title: Thoracoscopic lung biopsy in infants and children with endoloops allows smaller trocar sites and discreet biopsies.
abstract: BACKGROUND
  Thoracoscopy is replacing open lung biopsies because it is less invasive. However, most surgeons obtain biopsies with an endostapler, which requires a 12-mm trocar and a minimum of 4.5 cm of intrathoracic space to open, making its use in patients less then 10 kg impractical. This report describes the use of the Endoloop (Ethicon Endosurgery, Cincinnati, OH) in small pediatric patients undergoing thoracoscopic lung biopsies.
  
  
  METHODS
  From 1993 to February 2007, 69 patients underwent thoracoscopic lung biopsy for diagnosis and therapy. Ages ranged from 2 weeks to 4 years and weight from 2 to 22 kg. One 5- and two 3-mm trocars were used in all cases. In all cases, two Endoloops were placed proximal to the segment of lung being biopsied and the lung was divided sharply distal to the Endoloops. The specimen was removed through the 5-mm trocar site. The lung was reexpanded and no chest drains were left in postoperatively.
  
  
  RESULTS
  All 69 procedures were successfully completed thoracoscopically. Two biopsy specimens were obtained, in most cases. Operative time ranged from 10 to 35 minutes (average, 20). There were no intraoperative complications. One patient required reintubation and ventilator support on postoperative day 1 and developed a pneumothorax on postoperative day 2, requiring a chest tube. There were no other complications.
  
  
  CONCLUSIONS
  The thoracoscopic approach to lung biopsy is the preferred method of obtaining lung tissue for diagnosis. The use of the Endoloop technique is a safe, effective technique in small pediatric patients, avoiding problems with the limited size of the chest cavity in patients less than 10 kg, and avoids the use of large incisions in a small child.
authors.affiliation: Department of Pediatric Surgery, Case Western Reserve University, Cleveland, Ohio, USA. tponsky@yahoo.com
authors.forename: Todd A
authors.initials: TA
authors.lastname: Ponsky
authors.forename: Steven S
authors.initials: SS
authors.lastname: Rothenberg
mesh_terms: D001706:Biopsy / Q000295:instrumentation* / Q000379:methods*; D002675:Child, Preschool; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008168:Lung / Q000473:pathology*; D011183:Postoperative Complications; D013906:Thoracoscopy / Q000379:methods*