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Kankoç A, Sayan M, Çelik A. Videothoracoscopic surgery in children. TURK GOGUS KALP DAMAR CERRAHISI DERGISI 2024; 32:S43-S54. [PMID: 38584793 PMCID: PMC10995678 DOI: 10.5606/tgkdc.dergisi.2024.25710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 11/22/2023] [Indexed: 04/09/2024]
Abstract
Video-assisted thoracic surgery (VATS) is now being used with increasing frequency for a wide variety of indications in pediatric patients. Although there is no high level of evidence for the advantages of VATS in the pediatric patient group, the proven benefits of this method in the adult patient group have encouraged thoracic surgeons to perform VATS in this patient population. In this study, the procedures performed in pediatric patients under 18 years of age and their results were reviewed with the help of articles obtained as a result of searches using relevant keywords in the English literature (PubMed, Web of Science, EMBASE, and Cochrane). The frequency, indications, and results of the procedures performed differed according to age groups.
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Affiliation(s)
- Aykut Kankoç
- Department of Thoracic Surgery, Gazi University Faculty of Medicine, Ankara, Türkiye
| | - Muhammet Sayan
- Department of Thoracic Surgery, Gazi University Faculty of Medicine, Ankara, Türkiye
| | - Ali Çelik
- Department of Thoracic Surgery, Gazi University Faculty of Medicine, Ankara, Türkiye
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2
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Seguier-Lipszyc E, Rothenberg S, Mei-Zahav M, Stafler P, Zeitlin Y, Samuk I, Peysakhovich Y, Kravarusic D. Thoracoscopic Resection of Pulmonary Lesions in Israel: The Mentorship Approach. J Indian Assoc Pediatr Surg 2023; 28:508-513. [PMID: 38173630 PMCID: PMC10760613 DOI: 10.4103/jiaps.jiaps_115_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 07/13/2023] [Accepted: 07/30/2023] [Indexed: 01/05/2024] Open
Abstract
Background Most congenital pulmonary airway malformations (CPAMs) are detected antenatally. The majority of newborns are asymptomatic. Patients are prone to subsequent respiratory complications and to a lesser extent malignant transformation remains concerning. In Israel, until 2013, pediatric surgeries were performed by thoracotomy. To minimize its morbidity, we introduced thoracoscopy using a mentorship approach. We present our experience with thoracoscopic resections coordinated by the mentorship of a pediatric worldwide leader in his field and compare our results with resections performed by thoracotomy. Materials and Methods A retrospective review of records of children operated between 2013 and 2020 was conducted. Data were compared using t-test for quantitative variables. Results Fifty patients were operated by thoracoscopy with a median age of 4 years, a thoracoscopic lobectomy performed in 68%. There was no conversion with a median length of stay (LOS) of 3½ days. Thirty patients were operated by thoracotomy by a thoracic surgeon with a median age of 3.5 years. A lobectomy was performed in 87% with a median LOS of 7 days. Conclusions Thoracoscopic lobectomy is a technically demanding procedure with a long learning curve, strongly related to the low volume of cases. The role of a mentorship program in acquiring those surgical skills is crucial through standardization of the technique applied and supervised by the mentor. Early thoracoscopy for congenital pulmonary lesions at an early age can be achieved with a low conversion rate and minimal complications creating a change in the paradigm of practice when considering surgery for CPAM in Israel.
