Bronchopulmonary malformations that present in early infancy and childhood require surgical resection. These lesions may be detected antenatally, some remain relatively constant in size or may even regress. Despite lack of symptoms, these patients are prone to high incidence of subsequent respiratory complications such as recurrent pneumonias and in the long run the lesions may undergo malignant transformation. Various publications in the last years have shown that thoracoscopic lung resection is a safe and efficacious technique.
We present our initial experience with thoracoscopic resections of lung diseases from December 2013 to May 2015. Our program was generated with the mentorship of a senior surgeon with notorious thoracic experience. Sixteen patients were operated, 9 boys (56%) and 7 girls (44%), with a median age of 2 years and 4 months (8 months – 7 years). The diagnosis was antenatal in 13 (81%) and confirmed on CT scans after birth (at age 1 month to 2 years 8 months with a median of 10 months). The modality of choice for diagnosis before surgery was a CT scan in all but one patient who underwent an MRI. A thoracoscopic lobectomy was performed in 10 patients (63%), a segmental resection in 5 (31%) and a bronchogenic cyst excision in 1 patient. All surgeries were done thoracoscopically without conversion and with a median length of stay of 3 days (all patients were hospitalized the day before surgery). Pathological examinations showed: 8 congenital cystic pulmonary malformations (CPAM), 3 sequestrations, 3 CPAM associated sequestrations, 1 bronchogenic cyst, 1 bronchiectasis. Follow up ranges from 7 months to 2 years, and is event free.
Thoracoscopic lobectomy is a technically demanding procedure. Early performance associated with the standardization of the technique will facilitate surgery in terms of less inflammatory changes and a lower conversion rate. The presented series emphasizes the advantages of early thoracoscopic management of these lesions to achieve minimal complications and excellent outcomes.
