title: Thoracoscopic treatment of pulmonary sequestration.
abstract: OBJECTIVE
  Pulmonary sequestration is a rare congenital malformation and may be the cause of recurrent infections or hemoptysis. It has been shown in case reports that resection by video-assisted thoracic surgery (VATS) is feasible despite the possible technical difficulties due to inflammatory changes, but its role has not been evaluated yet in a larger series of consecutively treated patients.
  
  
  METHODS
  Retrospective analysis of all consecutively thoracoscopically treated patients (between January 1991 and January 2005) with pulmonary sequestration in a single center. We included 14 patients in the study who fulfilled the criteria; seven were women. Median age was 33 years (20-64 years). The following data were analyzed for all patients: major symptoms, diagnostic procedures, treatment, and outcome. Operative parameters and findings including operating time, blood loss, anatomical location of the sequestration, and feeding vessels were evaluated.
  
  
  RESULTS
  Leading symptoms were recurrent infections (10), hemoptysis (3), and chest discomfort (1). The diagnosis was made by CT scan. Additionally, an arteriography or an angio-MRI was done in three patients and one patient, respectively. Thirteen intralobar (all lower lobes, eight on the right) and one left-sided extralobar pulmonary sequestration were resected. We performed eight lobectomies, four atypical segmentectomies, one extralobar resection, and one occlusion of the aberrant artery. One case had to be converted to a thoracotomy due to bleeding from the aberrant artery. There was no mortality. Complications included pneumonia in three cases, one hemothorax, one pneumothorax after removing the chest tube, and one wound infection. All were treated conservatively.
  
  
  CONCLUSIONS
  Thoracoscopic treatment of pulmonary sequestration is feasible in experienced hands. The aberrant systemic artery can be freed and dissected safely despite the frequently occurring inflammatory changes. Conversion rate to thoracotomy is low.
authors.affiliation: Department of Surgery, Division for Thoracic Surgery, University Hospital Zurich, Rä mistrasse 100, CH 8091 Zurich, Switzerland.
authors.forename: Peter B
authors.initials: PB
authors.lastname: Kestenholz
authors.forename: Didier
authors.initials: D
authors.lastname: Schneiter
authors.forename: Sven
authors.initials: S
authors.lastname: Hillinger
authors.forename: Didier
authors.initials: D
authors.lastname: Lardinois
authors.forename: Walter
authors.initials: W
authors.lastname: Weder
mesh_terms: D000328:Adult; D001011:Aorta / Q000002:abnormalities; D001027:Aortography; D001998:Bronchopulmonary Sequestration / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy / Q000379:methods; D011183:Postoperative Complications; D012077:Renal Artery / Q000002:abnormalities; D012189:Retrospective Studies; D020775:Thoracic Surgery, Video-Assisted / Q000379:methods*; D014057:Tomography, X-Ray Computed