title: Thoracoscopic resection of congenital pulmonary malformations in infants: is the feasibility related to the size of the lesion?
abstract: BACKGROUND
  The size of congenital pulmonary malformation (CPM) in infants might interfere with the feasibility of thoracoscopic resection. This study was undertaken to evaluate the impact of the size of CPM on the applicability of video-assisted thoracic surgery (VATS) in infants.
  
  
  METHODS
  Twenty-two infants were operated on for CPM from November 2000 to June 2009. The intra- and postoperative course was analyzed retrospectively from patient charts. Preoperative scans were evaluated blindly by a radiologist to calculate the relation between the maximum size of the lesion and the thoracic diameter in VATS and open procedures.
  
  
  RESULTS
  VATS was performed in 14 (64%) of the 22 patients and thoracotomy in 8. VATS was successfully performed in 11 (79%) of the 14 patients, whereas VATS was converted to thoracotomy due to lack of overview in 3 (21%). The mean relative size of CPM at preoperative imaging was 0.34 ± 0.05 (range: 0.3-0.4) in patients who received successful VATS, 0.57 ± 0.06 (range: 0.5-0.6) in converted cases, and 0.68 ± 0.10 (range: 0.5-0.8) in infants who underwent thoracotomy. The relative CPM size was significantly lower in successful VATS than in cases of conversion (P<0.01) and thoracotomy (P<0.01).
  
  
  CONCLUSIONS
  The relative size of CPM at preoperative imaging might be useful information for a decision-making on the use of VATS in infants. A relative CPM size below 0.5, which is less than half of the thoracic diameter, indicates a good feasibility for thoracoscopic resection of CPM. A larger size may indicate that VATS might be technically difficult.
authors.affiliation: Department of Pediatric Surgery, Hannover Medical School, Hannover, Germany.
authors.forename: Marc
authors.initials: M
authors.lastname: Reismann
authors.forename: Johannes
authors.initials: J
authors.lastname: Gossner
authors.forename: Sylvia
authors.initials: S
authors.lastname: Glueer
authors.forename: Nicolaus
authors.initials: N
authors.lastname: Schwerk
authors.forename: Benno M
authors.initials: BM
authors.lastname: Ure
authors.forename: Martin L
authors.initials: ML
authors.lastname: Metzelder
mesh_terms: D015615:Cystic Adenomatoid Malformation of Lung, Congenital / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008279:Magnetic Resonance Imaging; D008297:Male; D012189:Retrospective Studies; D020775:Thoracic Surgery, Video-Assisted / Q000379:methods*; D013908:Thoracotomy; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome