Video-assisted thoracoscopy for the diagnosis of mediastinal masses in children (original) (raw)

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 thoracoscopic surgery in the paediatric population

Journal of Paediatrics and Child Health, 1995

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).

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.

Diagnosis and Treatment of Mediastinal Tumors by Thoracoscopy

Objectives: Thoracoscopic management of mediastinal tumors is still subject to analysis. Seventythree patients underwent thoracoscopy for treatment of mediastinal masses and were analyzed retrospectively in order to evaluate the effectiveness and complications of the procedure. Methods: Between 1983 and 1999, 21 conventional thoracoscopies and 52 video-assisted thoracic surgeries were performed (33 for diagnostic purposes and 40 for therapy). Patient ages ranged from 2 to 81 years (mean, 43.8 years) with a slight predominance of girls and women over men and boys (41 vs 32, respectively). All patients underwent general anesthesia using simple intubation (22 patients) or double-lumen intubation (51 patients). Results: The histologic type of tumors was obtained in all patients. For therapeutic purposes, a change of procedure to thoracotomy was necessary in nine patients. The reasons for this change were tumor size, tumor invasion of nearby structures, difficulties in continuing the dissection, the performance of an upper lobectomy, and suturing the iatrogenic lesion of the diaphragm. Four patients died during the first 30 postoperative days as a consequence of their primary pathology. Conclusion: Thoracoscopy was confirmed as an effective diagnostic and therapeutic alternative for the treatment of mediastinal disorders.

Diagnosis and Treatment of Mediastinal Tumors by Thoracoscopy*

CHEST Journal, 2000

Thoracoscopic management of mediastinal tumors is still subject to analysis. Seventythree patients underwent thoracoscopy for treatment of mediastinal masses and were analyzed retrospectively in order to evaluate the effectiveness and complications of the procedure. Methods: Between 1983 and 1999, 21 conventional thoracoscopies and 52 video-assisted thoracic surgeries were performed (33 for diagnostic purposes and 40 for therapy). Patient ages ranged from 2 to 81 years (mean, 43.8 years) with a slight predominance of girls and women over men and boys (41 vs 32, respectively). All patients underwent general anesthesia using simple intubation (22 patients) or double-lumen intubation (51 patients). Results: The histologic type of tumors was obtained in all patients. For therapeutic purposes, a change of procedure to thoracotomy was necessary in nine patients. The reasons for this change were tumor size, tumor invasion of nearby structures, difficulties in continuing the dissection, the performance of an upper lobectomy, and suturing the iatrogenic lesion of the diaphragm. Four patients died during the first 30 postoperative days as a consequence of their primary pathology. Conclusion: Thoracoscopy was confirmed as an effective diagnostic and therapeutic alternative for the treatment of mediastinal disorders.

Thoracoscopy in Children and Adolescents

CHEST Journal, 1997

, 77 thoracoscopic procedures were done on patients ranging in ages from 5 months to 18 years (mean, 9.8 years). Two-thirds (66.2%) were male. They were divided into three groups (1, 2, and 3) based on age (up to 2, from 2 to 8, and older than 8 years), predominance of certain diseases in these ages, and the size of the instruments utilized. They were operated on using general anesthesia with Carlens' mediastino¬ scope routinely used in 64 (83%) and videothoracoscopy in 13 (17%). The chief indication for therapeutic thoracoscopy was treatment of empyema, while for diagnostic thoracoscopy it was pleural biopsy and diagnosis of pleural effusions. Results: In group 1, thoracoscopy was solely for the treatment of pleural disorders. In group 2, it was for the treatment of pleuropulmonary diseases. Group 3 behaved almost like adults, with broad diagnostic and therapeutic indications for thoracoscopic procedure. Conclusions: Thoracoscopy, which is a useful diagnostic and therapeutic procedure, has secured an important place in pediatric surgical practice.

Current Application of Thoracoscopy in Children

Journal of Laparoendoscopic & Advanced Surgical Techniques, 2008

The safety and efficacy of thoracoscopy for thoracic lesions and conditions in children is evolving. Our experience with thoracoscopy has expanded in recent years. Therefore, we reviewed our most recent 7-year experience to examine the current applications for thoracoscopy in children.