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Pio L, Gentilino V, Macchini F, Scarpa AA, Lo Piccolo R, Conforti A, Ratta A, Guanà R, Molinaro F, Costanzo S, Riccipetitoni G, Lisi G, Midrio P, Tocchioni F, Cobellis G, Volpe A, Zolpi E, Morandi A, Ciardini E, Vella C, Grella MG, Sergio M, Guida E, Nanni L, Ceccanti S, Di Benedetto V, Cheli M, Garzi A, Nobili M, Gabriele V, Boroni G, Incerti F, Zampieri N, Cacciaguerra S, Ceccarelli PL, Escolino M, Briganti V, Gori D, Esposito C, Gamba P, Gennari F, Inserra A, Dall'Igna P, Romeo C, Bagolan P, Bleve C, Chiarenza F, Morini F, Pelizzo G, Torre M. Congenital lung malformations: a nationwide survey on management aspects by the Italian Society of Pediatric Surgery. Pediatr Surg Int 2024; 40:53. [PMID: 38340215 DOI: 10.1007/s00383-024-05635-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/07/2024] [Indexed: 02/12/2024]
Abstract
INTRODUCTION Over the years, congenital lung malformations (CLM) management remains a controversial topic in pediatric thoracic surgery. The Italian Society of Pediatric Surgery performed a national survey to study the current management variability among centers, trying to define national guidelines and a standardized approach of children with congenital lung malformations. METHODS Following a National Society approval, an electronic survey including 35 items on post-natal management was designed, focusing on surgical, anesthesiology, radiology and pneumology aspects. The survey was conducted contacting all pediatric surgical units performing thoracic surgery. RESULTS 39 pediatric surgery units (97.5%) participated in the study. 13 centers (33.3%) were classified as high-volume (Group A), while 26 centers (66.7%) were low volume (Group B). Variances in diagnostic imaging protocols were observed, with Group A performing fewer CT scans compared to Group B (p = 0.012). Surgical indications favored operative approaches for asymptomatic CLM and pulmonary sequestrations in both groups, while a wait-and-see approach was common for congenital lobar emphysema. Surgical timing for asymptomatic CLM differed significantly, with most high-volume centers operating on patients younger than 12 months (p = 0.02). Thoracoscopy was the preferred approach for asymptomatic CLM in most of centers, while postoperative long-term follow-up was not performed in most of the centers. CONCLUSION Thoracoscopic approach seems uniform in asymptomatic CLM patients and variable in symptomatic children. Lack of uniformity in surgical timing and preoperative imaging assessment has been identified as key areas to establish a common national pattern of care for CLM.
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Affiliation(s)
- Luca Pio
- Pediatric Thoracic and Airway Surgery, IRCCS Giannina Gaslini, Genoa, Italy.
- Department of Surgery, MS133, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105-3678, USA.
| | - Valerio Gentilino
- Unit of Pediatric Surgery, Woman and Child Department, Filippo del Ponte Hospital-ASST Sette Laghi, Varese, Italy
| | | | | | - Roberto Lo Piccolo
- Department of Emergency, Critical Area and Pediatric Surgery, Meyer University Children's Hospital, University of Florence, Florence, Italy
| | - Andrea Conforti
- Neonatal Surgery Unit, Department of Medical and Surgical Neonatology, Bambino Gesù Children Hospital-Research Institute, Rome, Italy
| | - Alberto Ratta
- Pediatric Surgery Unit, Infermi Hospital, Rimini, Italy
| | - Riccardo Guanà
- Department of Pediatric General Surgery, Regina Margherita Children's Hospital, Azienda Ospedaliero-Universitaria Città Della Salute E Della Scienza, Turin, Italy
| | - Francesco Molinaro
- Division of Pediatric Surgery, Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy
| | - Sara Costanzo
- Pediatric Surgery Department, Vittore Buzzi" Children's Hospital, Milan, Italy
| | - Giovanna Riccipetitoni
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
- Pediatric Surgery Unit, Department of Maternal and Child Health, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Gabriele Lisi
- Department of Pediatric Surgery "Spirito Santo", Hospital of Pescara "G. D'annunzio", University Chieti-Pescara, Pescara, Italy
| | - Paola Midrio
- Pediatric Surgery, Cà Foncello Hospital, Treviso, Italy
- Pediatric Surgery, University of Padua, Padua, Italy
| | - Francesca Tocchioni
- Department of Pediatric and Neonatal Surgery, Meyer Children's Hospital, Florence, Italy
| | - Giovannii Cobellis
- Unit of Pediatric Surgery, Salesi Children's Hospital, Marche Polytechnic University, Ancona, Italy
| | - Andrea Volpe
- Pediatric Surgery Unit, Women's and Children's Health Department, University Hospital of Padua, Padua, Italy
| | - Elisa Zolpi
- Department of Pediatric Surgery and Pediatric Minimally Invasive Surgery and New Technologies, San Bortolo Hospital, Vicenza, Italy
| | - Anna Morandi
- Department of Pediatric Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Claudio Vella
- Azienda Ospedaliero-Universitaria di Ferrara, Ferrara, Italy
| | - Maria Giovanna Grella
- Department of Pediatric Surgery, Santobono Pausilipon Children's Hospital, Naples, Italy
| | - Maria Sergio
- Policlinico Universitario di Palermo, Palermo, Italy
| | - Edoardo Guida
