title: Thoracoscopic pneumonectomy for severe bronchiectasis in a 9-year-old female.
abstract: 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.
authors.affiliation: Department of Surgery, Keck School of Medicine, University of Southern California and Children's Hospital, Los Angeles, CA 90027, USA.
authors.forename: Dean M
authors.initials: DM
authors.lastname: Anselmo
authors.forename: Iris A
authors.initials: IA
authors.lastname: Perez
authors.forename: Donald B
authors.initials: DB
authors.lastname: Shaul
mesh_terms: 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