Ciro Esposito, Arnaud Bonnard, Holger Till, Ernesto Leva, Naziha Khen-Dunlop, Andrea Zanini, Louise Montalva, Sabine Sarnacki, Maria Escolino
“Federico II” University of Naples. Robert Debrè Hospital. Medical University of Graz. Fondazione IRCCS Ca’ Grande Ospedale Maggiore Policlinico. Necker Enfants Malades Hospital.
Italy, France and Austria
Journal of Laparoendoscopic and Advanced Surgical Technique
J Laparoendosc Adv Surg Tech 2021; 31: 355-362
DOI: 10.1089/lap.2020.0596
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.
Category
Abnormal Systemic to Pulmonary Arterial Collaterals or Connections
Surgical and Catheter-mediated Interventions for Pulmonary Vascular Disease
Age Focus: Pediatric Pulmonary Vascular Disease
Fresh or Filed Publication: Filed (PHiled). Greater than 1-2 years since publication
Article Access
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