- Department of Pediatric Surgery, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
| | - Lorenzo Nanni
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Silvia Ceccanti
- Pediatric Surgery Unit, Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, Azienda Ospedaliero-Universitaria Policlinico Umberto I, Rome, Italy
| | | | - Maurizio Cheli
- Department of Paediatric Surgery, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Alfredo Garzi
- Dipartimento di Chirurgia Pediatrica e Robotica, Università di Salerno, Salerno, Italy
| | - Maria Nobili
- Pediatric Surgery Unit, University of Foggia, Foggia, Italy
| | | | - Giovanni Boroni
- Department of Pediatric Surgery, Azienda Ospedaliera Spedali Civili, Brescia, Italy
| | - Filippo Incerti
- Department of Pediatric Surgery, Umberto Bosio Center for Digestive Diseases, The Children Hospital AO SS Antonio E Biagio E Cesare Arrigo, Alessandria, Italy
| | - Nicola Zampieri
- Woman and Child Hospital, Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, Verona, Italy
| | | | | | - Maria Escolino
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Vito Briganti
- Department of Pediatric Surgery and Urology Unit, San Camillo Forlanini Hospital, Rome, Italy
| | - Davide Gori
- Department of Biomedical and Neuromotor Sciences, University of Bologna, 40126, Bologna, Italy
| | - Ciro Esposito
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Piergiorgio Gamba
- Pediatric Surgery Unit, Women's and Children's Health Department, University Hospital of Padua, Padua, Italy
- Pediatric Surgery, Department of Women's and Children's Health, Padua University, Padua, Italy
| | - Fabrizio Gennari
- Department of Pediatric General Surgery, Regina Margherita Children's Hospital, Azienda Ospedaliero-Universitaria Città Della Salute E Della Scienza, Turin, Italy
| | - Alessandro Inserra
- General Surgery Unit, Department of Surgery, Bambino Gesù Children's Hospital - IRCCS, Rome, Italy
- Department of Systems Medicine, University of Tor Vergata, Rome, Italy
| | - Patrizia Dall'Igna
- Department of Emergencies and Organ, Transplantation Azienda Ospedaliero-Universitaria Consorziale Ospedale Pediatrico Giovanni XXIII, Bari, Italy
- University of Bari, Bari, Italy
| | - Carmelo Romeo
- Unit of Pediatric Surgery, Department of Human Pathology of Adult and Childhood "Gaetano Barresi", University of Messina, Messina, Italy
| | - Pietro Bagolan
- Neonatal Surgery Unit, Department of Medical and Surgical Neonatology, Bambino Gesù Children Hospital-Research Institute, Rome, Italy
- Department of Systems Medicine, University of Tor Vergata, Rome, Italy
| | - Cosimo Bleve
- Department of Pediatric Surgery and Pediatric Minimally Invasive Surgery and New Technologies, San Bortolo Hospital, Vicenza, Italy
| | - Fabio Chiarenza
- Department of Pediatric Surgery and Pediatric Minimally Invasive Surgery and New Technologies, San Bortolo Hospital, Vicenza, Italy
| | - Francesco Morini
- Department of Pediatric and Neonatal Surgery, Meyer Children's Hospital, Florence, Italy
| | - Gloria Pelizzo
- Pediatric Surgery Department, Vittore Buzzi" Children's Hospital, Milan, Italy
| | - Michele Torre
- Pediatric Thoracic and Airway Surgery, IRCCS Giannina Gaslini, Genoa, Italy
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Raitio A, Vilkki V, Pakkasjärvi N. Introduction of pediatric thoracoscopic lung resections in a low-volume center - feasibility, outcome and cost analysis. Acta Chir Belg 2023; 123:497-501. [PMID: 35673976 DOI: 10.1080/00015458.2022.2086394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 06/01/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Early series of pediatric thoracoscopic surgery have reported high conversion rates and significant complications. This study investigated the introduction of pediatric thoracoscopic lung resections in a low-volume center with reference to corresponding open thoracotomy procedures with regards to operative times, length of stay, cost of admission, and outcomes. METHODS A single surgeon series. Data from the first 10 consecutive thoracoscopic lung resections were compared to a cohort of 10 consecutive open lung resections performed before the introduction of the thoracoscopic technique. All operations were performed between December 2015 and October 2021. The median follow-up was 34 months (range 4-65). RESULTS The cohort included 14 lobectomies (8 thoracoscopic and 6 open) for congenital pulmonary airway malformation (CPAM), and 6 resections (mainly non-anatomic) of pulmonary sequestration (2 thoracoscopic and 4 open). One lobectomy required conversion to thoracotomy, and one patient required reinsertion of a chest drain after open lobectomy due to persistent air leak. No other complications were recorded. All patients were asymptomatic at their follow-up. There was no significant difference in the mean age, mean weight, operative times, and intraoperative blood loss between open and minimally invasive procedures. Thoracoscopic technique was associated with significantly shorter stay at pediatric intensive care unit and shorter overall inpatients stay. CONCLUSION Thoracoscopic lung resections can be safely introduced in a low-volume center with comparable cost, operative time, and results and significantly shorter inpatient stay.
