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Riccipetitoni G, Bertozzi M, Gazzaneo M, Raffaele A, Vatta F. The Role of Video-Assisted Thoracoscopic Surgery in Pediatric Oncology: Single-Center Experience and Review of the Literature. Front Pediatr 2021; 9:721914. [PMID: 34712630 PMCID: PMC8546295 DOI: 10.3389/fped.2021.721914] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 09/06/2021] [Indexed: 01/25/2023] Open
Abstract
Aim: Video-assisted thoracoscopic surgery (VATS) has been widely used in the last decades. Nevertheless, the pros and cons of thoracoscopy vs. open surgery in pediatric oncology are still under debate. In literature, VATS has been applied for both diagnostic and ablative surgery to treat neurogenic tumors, thymic neoplasms, lung tumors and metastases, germ cell tumors, lymphoproliferative diseases, and other rare tumors. Recent reviews described excellent outcomes in pediatric oncology as well as in the treatment of adult lung cancer, with a significantly higher rate of mortality and complication in thoracotomy compared to VATS. We reviewed our experience on thoracoscopy in pediatric malignancy and compared it to the literature. Materials and Methods: This was a retrospective cohort-study of pediatric oncological patients who underwent VATS at our institution from 2007 to 2020, and a review of the recent literature on the topic. Results: A total of 43 procedures were performed on 38 oncological patients (18 males, 20 females). Median age was years 7.72 (0.35-18.6). Diagnosis: 10 neurogenic tumors, nine hematological diseases, five metastases, four lypoblastomas, three thymic pathologies, three germ cell tumors, two pleuropneumoblastomas, two myofibroblastic tumors, one myoepithelial carcinoma, one liposarcoma, and three suspected oncological mass. In three cases, a 3D model was elaborated to better plan the surgical approach. Diagnostic biopsies were 22 (51.1%), and ablative surgeries, 21 (48.9%). One neurogenic tumor was resected with the Da Vinci Robot. Median operative time was 120 min (30-420). A drain was left in place in 20 (46.5%) for a median of 4 days. Median length of hospitalization was 5 days (1-18). One case (2.3%) was converted (intraoperative bleeding). There were three post-operative complications (7.0%): one pneumonia, one pleural effusion, and one diaphragmatic paralysis (need for plication). Results were compared to recent literature, and morbidity and conversion rate were comparable to reviewed publications. Conclusion: VATS represents a valuable tool for diagnostic and therapeutic procedures in pediatric oncology. Nonetheless, it is a challenging technique that should be performed by expert surgeons on oncological and mini-invasive surgery. Three-dimensional reconstruction can optimize the pre-operative planning and guarantee a safer and more targeted treatment. Finally, the advent of robotics-assisted surgery represents a new challenge that may further implement the advantages of VATS.
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Affiliation(s)
- Giovanna Riccipetitoni
- Department of Pediatric Surgery, Fondazione Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Mirko Bertozzi
- Department of Pediatric Surgery, Fondazione Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Marta Gazzaneo
- Department of Pediatric Surgery, Fondazione Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Alessandro Raffaele
- Department of Pediatric Surgery, Fondazione Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Fabrizio Vatta
- Department of Pediatric Surgery, Fondazione Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo, University of Pavia, Pavia, Italy
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Utility of open surgical lung biopsy in children. Pulm Pharmacol Ther 2019; 58:101816. [PMID: 31279963 DOI: 10.1016/j.pupt.2019.101816] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 04/17/2019] [Accepted: 07/03/2019] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Open lung biopsy (OLB) is commonly used to obtain a definitive histological diagnosis in children with respiratory disorders. This allows correct treatment pathways to be followed and guides discussions surrounding prognosis. Our aim was to determine if OLB is useful in obtaining a conclusive diagnosis in a child with complex respiratory disease. MATERIALS AND METHODS In total, 179 OLB episodes were identified in children under 18 years from 2006 to 2016. Biopsies confirming congenital thoracic malformations or pulmonary metastatic disease were excluded. RESULTS 42 patients had 44 episodes of OLB in the period studied. A definitive histological diagnosis was reached in 35 (79%) cases. There were no deaths directly attributable to OLB surgery. CONCLUSION OLB contributed substantially in obtaining a definitive diagnosis for our patient population, no increase in mortality. It allowed targeted treatment and provided valuable prognostic information on the likely progression of the disease so families could plan for palliation where appropriate.