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Affiliation(s)
- Emmanuelle Seguier-Lipszyc
- Department of Pediatric Surgery, Meir Medical Center, Affiliated to Sackler School of Medicine, Tel Aviv University, Kfar Saba, Israel
| | - S. Rothenberg
- Division of Pediatric Surgery, The Rocky Mountain Hospital for Children, Denver, Colorado, USA
| | - Meir Mei-Zahav
- Institute of Pulmonology, Schneider Children's Medical Center of Israel (Affiliated to Sackler School of Medicine, Tel Aviv University), Petah-Tiqwa, Israel
| | - Patrick Stafler
- Institute of Pulmonology, Schneider Children's Medical Center of Israel (Affiliated to Sackler School of Medicine, Tel Aviv University), Petah-Tiqwa, Israel
| | - Yelena Zeitlin
- Department of Anesthesiology, Schneider Children's Medical Center of Israel, Petah-Tiqwa, Israel
| | - Inbal Samuk
- Department of Pediatric and Adolescent Surgery, Schneider Children's Medical Center of Israel (Affiliated to Sackler School of Medicine, Tel Aviv University), Petah-Tiqwa, Israel
| | - Yuri Peysakhovich
- Department of Thoracic Surgery, Beilinson Hospital (Affiliated to Sackler School of Medicine, Tel Aviv University), Petah-Tiqwa, Israel
| | - Dragan Kravarusic
- Department of Pediatric and Adolescent Surgery, Schneider Children's Medical Center of Israel (Affiliated to Sackler School of Medicine, Tel Aviv University), Petah-Tiqwa, Israel
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3
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Raitio A, Vilkki V, Pakkasjärvi N. Introduction of pediatric thoracoscopic lung resections in a low-volume center - feasibility, outcome and cost analysis. Acta Chir Belg 2023; 123:497-501. [PMID: 35673976 DOI: 10.1080/00015458.2022.2086394] [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] [Received: 07/31/2021] [Accepted: 06/01/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Early series of pediatric thoracoscopic surgery have reported high conversion rates and significant complications. This study investigated the introduction of pediatric thoracoscopic lung resections in a low-volume center with reference to corresponding open thoracotomy procedures with regards to operative times, length of stay, cost of admission, and outcomes. METHODS A single surgeon series. Data from the first 10 consecutive thoracoscopic lung resections were compared to a cohort of 10 consecutive open lung resections performed before the introduction of the thoracoscopic technique. All operations were performed between December 2015 and October 2021. The median follow-up was 34 months (range 4-65). RESULTS The cohort included 14 lobectomies (8 thoracoscopic and 6 open) for congenital pulmonary airway malformation (CPAM), and 6 resections (mainly non-anatomic) of pulmonary sequestration (2 thoracoscopic and 4 open). One lobectomy required conversion to thoracotomy, and one patient required reinsertion of a chest drain after open lobectomy due to persistent air leak. No other complications were recorded. All patients were asymptomatic at their follow-up. There was no significant difference in the mean age, mean weight, operative times, and intraoperative blood loss between open and minimally invasive procedures. Thoracoscopic technique was associated with significantly shorter stay at pediatric intensive care unit and shorter overall inpatients stay. CONCLUSION Thoracoscopic lung resections can be safely introduced in a low-volume center with comparable cost, operative time, and results and significantly shorter inpatient stay.
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Affiliation(s)
- Arimatias Raitio
- Department of Paediatric Surgery, University of Turku and Turku University Hospital, Turku, Finland
| | - Vesa Vilkki
- Heart Centre, Turku University Hospital, Turku, Finland
| | - Niklas Pakkasjärvi
- Department of Paediatric Surgery, University of Turku and Turku University Hospital, Turku, Finland
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4
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Yu KA, Kim SR, Ahn TH, Lee MY, Kim HY. Evaluation of LigaTie device for total lung lobectomy in small breed dogs - An ex vivo study. Res Vet Sci 2023; 156:29-35. [PMID: 36773582 DOI: 10.1016/j.rvsc.2023.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 01/19/2023] [Accepted: 01/21/2023] [Indexed: 01/26/2023]
Abstract
This study aimed to evaluate an effectiveness of airway-sealing techniques used in total lung lobectomies in small dog breeds. Total lung lobectomies were performed on five canine cadavers weighing 2.5-8 kg. Airway-sealing techniques were performed on two randomly selected lobes per cadaver. The airway-sealing techniques consisted of traditional suture ligation, Endoloop, and LigaTie. After applying all surgical methods, bronchial stump was collected from the tongue and prepared. The effectiveness of each airway-sealing technique was evaluated by submerging the bronchial stumps in saline, followed by intubation to gradually increase the airway pressure to 80 cmH2O to identify the presence of air leakage in each lobe. Seven of the ten lobes in the traditional suture ligation group had a leakage; the leakages were fatal in three lobes. A single fatal leak occurred in the Endoloop group, while no leakage was noted in the LigaTie group. Therefore, the LigaTie technique had a higher statistical efficacy than the traditional suture ligation (p = 0.007). In conclusion, the LigaTie application reduced the incidence of air leakage following total lung lobectomies in small dog breeds.