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Affiliation(s)
- Arimatias Raitio
- Department of Paediatric Surgery, University of Turku and Turku University Hospital, Turku, Finland
| | - Vesa Vilkki
- Heart Centre, Turku University Hospital, Turku, Finland
| | - Niklas Pakkasjärvi
- Department of Paediatric Surgery, University of Turku and Turku University Hospital, Turku, Finland
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Joo S, Yun T, Kang CH, Na KJ, Park S, Park IK, Kim YT. Thoracoscopic segmentectomy in children with congenital lung malformation. Sci Rep 2023; 13:9640. [PMID: 37316608 DOI: 10.1038/s41598-023-36700-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 06/08/2023] [Indexed: 06/16/2023] Open
Abstract
Congenital lung malformations (CLM) are most commonly treated with a pulmonary lobectomy. However, due to technological advancement, video-assisted thoracoscopic surgery (VATS) segmentectomy is becoming an attractive alternative to VATS lobectomy. This study aimed to evaluate the safety, feasibility, and efficacy of VATS segmentectomy as a lung parenchyma-saving strategy in children with CLM. A retrospective analysis was performed on 85 children, for whom VATS segmentectomy was tried for CLM between January 2010 and July 2020. We compared the surgical outcomes of VATS segmentectomy with the outcomes of 465 patients who underwent VATS lobectomy. Eighty-four patients received VATS segmentectomy and thoracotomy conversion was necessary for one patient for CLM. The mean age was 3.2 ± 2.5 (range 1.2-11.6) years. The mean operative time was 91.4 ± 35.6 (range 40-200) minutes. The median duration of chest tube drainage was 1 (range 1-21) day, and the median length of postoperative hospital stay was 4 (range 3-23) days. There were no postoperative mortality and postoperative complications developed in 7 patients (8.2%), including persistent air leakage in 6 patients (7.1%) and postoperative pneumonia in 1 patient (1.2%). The median follow-up period was 33.5 (interquartile range 31-57) months and there were no patients requiring re-intervention or reoperation during the follow-up period. In the VATS segmentectomy group, the persistent air leakage rate was higher than in the VATS lobectomy group (7.1 vs. 1.1%, p = 0.003). Otherwise, postoperative outcomes were comparable between the two groups. VATS segmentectomy in children with CLM is a technically feasible alternative to VATS lobectomy with acceptable early and mid-term outcomes. However, the persistent air-leakage rate was higher in VATS segmentectomy.
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Affiliation(s)
- Seohee Joo
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
| | - Taeyoung Yun
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
| | - Chang Hyun Kang
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea.
| | - Kwon Joong Na
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
| | - Samina Park
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
| | - In Kyu Park
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
| | - Young Tae Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
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Raymond SL, Sacks MA, Hashmi A, Robertson JO, Moores D, Tagge EP, Radulescu A, Islam S, Khan FA. Short-term outcomes of thoracoscopic versus open lobectomy for congenital lung malformations. Pediatr Surg Int 2023; 39:155. [PMID: 36944730 PMCID: PMC10030530 DOI: 10.1007/s00383-023-05445-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/13/2023] [Indexed: 03/23/2023]
Abstract
PURPOSE Thoracoscopic and open approaches for the management of congenital lung malformations (CLM) has been debated. The aim of this study is to compare 30-day outcomes for non-emergent lobectomies in children. METHODS The National Surgical Quality Improvement Program-Pediatric database was queried for patients undergoing CLM resection from 2013 to 2020. Outcomes were compared by operative technique in an intention-to-treat model and then propensity matched. RESULTS 2157 patients met inclusion criteria and underwent non-emergent pulmonary lobectomy for CLM. The intended operative approach was thoracoscopic in 57.7% of patients. Patients in the open group compared to the thoracoscopic were more likely to be born premature, have chronic lung disease, require preoperative oxygen support, and be ventilator dependent. After propensity matching, there was no statistically significant difference in 30-day mortality, unplanned readmission, and other complications between the thoracoscopic and open groups. Thoracoscopic approach was associated with a shorter length of stay. The proportion of cases approached via thoracoscopy increased over time from 48.8% in 2013 to 69.9% in 2020. CONCLUSIONS This large multicenter retrospective matched analysis demonstrates thoracoscopic lobectomy in children has similar favorable 30-day outcomes and shorter length of stay for the non-emergent management of CLM, compared to open thoracotomy. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Steven L Raymond
- Division of Pediatric Surgery, Department of Surgery, Loma Linda University School of Medicine, 11175 Campus St, Suite 21111, Loma Linda, CA, USA
| | - Marla A Sacks
- Division of Pediatric Surgery, Department of Surgery, Loma Linda University School of Medicine, 11175 Campus St, Suite 21111, Loma Linda, CA, USA
| | - Asra Hashmi
- Division of Plastic Surgery, Department of Surgery, Kaiser Permanente, San Jose, CA, USA
| | - Jason O Robertson
- Department of Pediatric Surgery, Cleveland Clinic Children's Hospital, Cleveland, OH, USA
| | - Donald Moores
- Division of Pediatric Surgery, Department of Surgery, Loma Linda University School of Medicine, 11175 Campus St, Suite 21111, Loma Linda, CA, USA
| | - Edward P Tagge
- Division of Pediatric Surgery, Department of Surgery, Loma Linda University School of Medicine, 11175 Campus St, Suite 21111, Loma Linda, CA, USA
| | - Andrei Radulescu
- Division of Pediatric Surgery, Department of Surgery, Loma Linda University School of Medicine, 11175 Campus St, Suite 21111, Loma Linda, CA, USA
| | - Saleem Islam
- Division of Pediatric Surgery, Department of Surgery, University of Florida College of Medicine, Gainesville, FL, USA
| | - Faraz A Khan
- Division of Pediatric Surgery, Department of Surgery, Loma Linda University School of Medicine, 11175 Campus St, Suite 21111, Loma Linda, CA, USA.