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Dieffenbach BV, Madenci AL, Murphy AJ, Weldon CB, Weil BR, Lehmann LE. Therapeutic Impact and Complications Associated with Surgical Lung Biopsy after Allogeneic Hematopoietic Stem Cell Transplantation in Children. Biol Blood Marrow Transplant 2019; 25:2181-2185. [PMID: 31255742 DOI: 10.1016/j.bbmt.2019.06.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 06/17/2019] [Accepted: 06/21/2019] [Indexed: 11/26/2022]
Abstract
Hematopoietic stem cell transplantation (HSCT) in the pediatric population is associated with pulmonary complications in 25% of recipients. The role of surgical lung biopsy (SLB) remains unclear because of concerns about both the therapeutic impact and morbidity associated with the procedure. A retrospective review of consecutive allogeneic HSCT recipients at Dana-Farber and Boston Children's Hospital Cancer and Blood Disorders Center between 2006 and 2016 was performed. All recipients who underwent SLB during the study period were identified and charts reviewed for perioperative complications, histopathologic findings, and changes in therapy delivered. Pearson's chi-square test and Student's t-test (or appropriate nonparametric test) were used to evaluate the associations between perioperative complication and categorical and continuous variables, respectively. Five hundred fifty-five HSCTs were included, among which 48 SLBs (8.6%) were identified. Median follow-up time was 24 months (range, 0 to 139). Thirty-day postoperative morbidity was 16.7% and 30-day postoperative mortality 10.4% (n = 5). The overall 30-day postoperative complication rate (including mortality) was 20.8% (n = 10). No mortalities were directly attributable to SLB. Definitive diagnoses were identified in 70.8% of SLBs (n = 34), and therapeutic changes occurred in 79.2% (n = 38). Overall, 83.3% of SLBs (n = 40) either provided a diagnosis or led to a change in therapy. SLB has an acceptable risk of perioperative complications in this medically complicated and often severely ill population. In most HSCT patients, SLB aids in defining the etiology of pulmonary infiltrates and can inform therapeutic decisions in patients where noninvasive diagnostic modalities have failed to provide a definitive diagnosis.
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Affiliation(s)
- Bryan V Dieffenbach
- Boston Children's Hospital, Boston, Massachusetts; Brigham and Women's Hospital, Boston, Massachusetts.
| | - Arin L Madenci
- Boston Children's Hospital, Boston, Massachusetts; Brigham and Women's Hospital, Boston, Massachusetts; Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | | | - Christopher B Weldon
- Boston Children's Hospital, Boston, Massachusetts; Dana-Farber and Boston Children's Hospital Cancer and Blood Disorders Center, Boston, Massachusetts
| | - Brent R Weil
- Boston Children's Hospital, Boston, Massachusetts; Dana-Farber and Boston Children's Hospital Cancer and Blood Disorders Center, Boston, Massachusetts
| | - Leslie E Lehmann
- Boston Children's Hospital, Boston, Massachusetts; Dana-Farber and Boston Children's Hospital Cancer and Blood Disorders Center, Boston, Massachusetts
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Seitz ST, Schellerer VS, Schmid A, Metzler M, Besendörfer M. Computed Tomography-Guided Wire-Marking for Thoracoscopic Resection of Small Lung Nodules in Children. J Laparoendosc Adv Surg Tech A 2019; 29:688-693. [PMID: 30946003 DOI: 10.1089/lap.2018.0184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction: In pediatric patients, thoracoscopic wedge-resection of pulmonary nodules is an established therapy. However, intraoperative localization of small lesions is still challenging. Purpose of this study was to evaluate the efficacy of preoperative computed tomography (CT)-guided wire-marking of small lung nodules. Materials and Methods: Between 2012 and 2017 a total of six cases receiving thoracoscopic resection of CT-marked lung nodules were analyzed. The nodules were preoperatively tagged by a wire, which was attached to the thoracic wall by sterile dressing. Characteristics of interest were stability of wire, complete resection, and prevention of open thoracotomy. Results: Six procedures were performed on five patients, including four men and one woman. Median age at intervention was 16 years (range 11-19 years). All patients had a history of primary malignancies, including osteosarcoma (n = 4) and synovial sarcoma (n = 1). A total of 10 nodules were visualized in CT of which 9 were marked by wire. The median expected size of nodules was 6 mm (range 2-23 mm). Two patients had bilateral, two left-sided and two right-sided lung lesions. There was no wire slippage. In five procedures wedge resection was possible; one case needed a near total lobe resection. In one case a mini-thoracotomy at port insertion site was performed to extract the specimen. There was no conversion to thoracotomy. Histopathology showed R0 resection in all patients. Malignancy was found in all specimens. In one patient postoperative hemorrhagic anemia necessitated transfusion. Conclusions: Preoperative wire-localization of small lung nodules is a safe and effective tool to enable thoracoscopic resection in children and to avoid thoracotomic interventions.
