Video-assisted thoracoscopic surgery in the paediatric population (original) (raw)
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Video assisted thoracoscopic surgery in paediatric mediastinal tumors
Mediastinum
Video assisted thoracoscopic surgery (VATS) is an emerging tool for approaching childhood mediastinal tumors in a minimally invasive way. The magnified visibility and availability of smaller instruments has allowed to explore even areas close to the great vessels and other vital structures. The safety and feasibility of this technique has been described for a wide range of these tumors. In spite of that the literature is deficient in use of this modality in paediatric mediastinal tumors. Although widely practiced in adults, various controversies have been set forward in application of this technique in children. This article aims to explore reasons for the underutilisation of VATS in these patients and tries to explain the areas of controversy with this technique. Various ways of comparison have been attempted for a broad understanding of the finer details (comparisons between open and VATS in children, VATS in children and adults, VATS in mediastinal tumors and lung surgeries).
Video-assisted thoracoscopy for the diagnosis of mediastinal masses in children
JSLS : Journal of the Society of Laparoendoscopic Surgeons / Society of Laparoendoscopic Surgeons
Video-assisted thoracoscopy has been successfully used for several different thoracic procedures in adults. However, its use in children has been limited. The present study evaluated our experience with video-assisted thoracoscopy in the diagnosis of mediastinal masses in children. Nine children (age range, 3 to 18 years) with undiagnosed mediastinal masses underwent video-assisted thoracoscopy. The operation was performed using general anesthesia, with the patient intubated with a single lumen endotracheal tube. In all cases adequate tissue for diagnosis was obtained. Three patients had tuberculosis, two had Hodgkin's disease, two had granuloma, one had metastatic Wilms' tumor, and one had thymic hyperplasia. There were no complications related to the operative procedure. Video-assisted thoracoscopy for the diagnosis of mediastinal masses in children is a safe procedure. It provides good visualization, access to the mediastinum and adequate tissue for diagnosis. Further, po...
Surgical Endoscopy, 2007
Background: Few reports have elucidated the role of minimally invasive surgery (MIS) for pediatric malignancies. This study aimed to review the results of a multicenter study on the management of thoracic tumors in children using MIS. Methods: A 5-year retrospective review of all MIS procedures for the treatment of pediatric malignancies performed in seven centers belonging to the Italian Society of Videosurgey in Infancy is reported. The data from 145 pediatric oncologic patients (80 girls and 65 boys) ages 30 days to 17 years (median, 7.2 years) were analyzed. Of the procedures performed, 87 were laparoscopies (60%), 55 were thoracoscopies (38%), and 3 were lumboscopies (2%). This study focused only on the results of the 55 thoracoscopic procedures performed for diagnostic purposes in 19 cases (34.6%) and for therapeutic purposes in 36 cases (65.4%). Results: The duration of surgery was 15 to 180 min (median, 65 min). Metastasectomies were performed for various etiologies in 31 of the 55 cases. Of the 55 patients, 5 underwent resection of a mediastinal tumor, and 19 underwent a diagnostic thoracoscopy. During a mean follow-up period of 25.6 months, 2 (3.6%) of the 55 patients experienced perioperative complications. Conclusions: The role of MIS in tumor resection for children is currently limited, but may be used in individual cases when the preoperative workup shows it to be feasible. Its indication is strictly dependent on the thoracoscopic experience of the surgeon and the tumor site for preoperative imaging techniques. When the indication for thoracoscopy is correct, this approach has high therapeutic applicability (65.4% in our series). Our preliminary experience shows that careful patient selection and an appropriate level of technical skill make thoracoscopy a reasonable and safe option for the treatment of pediatric malignancies.
Review of video-assisted thoracoscopy in children
Journal of Minimal Access Surgery, 2009
Open thoracotomy is the standard procedure for various thoracic diseases against which other procedures are compared. Currently Video Assisted Thoracoscopic Surgery (VATS) has gained widespread acceptance in the management of a variety of thoracic disorders. It decreases the morbidity and duration of hospital stay. A total of 133 children with various thoracic diseases who presented at a University Teaching Hospital in the Department of Pediatric Surgery, from June 2000 to December 2007, were included. Of the 133 patients, 116 patients had empyema, all of whom were subjected to VATS, and an attempt at debridement/decortication and drainage was made. Other thoracic disorders treated included lung abscesses, lung biopsies, hydatid cysts, and so on. Patients with empyema were treated according to their stage of disease. Of the 116 patients who underwent thoracoscopy, 16 had to be converted to open surgery due to various reasons. The mean duration for removal of drain was three days and the average total duration of hospital stay was six days. Similarly the application of VATS was advantageous in other thoracic diseases.