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He T, Sun X, Liu C, Yuan M, Yang G, Cheng K, Dai S, Xu C. Learning curve for total thoracoscopic segmentectomy in treating pediatric patients with congenital lung malformation. Surg Endosc 2023:10.1007/s00464-023-09987-8. [PMID: 36941411 DOI: 10.1007/s00464-023-09987-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 02/25/2023] [Indexed: 03/23/2023]
Abstract
BACKGROUND Total thoracoscopic segmentectomy (TTS) is a technically challenging procedure in children but results in more parenchyma preservation, better pain control, better cosmetic results, and a shorter hospital stay. However, definitive data describing the learning curve of TTS has yet to be obtained. Here, we review the safety and efficiency of our initial experiences with pediatric TTS and evaluate our learning curve. METHODS This was a retrospective study of all pediatric patients undergoing TTS between December 2016 and January 2020. Pediatric patients who underwent TTS were included, while those undergoing lobectomy or wedge resection were excluded. RESULTS One hundred and twelve patients were retrospectively analyzed to evaluate the learning curve and were divided chronologically into three phases, the ascending phase (A), plateau phase (B) and descending phase (C), through cumulative summation (CUSUM) of the operative time (OT). Phases A, B, and C comprised 28, 51, and 33 cases, respectively. OT decreased significantly from phases A to B (p < 0.001) and from phase B to C (p = 0.076). No significant differences were observed in the demographic factors among the three phases. The conversion rate was zero, and the complication rate was 0.9%. Differences in technical parameters, such as length of stay and chest tube duration, were statistically insignificant between phases A and B or B and C. There were no mortalities. CONCLUSION CUSUMOT indicates that the learning curve of at least 79 cases is required for TTS in our institute. We emphasize that the learning curve should be cautiously interpreted because many factors in different institutions may influence the exact parabola and actual learning curve.
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Affiliation(s)
- Taozhen He
- Department of Pediatric Surgery, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Xiaoyan Sun
- Health Management Centre, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Chenyu Liu
- Department of Pediatric Surgery, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Miao Yuan
- Department of Pediatric Surgery, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Gang Yang
- Department of Pediatric Surgery, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Kaisheng Cheng
- Department of Pediatric Surgery, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Shiyi Dai
- Department of Pediatric Surgery, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Chang Xu
- Department of Pediatric Surgery, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan Province, China.
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Cheng K, Liu X, Yuan M, Yang G, He T, Luo D, Liu C, Xu C. Thoracoscopic anatomic pulmonary segmentectomy for the treatment of congenital lung malformation in children. Asian J Surg 2023; 46:532-538. [PMID: 35780025 DOI: 10.1016/j.asjsur.2022.06.040] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 04/28/2022] [Accepted: 06/10/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Lung-sparing surgery has been used to treat congenital lung malformation in children, and segmentectomy has been advocated as a lung-preservation strategy. However, thoracoscopic pulmonary segmentectomy has gained limited popularity considering the complications, the potential for residual lesions, and the technical difficulties associated with this procedure. Therefore, this study aimed to investigate the safety and feasibility of pediatric thoracoscopic anatomic pulmonary segmentectomy for the treatment of congenital lung malformations. METHODS We conducted a retrospective review of the medical records of 568 patients who were treated at West China Hospital, Sichuan University, from January 2014 to January 2020. The patients were divided into segmentectomy and lobectomy groups according to the surgical procedures they underwent. Clinical and follow-up outcomes were compared between the two groups. RESULTS The segmentectomy and lobectomy groups included 206 and 361 cases, respectively. The mean intraoperative blood loss was significantly higher in the segmentectomy group (6.9 mL vs. 4.5 mL; p = 0.03). The mean surgical time was also significantly longer in the segmentectomy group, (55.6 min vs. 41.5 min; p = 0.018). However, the incidence of complications did not differ significantly between the two groups (2.9% vs. 1.1%, p = 0.21). Patients in both groups did not require reoperation or show residual lesions during hospitalization and follow-up. CONCLUSIONS Thoracoscopic anatomic pulmonary segmentectomy is a safe and feasible definitive lung-sparing treatment for specific cases of congenital lung malformation, and has a complication rate comparable to that of thoracoscopic lobectomy.
