title: Two decades of experience with thoracoscopic lobectomy in infants and children: standardizing techniques for advanced thoracoscopic surgery.
abstract: OBJECTIVE
  This study evaluates the safety and efficacy of thoracoscopic lobectomy in infants and children.
  
  
  METHODS
  From January 1994 to November 2013, 347 patients underwent video-assisted thoracoscopic lobe resection at two institutions. All procedures were performed by or under the direct guidance of a single surgeon. Patients' ages ranged from 1 day to 18 years, and weights ranged from 2.8 to 78 kg. Preoperative diagnosis included sequestration/congenital pulmonary airway malformation (n=306), severe bronchiectasis (n=24), congenital lobar emphysema (n=13), and malignancy (n=4).
  
  
  RESULTS
  Of the 347 procedures, 342 were completed thoracoscopically. Operative times ranged from 35 minutes to 240 minutes (average, 115 minutes). Average operative time when a trainee was the primary surgeon was 160 minutes. There were 81 upper, 25 middle, and 241 lower lobe resections. There were four intraoperative complications (1.1%) requiring conversion to an open thoracotomy. The postoperative complication rate was 3.3%, and 3 patients required re-exploration for a prolonged air leak. Hospital length of stay (LOS) ranged from 1 to 16 days (average). In patients <5 kg and <3 months of age, the average operative time was 90 minutes, and the LOS was 2.1 days.
  
  
  CONCLUSIONS
  Thoracoscopic lung resection is a safe and efficacious technique. With proper mentoring it is an exportable technique, which can be performed by pediatric surgical trainees. The procedures are safe and effective even when performed in the first 3 months of life. Early resection avoids the risk of later infection and malignancy.
authors.affiliation: 1 Division of Pediatric Surgery, Department of Surgery, Columbia University College of Physicians and Surgeons and Morgan Stanley Children's Hospital of New York-Presbyterian , New York, New York.
authors.forename: Steven S
authors.initials: SS
authors.lastname: Rothenberg
authors.forename: William
authors.initials: W
authors.lastname: Middlesworth
authors.forename: Angela
authors.initials: A
authors.lastname: Kadennhe-Chiweshe
authors.forename: Gudrun
authors.initials: G
authors.lastname: Aspelund
authors.forename: Keith
authors.initials: K
authors.lastname: Kuenzler
authors.forename: Robert
authors.initials: R
authors.lastname: Cowles
authors.forename: Lawrence
authors.initials: L
authors.lastname: Bodenstein
authors.forename: Saundra
authors.initials: S
authors.lastname: Kay
authors.forename: Kristin
authors.initials: K
authors.lastname: Shipman
authors.forename: Cathryn
authors.initials: C
authors.lastname: Rothenberg
authors.forename: Charles
authors.initials: C
authors.lastname: Stolar
authors.forename: Steven
authors.initials: S
authors.lastname: Stylianos
mesh_terms: D000293:Adolescent; D001987:Bronchiectasis / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D061887:Conversion to Open Surgery; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007431:Intraoperative Complications / Q000601:surgery; D007902:Length of Stay; D008168:Lung / Q000002:abnormalities / Q000601:surgery*; D008175:Lung Neoplasms / Q000601:surgery*; D061646:Operative Time; D011013:Pneumonectomy / Q000009:adverse effects / Q000379:methods; D011656:Pulmonary Emphysema / Q000151:congenital / Q000601:surgery; D012086:Reoperation; D020775:Thoracic Surgery, Video-Assisted / Q000009:adverse effects / Q000379:methods