Thoracoscopic pneumonectomy for severe bronchiectasis in a 9-year-old female.
BACKGROUND
Thoracoscopic total pneumonectomy has not been previously described in the pediatric surgical literature. In this paper, we describe a case of pneumonectomy performed through a minimally invasive approach in a 9-year-old female with Down's syndrome and gastroesophageal reflux disease.


METHODS
The patient suffered from multiple recurrent aspiration pneumonias, which progressed to bronchiectasis of the entire left lung. As a result, the patient was hypoxemic and required continuous supplemental oxygen. Preoperative perfusion scans showed diminished perfusion of the left lung. Thoracoscopy was performed by using 3-5 mm trocars and one 12-mm trocar. Insufflation pressure was maintained at 5 mm Hg. Dissection was performed at the hilum by using hook electrocautery and the LigaSure device (ValleyLab, Boulder, CO). The pulmonary artery, veins, and left mainstem bronchus were sequentially divided by using a 35-mm ENDO GIA vascular stapler (Ethicon Endo-Surgery, Cincinnati, OH). There were no intraoperative complications. Eight months following surgery, her health is improved and she no longer requires supplemental oxygen.


CONCLUSIONS
Thoracoscopic pneumonectomy is a safe, technically feasible approach for severe bronchiectasis in children.
Anselmo
Dean M
DM
Department of Surgery, Keck School of Medicine, University of Southern California and Children's Hospital, Los Angeles, CA 90027, USA.
Perez
Iris A
IA
Shaul
Donald B
DB
D001987:Bronchiectasis / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D002648:Child; D004314:Down Syndrome / Q000150:complications; D005260:Female; D005764:Gastroesophageal Reflux / Q000150:complications; D006801:Humans; D011013:Pneumonectomy / Q000379:methods*; D013906:Thoracoscopy / Q000379:methods*; D014057:Tomography, X-Ray Computed