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Affiliation(s)
- Kyung-Ah Yu
- DVM, Department of Veterinary Medicine, School of Konkuk University, Republic of Korea
| | - So-Rin Kim
- DVM, Department of Veterinary Medicine, School of Konkuk University, Republic of Korea
| | - Tae Hwan Ahn
- DVM, Department of Veterinary Medicine, School of Konkuk University, Republic of Korea
| | - Min Yeong Lee
- DVM, Department of Veterinary Medicine, School of Konkuk University, Republic of Korea
| | - Hwi-Yool Kim
- DVM, Department of Veterinary Medicine, School of Konkuk University, Republic of Korea.
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5
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King A, Olutoye OO, Lee TC, Keswani SG. Surgical Management of Congenital Lung Malformations. Neoreviews 2023; 24:e84-e96. [PMID: 36720690 DOI: 10.1542/neo.24-2-e84] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Congenital lung malformations (CLMs) are commonly diagnosed prenatal lesions with varied natural history. Prenatal diagnosis and monitoring help to guide fetal interventions, delivery planning, and need for urgent perinatal surgical interventions. All prenatally diagnosed CLMs should be evaluated postnatally, typically with cross-sectional imaging, because many lesions persist despite the appearance of complete 'regression' in utero. Management of CLMs in asymptomatic infants weighs the surgical and anesthetic risk of prophylactic resection against the risk of expectant management, including the possibility of infection, malignant degeneration, and more complicated surgical resection later with loss of compensatory lung growth.
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Affiliation(s)
- Alice King
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX.,Texas Children's Fetal Center, Baylor College of Medicine, Houston, TX.,Division of Pediatric Surgery, Department of Surgery, Texas Children's Hospital, Houston, TX
| | - Oluyinka O Olutoye
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX
| | - Timothy C Lee
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX.,Texas Children's Fetal Center, Baylor College of Medicine, Houston, TX.,Division of Pediatric Surgery, Department of Surgery, Texas Children's Hospital, Houston, TX
| | - Sundeep G Keswani
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX.,Texas Children's Fetal Center, Baylor College of Medicine, Houston, TX.,Division of Pediatric Surgery, Department of Surgery, Texas Children's Hospital, Houston, TX
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6
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Lobe TE, Panait L, Dapri G, Denk PM, Pechman D, Milone L, Scholz S, Slater BJ. A SAGES technology and value assessment and pediatric committee evaluation of mini-laparoscopic instrumentation. Surg Endosc 2022; 36:7077-7091. [DOI: 10.1007/s00464-022-09467-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 07/10/2022] [Indexed: 11/30/2022]
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7
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Hung WT, Wang YC, Huang HH, Tai JH, Wu ET, Shih JC, Hsu WM. Surgical resection for congenital lung malformation: Lessons learned from thoracotomy to biportal thoracoscopy under one-lung ventilation. J Formos Med Assoc 2022; 121:2152-2160. [DOI: 10.1016/j.jfma.2022.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 12/12/2021] [Accepted: 03/03/2022] [Indexed: 11/28/2022] Open
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Comprehensive assessment of the quality and reliability of the ten most-viewed YouTube videos on thoracoscopic lobectomy in children: a comparison from the available videos on a peer-reviewed platform. Pediatr Surg Int 2021; 37:1627-1632. [PMID: 34313820 DOI: 10.1007/s00383-021-04973-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/23/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Surgery residents often consider learning from the operative videos on YouTube, however, the quality of these videos is questionable. We aim to compare the quality and reliability of operative videos on thoracoscopic lobectomy (TL) in children available on YouTube (YT) and WebSurg (WS). METHODS Using a defined search strategy, the most-viewed YT videos and all available WS videos on TL in children were identified. The quality and reliability of the two groups of videos were compared using the video popularity index (VPI), Journal of American Medical Association (JAMA) benchmark criteria, and LAP-VEGaS quality assessment tool. On the basis of the LAP-VEGaS score, the videos were divided into acceptable quality (score ≥ 11) or poor quality (score < 11). RESULTS Ten most-viewed YT videos were compared with six relevant videos on WS. The median %VPI among the WS and YT videos were 83.3 (range 71.5-404.4) and 49.4 (range 0-270), respectively (p = 0.017). The median JAMA score of the WS videos was also significantly higher than the YT videos (p = 0.0003). In terms of the LAP-VEGaS scores, all WS videos versus only three YT had an acceptable quality. CONCLUSIONS As compared to the WS videos, the quality and reliability of the YT videos on TL were significantly poorer.
