title: Experiences and challenges of thorcoscopic lung surgery in the pediatric age group.
abstract: BACKGROUND
  We report a single-center study of minimally invasive thoracoscopic lung surgery with pediatric patients.
  
  
  METHODS
  We performed a retrospective analysis of patients who underwent thoracoscopic lung surgery between 2004 and 2013. The procedures were divided into anatomic and non-anatomical lung resections.
  
  
  RESULTS
  Seventy-six patients with a mean age of 6.5 years (range: 7 days-17 years) and a mean weight of 11 kg (range: 2.6-56.0 kg) received thoracoscopic lung surgery for tumor metastases (n = 20), sequestration/congenital adenomatoid malformation (19), cysts (12), aspergillomas (7), bullae (5), middle lobe syndrome (3), bronchiectasis (3), emphysema (2), and other reasons (5). Twenty-nine anatomical lung resections (Group I: lobectomies, segmentectomies) and 47 non-anatomical lung resections (Group II: wedge resections, lung tissue-sparing surgery) were performed. In 6 cases, preoperative CT-guided coiling was used to localize the lung lesions. Specimen removal was achieved using a widened (2 cm) trocar site. The operating times of Group I patients were longer compared than those of Group II patients (means: 154 and 68 min, respectively); conversion rates (8 versus 2), chest tube insertion rates (100% versus 51%), and postoperative ventilation (48% versus 13%) also differed.
  
  
  CONCLUSIONS
  Thoracoscopic anatomical lung resections appear to be safe and effective in infants and children. In congenital lung diseases, the key to success is the intraoperative destruction of space-occupying lesions. Limitations exist in cases with infectious adhesions. Non-anatomical lung resections are technically easier and should remain standard in pediatric surgery. Limitations exist in cases of metastases, which are deep within the parenchyma and are not visible on the lung surface.
authors.affiliation: Department of Pediatric Surgery and Pediatric Urology, University Children's Hospital, Hoppe-Seyler-Strasse 1, D-72076 Tübingen, Germany. Electronic address: justus.lieber@med.uni-tuebingen.de.
authors.forename: Justus
authors.initials: J
authors.lastname: Lieber
authors.affiliation: Department of Pediatric Surgery and Pediatric Urology, University Children's Hospital, Hoppe-Seyler-Strasse 1, D-72076 Tübingen, Germany. Electronic address: cristian.urla@med.uni-tuebingen.de.
authors.forename: Cristian Ioan
authors.initials: CI
authors.lastname: Urla
authors.affiliation: Department of Pediatric Cardiology and Pulmonology, University Children's Hospital, Hoppe-Seyler-Strasse 1, D-72076 Tübingen, Germany. Electronic address: winfried.baden@med.uni-tuebingen.de.
authors.forename: Winfried
authors.initials: W
authors.lastname: Baden
authors.affiliation: Department of Diagnostic Radiology, University Hospital, Hoppe-Seyler-Strasse 1, D-72076 Tübingen, Germany. Electronic address: juergen.schaefer@med.uni-tuebingen.de.
authors.forename: Jürgen
authors.initials: J
authors.lastname: Schäfer
authors.affiliation: Department of Pediatric Surgery and Pediatric Urology, University Children's Hospital, Hoppe-Seyler-Strasse 1, D-72076 Tübingen, Germany. Electronic address: hans-joachim.kirschner@med.uni-tuebingen.de.
authors.forename: Hans-Joachim
authors.initials: HJ
authors.lastname: Kirschner
authors.affiliation: Department of Pediatric Surgery and Pediatric Urology, University Children's Hospital, Hoppe-Seyler-Strasse 1, D-72076 Tübingen, Germany. Electronic address: joerg.fuchs@med.uni-tuebingen.de.
authors.forename: Jörg
authors.initials: J
authors.lastname: Fuchs
mesh_terms: D000293:Adolescent; D001835:Body Weight; D015505:Chest Tubes / Q000706:statistics & numerical data; D002648:Child; D002675:Child, Preschool; D061887:Conversion to Open Surgery / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008168:Lung / Q000601:surgery; D008297:Male; D061646:Operative Time; D011013:Pneumonectomy / Q000379:methods; D012189:Retrospective Studies; D013906:Thoracoscopy / Q000145:classification* / Q000379:methods / Q000706:statistics & numerical data*; D013908:Thoracotomy / Q000379:methods; D016896:Treatment Outcome
keywords: Congenital lung and airway malformation; Infants and children; Lung metastases; Minimal invasive lung surgery; Thoracoscopy