1. Thoracoscopic treatment of primary spontaneous pneumothorax in children Maria Marciniak Students' Scientific Society at the Department of Surgery and Oncology of Medical University in Lodz Tutor: J. Jablonski, MD Head of Pediatric Surgery and Oncology Clinic: Prof. E. Andrzejewska, MD, PhD

2. Pneumothorax The accumulation of free air within the pleural cavity with subsequent collapse of the lung 2 z 21 http://www.google.pl/imgres?imgurl=http://www.riversideonline.com/source/images/image_popup/ah6a92...

3. PNEUMOTHORAX Traumatic Idiopathic Iatrogenic SecondaryPrimary 3 z 21

4. Primary spontaneous pneumothorax Subpleural emphysema bubbles burst 4 z 21 Guimaraes CVA i wsp. CT findings for blebs and bullae in children with spontaneous pneumothorax and comparison with findings in normal age-matched controls. Pediatr Radiol. 2007

5. The formation of subpleural emphysema bubbles 5 z 21 Guimaraes CVA i wsp. CT findings for blebs and bullae in…

6. Treatment of PSP Conservative SurgicalDrainage passive / active Puncture and aspiration 6 z 21 http://www.google.pl/imgres?imgurl=http://www.famed.com.pl /produkty/_1... http://www.google.pl/imgres?imgurl=http://www.kryminalistyka. fr.pl/images/praktyk/otworzenie/skalpel1.jpg...

7. SURGICAL TREATMENT ThoracotomyThoracoscopy Excision of pulmonary emphysema bubbles Pleurodesis Pleurectomy 7 z 21

8. THORACOSCOPY Effective diagnostic and therapeutic tool Is considered by many authors as „gold standard" in the treatment of PSP 8 z 21

9. PSP treatment in children None of the guidelines for the PSP differentiate pediatric patients A small number of reports on the treatment of PSP in children (1985-2010 r. - 23 reports) There is no optimal algorithm 9 z 21

10. 40-61% 40-61% of children have recurrent pneumothorax after drainage of the first episode of PSP Small amount of relapses Shortening the duration of hospitalization Lower costs Earlierthoracoscopy Earlier thoracoscopy 10 z 21

11. Pneumothorax in children Lack of lung expansion after drainage Recurrence of pneumothorax on the opposite side Air leak > 5-7 days Simultaneous bilateral pneumothorax The first episode of pneumothorax The second episode of pneumothorax on the same side Drainage of the pleural cavity Thoracoscopy 11 z 21

12. Thoracoscopic treatment of spontaneous pneumothorax in the Department of Pediatric Surgery and Oncology 3 patients (4 operations) 2007-2010 all patients showed the presence of emphysema bubbles at the top of the lungs 12 z 21

13. Chest pain, shortness of breath n = 3 Radiological examination 13 z 21

14. Computed tomography n = 2 14 z 21

15. Boy 16 year old Episode I of pneumothorax on the left side – successful drainage of pleural cavity, discharged after 11 days of treatment Episode II (after 4 weeks) - drainage of pleural cavity Episode III (after 6 weeks) CT - emphysema bubble at the top of the lung thoracoscopy in the 3rd day of hospitalization, discharged after 10 days of treatment 15 z 21

16. Boy 15 year old Episode I - spontaneous pneumothorax on the left side indications - the persistent air leak after the insertion of pleural drainage thoracoscopy in 9th day of treatment discharged at 4th day after surgery Episode II - pneumothorax on the right side 8 weeks after recovery of the left pneumothorax thoracoscopy with resection of the pulmonary emphysema at the top of the right lung discharged after 3 days 16 z 21

17. Girl 17 year old pneumothorax on the right side - pleural drainage indications - persistent air leak after a period of improvement thoracoscopy in the 20th day of treatment - resection of pulmonary emphysema bubbles located at the top of the lung discharged after 7 days 17 z 21

18. Summary in all patients treated with thoracoscopy we obtained a good result there were no complications there were no recurrences - the period of observation 6 - 12 months 18 z 21

19. MOVIE

20. Conclusion 1. The high relapse rate in children treated with drainage of the pleural cavity due to the PSP supports the eligibility of these patients prior to thoracoscopy 2. Thoracoscopy in children with PSP is an effective and safe therapeutic procedure 20 z 21

22. Epidemiology of PSP - Children The average age 13 years (13-17) Incidence:? No simultaneous bilateral pneumothorax - 27% Simultaneous bilateral pneumothorax - 6 - 9%

23. THORACOSCOPY Minimally invasive method Very good visualization of lesions Shorter hospitalization Rapid return to full physical activity