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9
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Rothenberg SS. Thoracoscopic Lobectomy in Infants and Children. J Laparoendosc Adv Surg Tech A 2021; 31:1157-1161. [PMID: 34609926 DOI: 10.1089/lap.2021.0454] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Indications for pulmonary lobectomy in infants and children include cystic pulmonary adenomatoid malformation, congenital lobar emphysema, chronic infection, and malignancy. These procedures can now all be done thoracoscopically avoiding the short- and long-term morbidity of an open thoracotomy. In this article we describe the technique of thoracoscopic lobectomy as well as the preoperative and postoperative care.
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Affiliation(s)
- Steven S Rothenberg
- Department of Pediatric Surgery, Rocky Mountain Hospital for Children, Denver, Colorado, USA
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10
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Murakami M, Kaji T, Nagano A, Matsui M, Onishi S, Yamada K, Ieiri S. Complete laparoscopic choledochal cyst excision and hepaticojejunostomy with laparoscopic Roux-Y reconstruction using a 5-mm stapler: A case of a 2-month-old infant. Asian J Endosc Surg 2021; 14:824-827. [PMID: 33590686 DOI: 10.1111/ases.12928] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 01/25/2021] [Indexed: 11/28/2022]
Abstract
Laparoscopic choledochal cyst excision and hepaticojejunostomy for choledochal in children is performed only at particular institutions because of the technical difficulty. Although choledochal cyst excision and hepaticojejunostomy are feasible, the small working space of infants makes intraabdominal Roux-Y reconstruction technically challenging. A 2-month-old girl diagnosed with a choledochal cyst underwent complete laparoscopic choledochal cyst excision and hepaticojejunostomy, including intraabdominal Roux-Y reconstruction with a 5-mm stapler. After cyst excision, Roux-Y reconstruction was performed in the intraabdominal cavity. Jejunojejunostomy was performed in a side-to-side fashion using a 5-mm stapler, and the entry hole was closed laparoscopically by hand-sewing, along with the mesentery defect. All procedures were performed by laparoscopic surgery. The postoperative course was uneventful, and the patient showed a quick recovery. Using small-diameter instruments, completely laparoscopic procedures for choledochal cyst are feasible.
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Affiliation(s)
- Masakazu Murakami
- Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, Kagoshima, Japan
| | - Tatsuru Kaji
- Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, Kagoshima, Japan.,Clinical Training Center, Kagoshima University Hospital, Kagoshima, Japan
| | - Ayaka Nagano
- Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, Kagoshima, Japan
| | - Mayu Matsui
- Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, Kagoshima, Japan
| | - Shun Onishi
- Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, Kagoshima, Japan
| | - Koji Yamada
- Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, Kagoshima, Japan
| | - Satoshi Ieiri
- Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, Kagoshima, Japan
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11
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Shirota C, Tainaka T, Sumida W, Yokota K, Makita S, Takimoto A, Amano H, Hinoki A, Ono Y, Uchida H. Thoracoscopic surgery for congenital lung cysts: an attempt to limit pulmonary resection in cases of lesions involving multiple lobes. Pediatr Surg Int 2021; 37:213-221. [PMID: 33386446 DOI: 10.1007/s00383-020-04793-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/06/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE Although we generally perform thoracoscopic lobectomy for congenital lung cysts (CLCs), we recently began performing thoracoscopic-limited pulmonary resection (segmentectomy or small partial lung resection) on relatively small lesions and on lesions involving multiple lobes. Our study aimed to determine the therapeutic outcomes of thoracoscopic CLC surgery. METHODS We retrospectively reviewed patients aged ≤ 18 years who underwent their first CLC surgery at our facility between 2013 and 2020. RESULTS A comparison between patients < 4 months old and those ≥ 4 months old showed no significant difference in operating time or incidence of complications. Blood loss volume (mL/kg) was significantly greater in patients < 4 months old and in patients who had undergone semi-urgent or urgent surgery. Operating time and postoperative complications were not increased in semi-urgent or urgent surgeries. There was no significant difference in operating time, blood loss volume, or postoperative complications between patients with a preoperative history of pneumonia and patients with no such history. CONCLUSION In most patients, thoracoscopic surgery for CLC was safely performed. Limited pulmonary resection is considered difficult to perform thoracoscopically in children, but can be safely performed using new devices and navigation methods. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Chiyoe Shirota
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takahisa Tainaka
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Wataru Sumida
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kazuki Yokota
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Satoshi Makita
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Aitaro Takimoto
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hizuru Amano
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Akinari Hinoki
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yasuyuki Ono
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroo Uchida