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Affiliation(s)
- Kaisheng Cheng
- Department of Pediatric Surgery, West China Hospital, Sichuan University, China
| | - Xiaojuan Liu
- Department of Laboratory Medicine, West China Second University Hospital, Sichuan University, China
| | - Miao Yuan
- Department of Pediatric Surgery, West China Hospital, Sichuan University, China
| | - Gang Yang
- Department of Pediatric Surgery, West China Hospital, Sichuan University, China
| | - Taozhen He
- Department of Pediatric Surgery, West China Hospital, Sichuan University, China
| | - Dengke Luo
- Department of Pediatric Surgery, West China Hospital, Sichuan University, China
| | - Chenyu Liu
- Department of Pediatric Surgery, West China Hospital, Sichuan University, China
| | - Chang Xu
- Department of Pediatric Surgery, West China Hospital, Sichuan University, China.
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Luo D, Fu X, Wang Q, Cheng K, Lv Y, Yuan M, Xu C, He T, Yang G, Wang Y, Jia R, Liu C. Thoracoscopic Clockwise Lobectomy May Be a Stylized Procedure for Treating Children with Congenital Lung Malformations. J Laparoendosc Adv Surg Tech A 2022; 32:1293-1298. [PMID: 36257641 DOI: 10.1089/lap.2022.0078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background: Thoracoscopic lobectomy is a challenging procedure in children with congenital lung malformations (CLMs). This study aims to evaluate the safety and efficacy of thoracoscopic clockwise lobectomy (TCL) in CLMs in children and its potential to be a stylized procedure. Methods: All patients with CLMs who received TCL from 2015 to 2019 in our hospital were retrospectively reviewed. Clinical information was extracted from medical records, including patient demographics, operative details, and outcomes. Results: A total of 184 patients with a median age of 6.8 months (range, 3-156) and a median weight of 9 kg (range, 6-45) received TCL. Lesions were all located in the lower lobe and included congenital pulmonary airway malformation (n = 133), intralobar sequestration (n = 44), bronchiectasis (n = 4), and congenital lobar emphysema (n = 3). The mean (±standard deviation [SD]) operating time was 46 ± 7.5 minutes (range, 35-113). The mean (±SD) blood loss was 3.5 ± 0.8 mL (range, 1-60). Three patients converted to thoracotomy, and 162 patients did not have a chest tube placed. The postoperative course was uneventful in all patients except 2 patients who developed air leaks and 23 patients who developed a mild fever. The median length of postoperative hospital stay was 2 days. A total of 163 patients were followed up for more than 1 year without any complications. Conclusion: TCL is suitable for lower lobectomy and is safe and effective in standard and complicated thoracoscopic lobectomy. It could be recommended as a stylized procedure in treating children with CLMs.
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Affiliation(s)
- Dengke Luo
- Department of Pediatric Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaoying Fu
- Department of Pediatric Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Qinghai Wang
- Department of Pediatric Surgery, Guangyuan Central Hospital, Guangyuan, China
| | - Kaisheng Cheng
- Department of Pediatric Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Yong Lv
- Department of Pediatric Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Miao Yuan
- Department of Pediatric Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Chang Xu
- Department of Pediatric Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Taozhen He
- Department of Pediatric Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Gang Yang
- Department of Pediatric Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Yao Wang
- Department of Pediatric Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Ru Jia
- Department of Pediatric Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Chenyu Liu
- Department of Pediatric Surgery, West China Hospital, Sichuan University, Chengdu, China
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Yuan M, Xu C, Luo D, Cheng K, Yang G, He T. A Novel Surgical Method for Congenital Lung Malformations: A Pilot Study. Semin Thorac Cardiovasc Surg 2022; 35:541-547. [PMID: 35809837 DOI: 10.1053/j.semtcvs.2022.06.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 06/30/2022] [Indexed: 02/08/2023]
Abstract
Thoracoscopic surgery for congenital lung malformations (CLMs) has been widely used. However, there are still many shortcomings in the current surgical methods, such as the removal of some normal lung tissue and residual lesions. Thoracoscopic anatomical lesion resection (TALR) may be an effective and safe method to resolve these problems. This retrospective study was conducted to estimate the safety and efficiency of TALR. A retrospective review of clinical data involving patients who underwent TALR in our hospital from October 2019 to January 2021 was performed. Clinical data, including patients' demographic characteristics, manipulative details, and postoperative complications, were extracted and analyzed. A total of 95 cases were included in this study. All cases were operated on under thoracoscope, with no conversion to open surgery. The average operation time was 63.2 ± 15.2 min (range 36-142 min). The average bleeding volume during the operation was 5.8 ± 2.1 mL (range 2-10 mL). The mean diameter of the lesion was 4.4 ± 1.9 cm (range 3-7 cm). All cases had no complications, such as bronchopleurothelial fistula, hemorrhage, atelectasis, or pulmonary infection. Two patients developed pneumothorax 1 month after the operation and were cured by closed thoracic drainage. One month after the operation, chest CT showed regular cysts in 2 cases. The other patients were followed up for over 1 year by chest CT after the operation, and all recovered well without residual lesions or recurrence. Combined with the preoperative thin slice CT and intraoperative lesion boundary, anatomical intrapulmonary dissociation based on the pulmonary vein system, TALR, as a lung-sparing surgery of completely removing the lesion and retaining all normal lung tissue, has high safety and effectiveness in the treatment of CLMs.
