title: Early experience with single-incision thoracoscopic surgery in the pediatric population.
abstract: BACKGROUND
  Single-incision pediatric endosurgery is gaining popularity in children. We have recently applied the single-incision approach for thoracoscopic procedures. We report our initial experience with single-incision thoracoscopic surgery in the pediatric population.
  
  
  METHODS
  A retrospective chart review of the first 10 single-incision thoracoscopic operations done at our institution was conducted. The patients' mean age and weight and the median operative time, postoperative length of stay, and time until discontinuation of chest tubes were determined.
  
  
  RESULTS
  The 10 procedures were performed in eight patients (two patients each had bilateral procedures). The procedures performed included wedge resection and mechanical pleurodesis for spontaneous pneumothorax (n = 7), wedge biopsies for lymphoma (n = 1) and chronic granulomatous disease (n = 1), and resection of an apical extrapulmonary neuroblastoma (n = 1). All of the procedures were completed without intraoperative complication or significant blood loss. In each case, multiple trocars and/or unsheathed instruments were passed through a single small incision, which was subsequently used for the chest tube(s). The mean patient age was 13.5 years (range 3-18 years). The mean weight was 47 kilograms (range 16-63 kg). The median operative time was 64 minutes (range 50-201 minutes). The median postoperative length of stay was 7 days (range 3-19 days). The median time until chest tube removal was 3 days (range 2-15 days). The mean follow-up was 7 months (range 3-12 months). One patient developed a recurrent pneumothorax and persistent air leak after having undergone a wedge resection and pleurodesis for a spontaneous pneumothorax and required a reoperation.
  
  
  CONCLUSIONS
  Single-incision thoracoscopic surgery is a feasible alternative to the traditional multiple-incision approach in the pediatric population. The in-line positioning of the camera and instruments often proves to be an advantage rather than a hindrance.
authors.affiliation: Department of Pediatric Surgery, St. Christopher's Hospital for Children/Drexel University College of Medicine, Philadelphia, Pennsylvania, USA. rajeev.prasad@tenethealth.com
authors.forename: Rajeev
authors.initials: R
authors.lastname: Prasad
authors.forename: L Grier
authors.initials: LG
authors.lastname: Arthur
authors.forename: Shaheen J
authors.initials: SJ
authors.lastname: Timmapuri
authors.forename: Marshall Z
authors.initials: MZ
authors.lastname: Schwartz
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Fairbanks
authors.forename: Kim G
authors.initials: KG
authors.lastname: Mendelson
authors.forename: Keith
authors.initials: K
authors.lastname: Thatch
authors.forename: Matthew L
authors.initials: ML
authors.lastname: Moront
mesh_terms: D000293:Adolescent; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D010995:Pleural Diseases / Q000150:complications / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D013896:Thoracic Diseases / Q000150:complications / Q000473:pathology / Q000601:surgery*; D013906:Thoracoscopy; D013997:Time Factors; D016896:Treatment Outcome