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
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Esposito C, Bonnard A, Till H, Leva E, Khen-Dunlop N, Zanini A, Montalva L, Sarnacki S, Escolino M. Thoracoscopic Management of Pediatric Patients with Congenital Lung Malformations: Results of a European Multicenter Survey. J Laparoendosc Adv Surg Tech A 2021; 31:355-362. [PMID: 33428520 DOI: 10.1089/lap.2020.0596] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: This study aimed to report a European multi-institutional experience about thoracoscopic management of children with congenital lung malformations. Methods: The records of 102 patients (49 girls and 53 boys) with median age at surgery of 1 year (range 6 months-1.5 years), who underwent thoracoscopic lobectomy in five European Pediatric Surgery units, were retrospectively collected. Indications for surgery included congenital pulmonary airway malformation (CPAM) (n = 47), intra- and extralobar pulmonary sequestration (n = 34), hybrid lesion (CPAM/intralobar sequestration) (n = 2), severe bronchiectasis (n = 9), congenital lobar emphysema (n = 8), and others (n = 2). The condition was asymptomatic in 77/102 (75.5%), whereas symptoms such as recurrent pneumonia and/or respiratory distress were present in 25/102 (24.5%). Results: Surgical procedures included 18 upper, 20 middle, and 64 lower lobe resections. No conversions to open were reported. A 3 mm sealing device and 5 mm stapler were adopted in the last 48/102 patients (47%). The median operative time was 92.2 minutes (range 74-141). The median operative time significantly decreased in patients in whom the vessel division and bronchial sealing were performed using sealing devices (75.5 minutes) compared with suture ligations (118.9 minutes) (P = .001). The median hospital stay was 3.7 days (range 2-6.2). Three/102 patients (2.9%) developed postoperative complications, including air leakage requiring pleural drainage (n = 1) (Clavien IIIb) and respiratory infection (n = 2) (Clavien II). A reoperation was required in one patient with residual pleuropulmonary blastoma (0.9%). All symptomatic patients reported resolution of symptoms postoperatively. Conclusions: Thoracoscopic lobectomy is a safe and effective procedure with excellent cosmetic outcome, in expert hands. Based upon our experience, we strongly recommend surgery in patients with congenital lung malformations by the first year of life, to reduce the risk of infection and make the procedure technically easier, despite the small patients' size. Surgeon's experience and use of miniaturized instruments and sealing devices remain key factors for successful outcome.
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Affiliation(s)
- Ciro Esposito
- Pediatric Surgery Unit, "Federico II" University of Naples, Naples, Italy
| | - Arnaud Bonnard
- Pediatric Surgery Unit, Robert Debrè Hospital, Paris, France
| | - Holger Till
- Pediatric Surgery Unit, Medical University of Graz, Graz, Austria
| | - Ernesto Leva
- Pediatric Surgery Unit, Fondazione IRCCS Ca' Grande Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Andrea Zanini
- Pediatric Surgery Unit, Fondazione IRCCS Ca' Grande Ospedale Maggiore Policlinico, Milan, Italy
| | - Louise Montalva
- Pediatric Surgery Unit, Robert Debrè Hospital, Paris, France
| | - Sabine Sarnacki
- Pediatric Surgery Unit, Necker Enfants Malades Hospital, Paris, France
| | - Maria Escolino
- Pediatric Surgery Unit, "Federico II" University of Naples, Naples, Italy
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13
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King A, Lee TC, Steen E, Olutoye OO, Belfort MA, Cassady CI, Mehollin-Ray AR, Keswani SG. Prenatal Imaging to Predict Need for Urgent Perinatal Surgery in Congenital Lung Lesions. J Surg Res 2020; 255:463-468. [PMID: 32622160 DOI: 10.1016/j.jss.2020.06.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 05/30/2020] [Accepted: 06/01/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Congenital lung malformations (CLMs) have a variable natural history: some patients require urgent perinatal surgical intervention (UPSI) and others remain asymptomatic. These lesions have potential growth until 26-28 wk gestation. CLM volume ratio (CVR) has been shown to predict the risk of hydrops in CLMs. However, no criteria exist to delineate lesions requiring urgent surgical intervention in the perinatal period. Our goal was to determine prenatal diagnostic features that predict the need for UPSI in patients diagnosed with CLM. METHODS Records and imaging features of all fetuses evaluated by our fetal center between May 2015 and December 2018 were retrospectively reviewed. Data included demographics, fetal ultrasound and magnetic resonance imaging, CVR, surgical treatment, and outcome. Features were analyzed for their ability to predict the need for UPSI. RESULTS Sixty-four patients were referred for CLM, with 48 patients serially followed. Nine (18.8%) patients were followed nonoperatively, 35 (72.9%) underwent resection, and four (8.3%) were lost to follow-up. Of the patients who underwent resection, 24 (68.5%) were electively resected and 11 were urgently resected. Five (14.3%) patients underwent ex utero intrapartum treatment resection, and six (17.1%) were urgently resected for symptomatic CLM. There were no cases of UPSI with final CVR <1.1. Of the patients with final CVR 1.1-1.7, 43% required urgent resection. CVR ≥1.1 has 100% sensitivity and 87.8% specificity to predict patients requiring UPSI (area under the curve of 0.98). CONCLUSIONS A final CVR ≥1.1 is highly predictive for UPSI. Patients with a final CVR ≥1.1 should be referred for delivery at centers with pediatric surgeons equipped for potential UPSI for CLM.