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Affiliation(s)
- Miao Yuan
- Department of Pediatric Surgery, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu 610041, China
| | - Chang Xu
- Department of Pediatric Surgery, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu 610041, China.
| | - Dengke Luo
- Department of Pediatric Surgery, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu 610041, China
| | - Kaisheng Cheng
- Department of Pediatric Surgery, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu 610041, China
| | - Gang Yang
- Department of Pediatric Surgery, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu 610041, China
| | - Taozhen He
- Department of Pediatric Surgery, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu 610041, China
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Weller JH, Peter SDS, Fallat ME, Saito JM, Burns CR, Deans KJ, Fraser JD, Gadepalli SK, Helmrath MA, Hirschl RB, Kabre R, Lal DR, Landman MP, Leys CM, Mak GZ, Minneci PC, Wright TN, Kunisaki SM. Thoracoscopic versus open lobectomy in infants with congenital lung malformations: A multi-institutional propensity score analysis. J Pediatr Surg 2021; 56:2148-2156. [PMID: 34030879 DOI: 10.1016/j.jpedsurg.2021.04.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 03/18/2021] [Accepted: 04/15/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE The impact of thoracoscopic surgery on outcomes in children with congenital lung malformations (CLM) remains controversial. The purpose of this study was to determine the effect of operative approach on perioperative outcomes in infants undergoing lobectomy for an asymptomatic CLM. METHODS After IRB approval, a retrospective cohort study was conducted on 506 children with a CLM resected at one of eleven children's hospitals over a seven-year period. Infants undergoing elective lobectomy were identified, and covariates were balanced based on operative approach using propensity scores with full matching. Outcomes were analyzed based on intention to treat with weighted conditional regression. RESULTS One hundred seventy-five infants met inclusion criteria. There were 67 (38.3%) open, 89 (50.9%) thoracoscopic, and 19 (10.9%) thoracoscopic-converted-to-open lobectomies. Thoracoscopic lobectomy was associated with significantly longer operative times (26 min, 95% CI 6-47 min, p = 0.012) but used less epidural anesthesia (OR 0.02, 95% CI 0.004-0.11, p<0.001) when compared to open lobectomy. There were no significant differences in intraoperative blood loss, postoperative complications, chest tube duration, or length of stay. CONCLUSIONS Thoracoscopy has become the most common operative approach for elective lobectomy in infants with asymptomatic CLMs. The non-inferiority of thoracoscopic lobectomy in postoperative outcomes supports its continued use as an alternative to open lobectomy. LEVEL OF EVIDENCE Treatment study, Level III.
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Affiliation(s)
- Jennine H Weller
- Division of General Pediatric Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Johns Hopkins Children's Center, Baltimore, MD, United States
| | | | - Mary E Fallat
- Division of Pediatric Surgery, Hiram C. Polk, Jr., M.D. Department of Surgery, University of Louisville, Norton Children's Hospital, Louisville, KY, United States
| | - Jacqueline M Saito
- Division of Pediatric Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO, United States
| | - Cartland R Burns
- Division of Pediatric Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Katherine J Deans
- Center for Surgical Outcomes Research, the Research Institute and Department of Surgery, Nationwide Children's Hospital, Ohio State University College of Medicine, Columbus, OH, United States
| | - Jason D Fraser
- Children's Mercy Hospital, Kansas City, MO, United States
| | - Samir K Gadepalli
- University of Michigan and Michigan Medicine, C.S. Mott Children's Hospital, Ann Arbor, MI, United States
| | - Michael A Helmrath
- Division of Pediatric Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Ronald B Hirschl
- University of Michigan and Michigan Medicine, C.S. Mott Children's Hospital, Ann Arbor, MI, United States
| | - Rashmi Kabre
- Division of Pediatric Surgery, Department of Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Dave R Lal
- Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Matthew P Landman
- Division of Pediatric Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Charles M Leys
- Division of Pediatric Surgery, Department of Surgery, University of Wisconsin, Madison, WI, United States
| | - Grace Z Mak
- Section of Pediatric Surgery, Department of Surgery, Comer Children's Hospital, University of Chicago Medicine and Biological Sciences, Chicago, IL, United States
| | - Peter C Minneci
- Center for Surgical Outcomes Research, the Research Institute and Department of Surgery, Nationwide Children's Hospital, Ohio State University College of Medicine, Columbus, OH, United States
| | - Tiffany N Wright
- Division of Pediatric Surgery, Hiram C. Polk, Jr., M.D. Department of Surgery, University of Louisville, Norton Children's Hospital, Louisville, KY, United States
| | - Shaun M Kunisaki
- Division of General Pediatric Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Johns Hopkins Children's Center, Baltimore, MD, United States.
