Objective: For symptomatic congenital lung malformations open surgery is a common practice. For asymptomatic CPAM / pulmonary sequestrations , discovered on routine pre / postnatal imaging, management is controversial. This report evaluates the safety and efficacy of thoracoscopic lung resections in pediatric patients.
Methods: During the 2013-2014, sixteen patients underwent thoracoscopic lobectomy / segmentectomy. Patients ages ranged from 8 months to 7 years. Preoperative diagnosis included congenital cystic adenomatoid malformation (n = 9) , pulmonary sequestration (n = 5), bronchogenic cyst (n = 1) and complex bronchiectasis (n = 1). Seven patients were symptomatic with previous lung infections and nine others were asymptomatic. Single lung ventilation was desired but not accomplished in 6 patients. Three ports 3–5 mm were used with controlled pressure pneumothorax. A ligasure sealing device was the mode for tissue dissection / vessel ligation and bronchi were closed either by stapling device or by interrupted sutures.
Results: All the procedures were completed thoracoscopically. Operating times ranged from 70 to 200 min (remarkable longer in patients with previous infections ). We performed eleven lobectomies and four segmental lung resections without intraoperative complications. Hospital stay ranged from 1 to 3 days and only two patient required ICU admission post operatively.
Conclusions: Supervised mentorship in thoracoscopic approached surgeries for congenital lung malformations changed our paradigm of practice. Thoracoscopic lobectomy / segmentectomy in selected patients is feasible and safe technique. There is a clear difference in dissection complexity in patients with previous infectious complications. Decreased postoperative pain, shorter hospital stay and better cosmetic results are definite advantages
