Experience with 144 consecutive pediatric thoracoscopic lobectomies.
OBJECTIVE
The early experience with the technique and short-term outcomes after pediatric thoracoscopic lobectomy were independently reported by the authors several years ago. This paper updates their combined experience, evaluating the safety, efficacy, and long-term outcomes.


METHODS
From January 1995 to May 2005, 144 consecutive patients underwent a thoracoscopic lobectomy. Preoperative diagnoses included cystic adenomatoid malformation/sequestration (n = 112), bronchiectasis (n = 19), lobar emphysema (n = 10), and malignancy (n = 3). Ages ranged from 2 days to 18 years, and weight ranged from 2.8 to 78 kgs. Three or four valved ports were used with a controlled pneumothorax. Single-lung ventilation was used in all cases. Follow-up ranged from 1 to 10 years.


RESULTS
All but three procedures were completed thoracoscopically; one was converted to repair an injured upper lobe bronchus during a lower lobectomy, one resulting from bleeding, and another caused by what was believed to be a potentially inadequate margin during the resection of a large tumor. The operating time ranged from 35 to 220 minutes (median, 125). There were 110 lower, 24 upper, and 10 middle lobe resections. There was one intraoperative complication--the compromise of a left upper lobe bronchus. There were four postoperative complications: pneumonia, pneumothorax, empyema, and prolonged chest tube drainage. There were no reoperations. The median duration of hospital stay was 2.8 days. A long-term follow-up revealed no cases of musculoskeletal deformity or weakness.


CONCLUSIONS
The current techniques and equipment allow for the complete thoracoscopic resection of pulmonary lobes in any age or size of a child, with low morbidity and no mortality. Long-term outcomes support the efficacy of this technique that spares growing children a thoracotomy that has the potential for late musculoskeletal morbidity.
Albanese
Craig T
CT
Department of Surgery, Division of Pediatric Surgery, Lucile Packard Children's Hospital at Stanford University Medical Center, Stanford, California 94305-5733, USA.
Rothenberg
Steven S
SS
D000293:Adolescent; D016063:Blood Loss, Surgical; D001980:Bronchi / Q000293:injuries; D001987:Bronchiectasis / Q000601:surgery; D015505:Chest Tubes; D002648:Child; D002675:Child, Preschool; D015615:Cystic Adenomatoid Malformation of Lung, Congenital / Q000601:surgery; D016724:Empyema, Pleural / Q000209:etiology; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007431:Intraoperative Complications; D007902:Length of Stay; D008137:Longitudinal Studies; D008175:Lung Neoplasms / Q000601:surgery; D011013:Pneumonectomy / Q000379:methods*; D011014:Pneumonia / Q000209:etiology; D011030:Pneumothorax / Q000209:etiology; D011183:Postoperative Complications; D011656:Pulmonary Emphysema / Q000601:surgery; D012449:Safety; D013906:Thoracoscopy / Q000379:methods*; D016896:Treatment Outcome