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10
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He T, Sun X, Yang Y, Yuan M, Yang G, Cheng K, Xu C. Learning curve for total thoracoscopic lobectomy for treating pediatric patients with congenital lung malformation. Asian J Surg 2021; 45:1383-1388. [PMID: 34635410 DOI: 10.1016/j.asjsur.2021.08.061] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 08/12/2021] [Accepted: 08/29/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Pediatric thoracoscopic lobectomy is a technically challenging procedure that may result in better pain control, better cosmetic results, and shorter hospital stay. However, data describing the learning curve of total thoracoscopic lobectomy (TTL) have yet to be obtained. To evaluate our learning curve for TTL in children, we reviewed the safety and efficiency of our initial experiences with TTL in pediatric patients with congenital lung malformation. METHODS This was a retrospective study of all pediatric patients undergoing TTL between March 2011 and January 2017. Cumulative summation (CUSUM) analysis of operative time (OT) was used. RESULTS One hundred patients were retrospectively analyzed and chronologically divided into three phases: the ascending (A), plateau (B), and descending (C) phases of CUSUM of OT. Phases A, B, and C comprised 35, 22, and 43 cases, respectively. OT decreased significantly from phases A to B (P = 0.035) and B to C (P = 0.019). Age and weight of patients both reduced significantly from phase A to B (p = 0.017 and p = 0.012, respectively), while the two measures did not vary from phase B to C (p = 0.987 and p = 0.874, respectively). Chest tube duration and length of hospital stay had similar trend. All complications occurred in five cases in phase A (5/35). Six cases were converted to open surgery (6%). Four conversions occurred within phase A and two in phase C (4/35 vs 2/43, p = 0.490). There were no mortalities. CONCLUSIONS Repeated standardized training plays a role in overcoming the learning curve for thoracoscopic lobectomy in children, and CUSUMOT indicates that a learning curve of approximately 57 cases is required in our institute.
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Affiliation(s)
- Taozhen He
- Department of Pediatric Surgery, West China Hospital of Sichuan University, NO. 37 GUOXUE Lane, Chengdu, 610041, China
| | - Xiaoyan Sun
- Health Management Centre, West China Hospital of Sichuan University, NO. 37 GUOXUE Lane, Chengdu, 610041, China
| | - Yang Yang
- Department of Pediatric Surgery, West China Hospital of Sichuan University, NO. 37 GUOXUE Lane, Chengdu, 610041, China
| | - Miao Yuan
- Department of Pediatric Surgery, West China Hospital of Sichuan University, NO. 37 GUOXUE Lane, Chengdu, 610041, China
| | - Gang Yang
- Department of Pediatric Surgery, West China Hospital of Sichuan University, NO. 37 GUOXUE Lane, Chengdu, 610041, China
| | - Kaisheng Cheng
- Department of Pediatric Surgery, West China Hospital of Sichuan University, NO. 37 GUOXUE Lane, Chengdu, 610041, China
| | - Chang Xu
- Department of Pediatric Surgery, West China Hospital of Sichuan University, NO. 37 GUOXUE Lane, Chengdu, 610041, China.
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11
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Koga H, Ochi T, Hirayama S, Watanabe Y, Ueno H, Imashimizu K, Suzuki K, Kuwatsuru R, Nishimura K, Lane GJ, Suzuki K, Yamataka A. Congenital Pulmonary Airway Malformation in Children: Advantages of an Additional Trocar in the Lower Thorax for Pulmonary Lobectomy. Front Pediatr 2021; 9:722428. [PMID: 34926336 PMCID: PMC8678478 DOI: 10.3389/fped.2021.722428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 10/14/2021] [Indexed: 11/16/2022] Open
Abstract
Aim: To present the use of an additional trocar (AT) in the lower thorax during thoracoscopic pulmonary lobectomy (TPL) in children with congenital pulmonary airway malformation. Methods: For a lower lobe TPL (LL), an AT is inserted in the 10th intercostal space (IS) in the posterior axillary line after trocars for a 5-mm 30° scope, and the surgeon's left and right hands are inserted conventionally in the 6th, 4th, and 8th IS in the anterior axillary line, respectively. For an upper lobe TPL (UL), the AT is inserted in the 9th IS, and trocars are inserted in the 5th, 3rd, and 7th IS, respectively. By switching between trocars (6th↔8th for the scope, 4th↔6th for the left hand, and 8th↔10th for the right hand during LL and 5th↔7th, 3rd↔5th, and 7th↔9th during UL, respectively), vital anatomic landmarks (pulmonary veins, bronchi, and feeding arteries) can be viewed posteriorly. The value of AT was assessed from blood loss, operative time, duration of chest tube insertion, requirement for post-operative analgesia, and incidence of perioperative complications. Results: On comparing AT+ (n = 28) and AT- (n = 27), mean intraoperative blood loss (5.6 vs. 13.0 ml), operative time (3.9 vs. 5.1 h), and duration of chest tube insertion (2.2 vs. 3.4 days) were significantly decreased with AT (p < 0.05, respectively). Differences in post-operative analgesia were not significant. There were three complications requiring conversion to open/mini-thoracotomy: AT- (n = 2; bleeding), AT+: (n = 1; erroneous stapling). Conclusions: An AT and switching facilitated posterior dissection during TPL in children with congenital pulmonary airway malformation enhancing safety and efficiency.