A Modified Approach for Video Assisted Thoracoscopy In Paediatric Patients
Background: Thoracoscopy requires selective bronchial intubation and a sophisticated technical setup. This study was designed to assess the difficulty and feasibility of thoracoscopy using modified intubation maneuver and modified position for the surgery. Methods: 138 children below 12 years underwent right thoracoscopy from June2014-November2017. Data were collected from CCM Medical College and Pt. JNM Medical College. All procedures were done using modified technique of selective left endobronchial intubation. Modified position used was 45°tilt. The infrastructure used included 5mm telescope, single chip camera, halogen light source, suction apparatus and 14 inch television. CO2 insuflation was not used and ports were kept open. Results: Right thoracoscopy was performed. Follow-up ranged from 1-17 months. Age range was 18–144 months. All cases were asymptomatic at last follow up. Mean operating time was 1.30 hours (Range: 1.00-2.30 hours). There were 126 empyema, 9 hydatid cysts and 3 esophageal duplication cyst. There were 48 tubercular empyema and 78 post pneumonia empyema. Intercostal drain was kept for a mean period of 3 days (Range: 2-4 days). All the cases were kept nil by mouth for 6 hours and discharged at a mean duration of 5 days (Range: 4-6 days). Conclusions: Thoracoscopic procedures could safely and easily be performed even with limited facilities with modified position.
Efficacy of primary and secondary video-assisted thoracic surgery in children
Journal of Pediatric Surgery, 2000
Background/Purpose:Video-assisted thoracic surgery (VATS) is used commonly for diagnostic and therapeutic procedures in children. The purpose of this study was to determine the accuracy, efficacy, and complications associated with primary and secondary VATS in children. Methods: Eighty-seven infants, children, and adolescents underwent 104 VATS procedures between March 1993 and April 1999. There were 47 boys and 40 girls with an age range of 6 months to 19 years. VATS was performed for excision of From the Section qf Pediatric Surgery,
Thoracoscopy for Pediatric Thoracic Neurogenic Tumors—A European Multi-Center Study
Cancers
Objectives: To assess the efficacy of thoracoscopy and the outcome for children with thoracic neurogenic tumors. Methods: We performed a retrospective review of 15 European centers between 2000 and 2020 with patients who underwent thoracoscopy for a neurogenic mediastinal tumor. We assessed preoperative data, complications, and outcomes. Results were expressed with the median and range values. Results: We identified 119 patients with a median age of 4 years old (3 months–17 years). The diameter was 5.7 cm (1.1–15). INRG stage was L1 n = 46, L2 n = 56, MS n = 5, M n = 12. Of 69 patients with image-defined risk factors (IDRF), 29 had only (T9–T12) locations. Twenty-three out of 34 patients with preoperative chemotherapy had an 18 mm (7–24) decrease in diameter. Seven out of 31 patients lost their IDRF after chemotherapy. Fourteen had a conversion to thoracotomy. The length of the hospital stay was 4 days (0–46). The main complications included chylothorax (n = 7) and pneumothorax (n =...
Recent advances in video-assisted thoracoscopic approach to posterior mediastinal tumours
The Surgeon, 2010
a b s t r a c t Minimal invasive video-assisted thoracic surgery can be a safe alternative technique in the assessment, diagnosis and surgical resection of posterior mediastinal tumours. Videoassisted thoracic surgery may be particularly suited for the management of posterior mediastinal tumours as most are benign. Surgical technique continues to evolve from the classic 3-port access in order to tackle more complex tumours positioned at the apical and inferior recesses of the posterior mediastinum. The preoperative identification of dumbbell tumours is important to facilitate arrangements for a single-stage combined resection for both the intra-thoracic and intraspinal tumour. Results from Video-assisted thoracic surgery posterior mediastinal tumour resection are comparable with conventional surgical techniques in terms of symptomatic improvement, recurrence and survival. Video-assisted thoracic surgery approach has been shown to result in less post-operative pain, improved cosmesis, shorter hospital stay, and more rapid recovery and return to normal activities. In over a decade, video-assisted thoracic surgery has gradually matured and is now a promising therapeutic alternative to open approach. In certain selected patients, video-assisted thoracic surgery may be considered the standard of care for conditions of the posterior mediastinum. Recent developments in robotic surgery for the management of mediastinal tumours are promising, however, long-term results are pending.
Video-assisted thoracoscopic surgery for complex mediastinal mass resections
Annals of cardiothoracic surgery, 2015
Minimally invasive surgery has changed the way operative procedures are performed in many specialties. As surgeons have become progressively facile with these techniques, the opportunities to use them have expanded. In thoracic surgery, many surgeons now use minimally invasive techniques to resect small, uncomplicated pathologies of the mediastinum as well as to perform thymectomy for myasthenia gravis. Experience with these techniques has allowed new knowledge to be gained and expansion of the use of these techniques for more complicated mediastinal pathology. This keynote address will outline the instrumentation and techniques that we have adopted over a decade of using these techniques for more complicated mediastinal pathology.