title: Traction sutures allow endoscopic staples to be used safely during thoracoscopic pulmonary lobectomy in children weighing less than 15 kg.
abstract: OBJECTIVE
  During thoracoscopic pulmonary lobectomy (TPL) in larger children (>15 kg), an endoscopic stapler (ES) and endoscopic clipper (EC) are used during dissection and division of the pulmonary vessels (PVs) and bronchus. However, in smaller children (<15 kg), ES/EC cannot be used because of limited space. We report our technique for thoracoscopic dissection and division of the PVs and bronchus in smaller children.
  
  
  METHODS
  Fifteen cases of sequestration/congenital cystic adenomatoid malformation weighing less than 15 kg (range, 8-15 kg; mean, 11 kg) were the subjects for this review. With the patient under single-lung ventilation in the lateral decubitus position, four ports ranging from 5 to 12 mm were placed. After the PVs and bronchus were exposed, thick silk was used to encircle them as a traction suture. By applying traction, the PVs and bronchus could be exposed, and ES/EC were used safely by applying countertraction.
  
  
  RESULTS
  All cases had uneventful TPL (upper in 3 patients, middle in 3 patients, and lower in 9 patients). ES/EC were easy to use. Mean operative time was 220 minutes.
  
  
  CONCLUSIONS
  Our technique allows the PVs and bronchus in children weighing less than 15 kg to be divided safely using ES/EC. We strongly recommend our technique, although simple, be used during TPL in smaller children.
authors.affiliation: Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo, Japan. h-koga@juntendo.ac.jp
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Koga
authors.forename: Kenji
authors.initials: K
authors.lastname: Suzuki
authors.forename: Kinya
authors.initials: K
authors.lastname: Nishimura
authors.forename: Tadaharu
authors.initials: T
authors.lastname: Okazaki
authors.forename: Geoffrey J
authors.initials: GJ
authors.lastname: Lane
authors.forename: Eiichi
authors.initials: E
authors.lastname: Inada
authors.forename: Atsuyuki
authors.initials: A
authors.lastname: Yamataka
mesh_terms: D001835:Body Weight; D002675:Child, Preschool; D015615:Cystic Adenomatoid Malformation of Lung, Congenital / Q000601:surgery*; D006801:Humans; D007223:Infant; D011013:Pneumonectomy / Q000379:methods*; D017792:Surgical Stapling; D013537:Sutures; D013906:Thoracoscopy / Q000379:methods*