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Affiliation(s)
- Hiroyuki Koga
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Takanori Ochi
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Shunki Hirayama
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Yukio Watanabe
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Hiroyasu Ueno
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Kota Imashimizu
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Kazuhiro Suzuki
- Department of Radiology, Juntendo University School of Medicine, Tokyo, Japan
| | - Ryohei Kuwatsuru
- Department of Radiology, Juntendo University School of Medicine, Tokyo, Japan
| | - Kinya Nishimura
- Department of Anesthesiology and Pain Medicine, Juntendo University School of Medicine, Tokyo, Japan
| | - Geoffrey J Lane
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Kenji Suzuki
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Atsuyuki Yamataka
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo, Japan
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12
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Navarrete-Arellano M. Thoracic surgery by minimally invasion robot-assisted in children: “experience and current status”. MINI-INVASIVE SURGERY 2020. [DOI: 10.20517/2574-1225.2019.70] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
Aim: We report our experience in minimally invasive thoracic robot-assisted surgery in children, and a current analysis is carried out on this topic.
Methods: Observational, prospective, and longitudinal studies were performed for children with thoracic pathology treated with robotic surgery, from March 2015 to April 2019. We used the “da Vinci surgical system” (Intuitive Surgical, Inc., Sunnyvale, CA. USA). Registered variables included demographic data, diagnosis, surgery, total time, time of console surgery, bleeding, hemotransfusions, conversions, complications, postoperative (PO) stay, and follow-up. Measures of central tendency were used. Research Ethics Committee of Hospital approved the study. We conducted a detailed non-systematic review of previous publications of children undergoing thoracic robotic surgery.
Results: We treated 11 children, with average age of 5.7 years and weight of 21.3 kg. Diagnosis were: congenital cystic adenomatoid malformation, intralobar sequestration, diaphragmatic paralysis, diaphragmatic eventration, mediastinal teratoma, Ewing’s tumor of the fourth left rib, and pulmonary tuberculosis. Surgeries performed were: four lobectomies, four diaphragmatic plications, two tumor resections, and a case of pleural and lung biopsies. The average of console surgery time was 166.45 min, PO stay was 3.6 days, and follow-up was 24.7 months. Conversions and PO complications were 9.1%, and there were no intraoperative complications and mortality. Currently, the number of children treated with thoracic robot-assisted surgery has barely reached 100 cases.
Conclusion: Our results are encouraging, although our experience is limited to a few cases. Robotic surgery for the treatment of thoracic pathology is feasible and safe, and has advantages. To date, very few patients have been treated, and few pediatric surgeons worldwide have applied thoracic robotic surgery in children.
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Puri V, Gaissert HA, Wormuth DW, Grogan EL, Burfeind WR, Chang AC, Seder CW, Fernandez FG, Brown L, Magee MJ, Kosinski AS, Raymond DP, Broderick SR, Welsh RJ, DeCamp MM, Farjah F, Edwards MA, Kozower BD. Defining Proficiency for The Society of Thoracic Surgeons Participants Performing Thoracoscopic Lobectomy. Ann Thorac Surg 2019; 107:202-208. [DOI: 10.1016/j.athoracsur.2018.07.074] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 07/13/2018] [Accepted: 07/17/2018] [Indexed: 11/16/2022]
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Abstract
Thoracoscopic surgery and other minimally invasive approaches in children achieved marked advancement and expanded to include several disciplines in the last decade. The new armamentarium of the minimally invasive surgery including the smaller instruments and better magnification led to the application of this technology in the small infants and neonates. Currently, thoracoscopy is considered the preferred surgical approach for various conditions in neonates and infants over the standard thoracotomy, and thoracoscopic training is included in the surgical training curriculum for the residents in many institutes worldwide. Children are different from adults, and technique modifications are required when using thoracoscopy in children. Thoracoscopy showed satisfactory results in several operations including pulmonary resections, mediastinal tumors biopsies or resections, repair of the diaphragmatic hernias, decortication, and tracheoesophageal fistula. This review aims to address the unique aspects of thoracoscopic surgery in children, identify its potential technical and anatomical challenges, and the proposed solutions. A literature search for latest and relevant publications was done using the keywords (thoracoscopy; pediatric; lung biopsy; decortication; lobectomy; mediastinum; esophagus; and diaphragmatic hernia).
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Affiliation(s)
- Osama A Bawazir
- Department of Surgery, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
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