Thoracoscopy in Children and Adolescents (original) (raw)

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.

Thoracoscopy in children: anaesthesiological implications and case reports

Minerva anestesiologica, 2007

Videoassisted thoracic surgical technique in children is being used with increasing frequency for an extensive variety of diagnostic and therapeutic procedures. The aim of the study was to assess respiratory, cardiocirculatory and body temperature changes in children undergoing thoracoscopy and to identify if the trend of such changes was modifiable by factors such as lung exclusion, length of the thoracoscopy and preoperative respiratory compromise. A total of 50 patients (38 boys and 12 girls) undergoing general anaesthesia for diagnostic and therapeutic thoracoscopic procedures were analysed. The values of the monitored parameters were compared at 6 specific times: T1 - at the end of anaesthesia induction (considered the basal level); T2 - after lateral position; T3 - before pleural CO2 insufflation; T4 - 10 min after pleural CO2 insufflation; T5 - before pleural deflation; T6 - 10 min after pleural deflation. All patients tolerated the thoracoscopy well, without intraoperative c...

Thoracotomy in Children: Review from a Low-Income Country

Pediatric Health, Medicine and Therapeutics

Background: Thoracotomy is indicated for several congenital and acquired disorders in children. It is among the surgical procedures which require a well-trained and dedicated surgical, anesthesia and critical care team which can be difficult to assemble in a lowincome country setup. As the pattern and outcome of thoracotomy in children remained unreported from such setting, this study aims to shed light on this matter. Methodology: A descriptive cross-sectional review was conducted. Children who have undergone thoracotomy for non-cardiac pathologies were included in the study. Demographic and clinical data were collected by chart review. Frequencies and percentages were used to describe categorical variables while mean, median, standard deviation and interquartile range were calculated for continuous variables. Results: A total of 68 patients were operated on in the study period, out of which 44 (64.7%) were males. The mean ages of the children at the time of diagnosis and procedure were 4.05 ± 3.9 years and 4.14 ± 4.03 years, respectively. The most common indication for thoracotomy was pulmonary hydatid cyst (17; 25%) followed by congenital lobar emphysema (11; 16.2%). Muscle sparing posterolateral thoracotomy was the most common approach in 66 (97.1%) patients. The analgesic medications that were used in the post-operative period were paracetamol, diclofenac, ibuprofen, tramadol and morphine. Combined analgesics were administered in two-thirds of the patients while a single analgesic was used in the rest of the children. No regional blocks were administered post operatively as pediatric size catheters were not available. The morbidity and mortality rates were found to be 11.8% and 8.8%, respectively. Conclusion: The most common indication for thoracotomy in this study was pulmonary hydatid cyst. The provision of postthoracotomy analgesia in our institution is suboptimal as evidenced by no use of regional blocks and poor practice of administering multimodal analgesia. Thoracotomy was associated with fairly high morbidity and mortality.

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.

Single port thoracoscopy for the treatment of pleural empyema in children

Journal of Pediatric Surgery, 2004

Background/Purpose: This report is an evaluation of a single-port technique for the thoracoscopic treatment of pleural empyema in children. Methods: Ten consecutive patients with pleural empyema were treated by means of a "Single Port Thoracoscopy" (SPOT). Mean age was 6.9 years (range, 2 to 13 years). The surgery was performed 5 to 26 days after the onset of symptoms. Three patients received this treatment as the first procedure, whereas the other 7 underwent closed placement of a chest tube, 3 to 12 days before the surgery. Only 1 11.5-mm thoracoport was used. Through this single port, standard scopes and instruments were introduced simultaneously to debride and unify the pleural space. Results: Satisfactory debridement of the pleural cavity was achieved in all cases. Mean operating time was 70 minutes

History and clinical use of thoracoscopy/pleuroscopy in respiratory medicine

Breathe, 2011

Thoracoscopy was introduced over 100 years ago and for 40 years has been mainly used in the pneumothorax treatment of tuberculosis in those cases where pleuro-pulmonary adhesions prevented collapse of the lung. In the 1950s, the pneumothorax treatment of tuberculosis came to an end and thoracoscopy was used in a few centres by chest physicians as a diagnostic and therapeutic method in several pleuro-pulmonary diseases. In the 1990s, thoracic surgeons introduced the technique for minimally invasive surgery, known as ''surgical thoracoscopy'' or more precisely ''video-assisted thoracic surgery'' (VATS), which is performed under general anaesthesia with one-lung ventilation. In contrast, medical thoracoscopy/pleuroscopy can be performed under local anaesthesia or conscious sedation, in an endoscopy suite, using non-disposable rigid or semi-rigid instruments. Thus, it is considerably less invasive and less expensive. Today, medical thoracoscopy/ pleuroscopy is increasingly used by chest physicians, mainly in patients with pleural effusion or pneumothorax including talc poudrage as best conservative pleurodesis treatment. Meanwhile, the technique is considered to be one of the main areas of interventional pneumology.

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.

Thoracoscopy in infants and children: the state of the art

Journal of Pediatric Surgery, 2005

It is truly a great honor for me to be here addressing this congress today on the state of the art of thoracoscopy in infants and children. There are a number of reasons for this. BAPS was the first international meeting I ever attended as a resident. That encounter showed me the importance and the strength of the global pediatric surgery community and the impact it could and would have on the treatment for children. It also opened the door to many great friendships and collaborations. But the second is that my career as a thoracic surgeon really started in England during a year fellowship in Liverpool at Broadgreen Hospital, now known as the Cardiothoracic Center for Northern England. It was here that I honed my skills as a noncardiac thoracic surgeon and learned the beauty of chest surgery. It was also where I had my first exposure to thoracoscopy, although this was quite primitive by our standards (today). It consisted of the use of a single rigid trocar and modified cystoscopy equipment with the surgeon looking directly through the eyepiece of the scope. It allowed us to do limited explorations and pleural biopsies in patients with suspected malignancy. However, the combination of the vast open experience and introduction to thoracoscopy allowed me to dream about possible applications for the future and build on the pioneering work of others.

Thoracoscopy in pediatric pleural empyema: a prospective study of prognostic factors

Journal of Pediatric Surgery, 2006

Purpose: The indications for thoracoscopy remain imprecise in cases of pleural empyema. This study aimed to identify preoperative prognostic factors to help in the surgical decision. Methods: From 1996 to 2004, 50 children with parapneumonic pleural empyema underwent thoracoscopy either as the initial procedure (n = 26) or after failure of medical treatment (n = 24). Using multivariate analysis, we tested the prognostic value of clinical and bacteriological data, the ultrasonographic staging of empyema, and the delay before surgery. Outcome measures were technical difficulties, postoperative complications, time to apyrexia, duration of drainage, and length of hospitalization. Results: The clinical and bacterial data did not significantly predict the postoperative course. Echogenicity and the presence of pleural loculations at ultrasonography were not independent significant prognostic factors. A delay between diagnosis and surgery of more than 4 days was significantly correlated ( P b .05) with more frequent surgical difficulties, longer operative time, more postoperative fever, longer drainage time, longer hospitalization, and more postoperative complications, such as bronchopleural fistula, empyema relapse, and persistent atelectasia. Conclusion: The main prognostic factor for thoracoscopic treatment of pleural empyema is the interval between diagnosis and surgery. A 4-day limit, corresponding to the natural process of empyema organization, is significant. The assessment of loculations by ultrasonography alone is not sufficient to predict the postoperative course. D