title: Thoracoscopic vs open lobectomy in infants and young children with congenital lung malformations.
abstract: BACKGROUND
  Although thoracoscopic lobectomy is a widely accepted surgical procedure in adult thoracic surgery, its role in small children remains controversial. The purpose of this study was to evaluate perioperative outcomes after thoracoscopic and open lobectomy in infants and young children with congenital lung malformations at a single academic referral center.
  
  
  METHODS
  A cohort study of 62 consecutive children who underwent elective pulmonary lobectomy for a congenital lung lesion between 2001 and 2013 was performed. Patient demographics and perioperative outcomes were evaluated in univariate and logistic regression analyses.
  
  
  RESULTS
  Forty-nine patients underwent thoracoscopy and 13 had a thoracotomy. Six children undergoing thoracoscopy required conversion to thoracotomy (conversion 12.2%). Perioperative outcomes, including median blood loss (2.0 vs 1.1 mL/kg; p = 0.34), chest tube duration (3 vs 3 days; p = 0.33), hospital length of stay (3 vs 3 days; p = 0.42), and morbidity as defined by the Accordion Grading Scale (30.6% vs 30.8%; p = 0.73), were similar between thoracoscopy and thoracotomy, respectively. Although thoracoscopy was associated with increased operative duration compared with thoracotomy (239.9 vs 181.2 minutes, respectively; p = 0.03), thoracoscopy operative times decreased with increasing institutional experience (p = 0.048). Thoracoscopic lobectomy infants younger than 5 months of age had a 2.5-fold higher rate of perioperative adverse outcomes compared with older children (p = 0.048).
  
  
  CONCLUSIONS
  In small children undergoing pulmonary lobectomy, both thoracoscopy and thoracotomy are associated with similar perioperative outcomes. The cosmetic and musculoskeletal benefits of the thoracoscopic approach must be balanced against institutional expertise and a potentially higher risk for complications in younger patients.
authors: Section of Pediatric Surgery, Department of Surgery, CS Mott Children's Hospital, University of Michigan Health System, Ann Arbor, MI. Electronic address: shaunkun@umich.edu.
authors: Shaun M
authors: SM
authors: Kunisaki
authors: Section of Pediatric Surgery, Department of Surgery, CS Mott Children's Hospital, University of Michigan Health System, Ann Arbor, MI.
authors: Ian A
authors: IA
authors: Powelson
authors: Pediatric Anesthesiology Section, Department of Anesthesiology, CS Mott Children's Hospital, University of Michigan Health System, Ann Arbor, MI.
authors: Bishr
authors: B
authors: Haydar
authors: Pediatric Anesthesiology Section, Department of Anesthesiology, CS Mott Children's Hospital, University of Michigan Health System, Ann Arbor, MI.
authors: Brian C
authors: BC
authors: Bowshier
authors: Section of Pediatric Surgery, Department of Surgery, CS Mott Children's Hospital, University of Michigan Health System, Ann Arbor, MI.
authors: Marcus D
authors: MD
authors: Jarboe
authors: Section of Pediatric Surgery, Department of Surgery, CS Mott Children's Hospital, University of Michigan Health System, Ann Arbor, MI.
authors: George B
authors: GB
authors: Mychaliska
authors: Section of Pediatric Surgery, Department of Surgery, CS Mott Children's Hospital, University of Michigan Health System, Ann Arbor, MI.
authors: James D
authors: JD
authors: Geiger
authors: Section of Pediatric Surgery, Department of Surgery, CS Mott Children's Hospital, University of Michigan Health System, Ann Arbor, MI.
authors: Ronald B
authors: RB
authors: Hirschl
mesh_terms: D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D007902:Length of Stay / Q000639:trends; D008168:Lung / Q000002:abnormalities*; D008171:Lung Diseases / Q000151:congenital / Q000601:surgery*; D008297:Male; D008824:Michigan / Q000453:epidemiology; D011013:Pneumonectomy / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D020775:Thoracic Surgery, Video-Assisted / Q000379:methods*; D013908:Thoracotomy / Q000379:methods*; D016896:Treatment Outcome