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Affiliation(s)
- Alice King
- Division of Pediatric Surgery, Texas Children's Hospital/Baylor College of Medicine, Houston, Texas.
| | - Timothy C Lee
- Division of Pediatric Surgery, Texas Children's Hospital/Baylor College of Medicine, Houston, Texas
| | - Emily Steen
- Division of Pediatric Surgery, Texas Children's Hospital/Baylor College of Medicine, Houston, Texas
| | - Oluyinka O Olutoye
- General Pediatric Surgery, Nationwide Children's Hospital, Columbus, Ohio
| | - Michael A Belfort
- Division of Obstetrics and Gynecology, Texas Children's Hospital/Baylor College of Medicine, Houston, Texas
| | - Christopher I Cassady
- Division of Obstetrics and Gynecology, Texas Children's Hospital/Baylor College of Medicine, Houston, Texas; Division of Radiology, Texas Children's Hospital/Baylor College of Medicine, Houston, Texas
| | - Amy R Mehollin-Ray
- Division of Obstetrics and Gynecology, Texas Children's Hospital/Baylor College of Medicine, Houston, Texas; Division of Radiology, Texas Children's Hospital/Baylor College of Medicine, Houston, Texas
| | - Sundeep G Keswani
- Division of Pediatric Surgery, Texas Children's Hospital/Baylor College of Medicine, Houston, Texas
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14
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Macchini F, Zanini A, Morandi A, Ichino M, Leva E. Thoracoscopic Surgery for Congenital Lung Malformation Using Miniaturized 3-mm Vessel Sealing and 5-mm Stapling Devices: Single-Center Experience. J Laparoendosc Adv Surg Tech A 2020; 30:444-447. [PMID: 31928495 DOI: 10.1089/lap.2019.0589] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Aim: To evaluate the outcomes of thoracoscopic resection of congenital lung malformations (CLM) by using JustRight® (Bolder Surgical) 3-mm vessel sealing system and 5-mm stapler. Methods: Patients who underwent thoracoscopic resection of CLM in our Center from January 2016 to July 2019 were selected and divided into two groups: G1 (2018-2019), treated with the new JustRight instruments, and G2 (2016-2017), treated with Ligasure® and Hem-o-lok. Surgical outcomes in term of length of surgery and complications were compared between groups, stratifying the groups for type of resection (lobectomy, extralobar sequestration [ES] resection, and bronchogenic cyst [BC] resection). Results: Thirteen patients were included in G1, and 16 patients were included in G2. Seven lobectomies, 5 ES resections, and 1 BC resection were performed in G1; whereas 12 lobectomies, 3 ES resections, and 1 BC resection were performed in G2. Mean age at the time of surgery was 7.8 ± 6 months (G1) and 6.8 ± 3.3 months (G2) (P = .57). The average length of surgery was shorter for G1 (lobectomies: 120.7 ± 28.2 versus 171.7 ± 37.5, P = .006; ES resection: 63 ± 21.4 versus 91.7 ± 29.3, P = .15; BC 40 minutes versus 100 minutes). No significant difference was found for length of stay (4 ± 1 days versus 5 ± 2 days, P = .18). Neither the need for conversion nor major complications were observed in either group. Conclusion: In our experience, thoracoscopic resections of CLM with the new JustRight instruments were revealed to be safe and effective. On account of having adequate dimensions for small cavities, these instruments can facilitate the procedure and help to reduce the length of surgery.
