Experiences and challenges of thorcoscopic lung surgery in the pediatric age group Justus Lieber, Cristian Ioan Urla, Winfried Baden, Jürgen Schäfer,

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Presentation transcript:

Experiences and challenges of thorcoscopic lung surgery in the pediatric age group Justus Lieber, Cristian Ioan Urla, Winfried Baden, Jürgen Schäfer, Hans-Joachim Kirschner, Jörg Fuchs International Journal of Surgery Volume 23, Pages 169-175 (November 2015) DOI: 10.1016/j.ijsu.2015.10.005 Copyright © 2015 IJS Publishing Group Limited Terms and Conditions

Fig. 1 Trocar positioning for anatomical resections. For upper-lobe resections, camera positioning on the mid-axillary line (A) enables initial identification of the segmental veins (B). In middle/lower lobe resections, the sequence of dissection/ligation of bronchopulmonary structures starts with the arteries and bronchi, which requires a camera position on the anterior axillary line (C). This positioning also enables good access to the inferior pulmonary vein (inf PV) as the final step of the procedure (D). International Journal of Surgery 2015 23, 169-175DOI: (10.1016/j.ijsu.2015.10.005) Copyright © 2015 IJS Publishing Group Limited Terms and Conditions

Fig. 2 Thoracoscopic lobectomy. Postnatal conventional X-rays (A) and CT scans (B) of a newborn girl with a CPAM in her lower-left lobe. Intraoperative view of the arteries of the lower lobe before ligation in the patient at an age of 11 months (PB = pars basalis; A = segmental arteries 4–6) (C). The specimen was retrieved via a slightly enlarged trocar site (D). Postoperative X-ray before hospital discharge and cosmetic view 7 months after the thoracoscopic lobectomy (E, F). International Journal of Surgery 2015 23, 169-175DOI: (10.1016/j.ijsu.2015.10.005) Copyright © 2015 IJS Publishing Group Limited Terms and Conditions

Fig. 3 Thoracoscopic lung tissue-sparing resection of an intraparenchymal bronchogenic cyst. CT scan of an intraparenchymal air-filled cyst in a 5-year-old girl (A, B). A bronchogram was performed but did not precisely localize the connection to the bronchial system (C). Postoperative X-ray after thorcoscopic lung tissue-sparing enucleation of an intraparenchymal bronchogenic cyst (D). International Journal of Surgery 2015 23, 169-175DOI: (10.1016/j.ijsu.2015.10.005) Copyright © 2015 IJS Publishing Group Limited Terms and Conditions

Fig. 4 Wedge resection after CT-guided labeling of an intraparenchymal metastasis. Preoperative CT-guided localization of a pulmonary metastasis in a 14-year-old girl with a primitive neuroectodermal tumor using a hook-wire. The CT scan of the patient in a prone position shows a small intraparenchymal lesion (A). A hook-wire is exactly inserted into the lesion (B, C). Preoperative aspect of the percutaneously inserted wire (D), and intraoperative view during the thoracoscopic metastasectomy (E, F). International Journal of Surgery 2015 23, 169-175DOI: (10.1016/j.ijsu.2015.10.005) Copyright © 2015 IJS Publishing Group Limited Terms and Conditions

Fig. 5 Conversions to open thoracotomy in anatomical lung resections. Conversion to thoracotomy was necessary in 8 cases of anatomical lobectomies because of severe tissue destruction and infectious adhesions (n = 6) and a vascular (n = 1) or bronchial (n = 1) anomaly. A significant learning curve in the first 5 years of the study period was seen compared to the second 5-year study period (p = 0.006). International Journal of Surgery 2015 23, 169-175DOI: (10.1016/j.ijsu.2015.10.005) Copyright © 2015 IJS Publishing Group Limited Terms and Conditions