parenchyma particularly in cases of total or near total incomplete fissure are crucial for preventing air leakage following thoracoscopic pulmonary lobectomy (TPL). However, conventional endoscopic stapling devices cannot be used during TPL in small children because of limited space. Consequently, Ligasure (LS) and Enseal (ES) devices are being used instead. We are the first to compare LS and ES for efficacy and efficiency during TPL. Of 26 TPL (6 upper, 3 middle, and 17 lower) performed for congenital adenomatoid malformation (n = 16) and sequestration (n = 10), incomplete fissure was found in 14. TPL (LS = 11; ES = 15) was performed conventionally in the lateral decubitus position with single lung ventilation using four 5 mm trocars. All cases had a chest tube inserted intraoperatively that was left in situ. Patient demographics, location of pathology, incidence of incomplete fissure, mean age/weight at TPL, mean blood loss, and mean operative time were all similar. However, duration of chest tube insertion was significantly shorter in ES because there was less postoperative air leakage (1.3 vs. 3.9 days; p < 0.05). ES would appear to seal lung parenchyma more effectively during TPL based on the shorter duration of chest tube insertion.
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Affiliation(s)
- Hiroyuki Koga
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo, 113-8421, Japan,
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