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Affiliation(s)
- Francesco Macchini
- Department of Pediatric Surgery, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Andrea Zanini
- Department of Pediatric Surgery, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Anna Morandi
- Department of Pediatric Surgery, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Martina Ichino
- Department of Pediatric Surgery, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Ernesto Leva
- Department of Pediatric Surgery, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
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15
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Abstract
Growing adoption of thoracoscopy by pediatric surgeons has resulted in increasingly complex operations being performed. Although common complications of these procedures have decreased with experience, surgeons are still at risk to fall into error traps where routine practice in uncommon situations results in unanticipated complications. A background culture of safety that rewards multidisciplinary communication, teamwork, openness and standardization of care can assist surgeons to recognize, address and report error traps when they arise. This article serves to encourage a culture of safety and raise awareness of error traps in pediatric thoracoscopy to minimize potential harm and improve quality of care.
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Affiliation(s)
- Sarah W Lai
- Rocky Mountain Pediatric Surgery, Rocky Mountain Hospital for Children, 2055 High Street, Suite 370, Denver, CO 80205, USA.
| | - Steven S Rothenberg
- Rocky Mountain Pediatric Surgery, Rocky Mountain Hospital for Children, 2055 High Street, Suite 370, Denver, CO 80205, USA.
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16
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Cronin AM, Pustelnik SB, Owen L, Hall JL. Evaluation of a pre-tied ligature loop for canine total lung lobectomy. Vet Surg 2019; 48:570-577. [PMID: 30888076 DOI: 10.1111/vsu.13194] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Revised: 02/17/2019] [Accepted: 02/26/2019] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To determine the ability of a pre-tied ligature loop (PLL) to create a seal against physiological airway pressures after total lung lobectomy and report outcomes in dogs requiring lung lobectomy. STUDY DESIGN Ex vivo experimental randomized study and clinical case study. SAMPLE POPULATION Thirty cadaveric canine lung lobes and 5 client-owned dogs. METHODS Thirty canine lung lobes from dogs weighing 22.5-35 kg were randomized to lobectomy with stapler, PLL, or suture ligation. After lobectomy, each bronchial stump was submerged in water, and the mainstem airway pressure was increased to 80 mm Hg. Leakage was compared between techniques. The PLL was subsequently used in 5 dogs (17-25 kg) with neoplastic disease requiring total lung lobectomy. RESULTS Two stapled and 4 sutured bronchial stumps leaked at supraphysiological pressures >15 mm Hg. One stapled bronchial stump failed at a physiological airway pressure (5 mm Hg). None of the PLL lobectomies leaked. The incidence of bronchial stump failures did not differ among techniques (P = .15). Lung lobectomy was performed successfully with the PLL in 5 clinical cases with no intraoperative or postoperative complications; median follow-up time was 6 months. CONCLUSION Bronchial ligation with the PLL reliably resisted physiological airway pressures and performed comparably to current standard techniques in cadavers. The PLL provided an adequate air and vascular seal in 5 clinical cases undergoing total lung lobectomy. CLINICAL RELEVANCE Pre-tied ligature loops provide an alternative method for total lung lobectomy in dogs.
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Affiliation(s)
- Anna M Cronin
- Department of Veterinary Medicine, University of Cambridge, Cambridge, UK
| | - Sasja B Pustelnik
- Department of Veterinary Medicine, University of Cambridge, Cambridge, UK
| | - Laura Owen
- Department of Veterinary Medicine, University of Cambridge, Cambridge, UK
| | - Jon L Hall
- The Royal (Dick) School of Veterinary Studies, University of Edinburgh, Eater Bush Campus, Midlothian, UK
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17
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Kugler C. Minimal-invasive thoracic surgery in pediatric patients. J Vis Surg 2018; 4:10. [PMID: 29445596 DOI: 10.21037/jovs.2017.11.08] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 11/22/2017] [Indexed: 11/06/2022]
Abstract
During the last two decades, there was a tremendous development of video-assisted thoracoscopic surgery (VATS), especially in the field of video-assisted lung resections. This article describes the actually state of this surgical technique in the treatment of pediatric patients. The problems in practical application are illustrated as well as clinical results, like they are presented in literature.
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