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Affiliation(s)
- Sigurd T Seitz
- 1 Department of Paediatric Surgery, University Medical Center Erlangen, Friedrich-Alexander-University of Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - Vera S Schellerer
- 1 Department of Paediatric Surgery, University Medical Center Erlangen, Friedrich-Alexander-University of Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - Axel Schmid
- 2 Department of Radiology, University Medical Center Erlangen, Friedrich-Alexander-University of Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - Markus Metzler
- 3 Paediatric Oncology and Haematology, Department of Paediatrics, University Medical Center Erlangen, Friedrich-Alexander-University of Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - Manuel Besendörfer
- 1 Department of Paediatric Surgery, University Medical Center Erlangen, Friedrich-Alexander-University of Erlangen-Nuremberg (FAU), Erlangen, Germany
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Sobrino JA, Le N, Sujka JA, Benedict LA, Rentea RM, Alemayehu H, St. Peter SD. Therapeutic Direction Versus Adverse Outcomes in Children Undergoing Lung Biopsy. J Surg Res 2019; 236:106-109. [DOI: 10.1016/j.jss.2018.10.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 10/10/2018] [Accepted: 10/17/2018] [Indexed: 11/26/2022]
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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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Fortmann C, Schwerk N, Wetzke M, Schukfeh N, Ure BM, Dingemann J. Diagnostic accuracy and therapeutic relevance of thoracoscopic lung biopsies in children. Pediatr Pulmonol 2018; 53:948-953. [PMID: 29578653 DOI: 10.1002/ppul.23999] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 03/05/2018] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Histopathological assessment of lung biopsies does play an important diagnostic role in children's interstitial lung disease (ChILD). Thoracoscopic lung biopsy has been shown to be safe and effective. The aim of this study was to evaluate the diagnostic accuracy of thoracoscopic lung biopsies in children with ChILD. Furthermore, therapeutic relevance of the procedure, operative details, and perioperative complications of our series were investigated. METHODS We retrospectively reviewed all consecutive thoracoscopic lung biopsies taken from children with suspected ChILD in our institution over an 11-year period. Feasibility and complications were evaluated as well as histopathological diagnoses according to the recent ChILD classification and relevance of the procedure for medical treatment. RESULTS Fifty-nine patients (54.2% male, median age 7 years [8 d-18 y]) underwent 112 thoracoscopic lung biopsies. An endostapler (27%), endoloop ligature (63%), or cut and suture technique (10%) were used. A chest tube was placed in 54% of the cases. Complications occurred in 15% of cases and mainly consisted of pneumothoraces or bleedings. Adequate tissue was obtained in all but one case and the biopsy led to a specific diagnosis according to the ChILD classification in 98%. Medical treatment of the underlying disease was changed due to the results of the biopsy in 86%. CONCLUSIONS The diagnostic accuracy of thoracoscopic lung biopsies in children with suspected ChILD is high. The histopathologic results lead to a disease-specific treatment in the majority of the cases. Thoracoscopic lung biopsy is a safe and effective procedure with a low complication rate.
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Affiliation(s)
- Caroline Fortmann
- Center of Pediatric Surgery Hannover, Hannover Medical School and Bult Children's Hospital Hannover, Hannover, Germany
| | - Nicolaus Schwerk
- Department of Pediatric Pulmonology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany
| | - Martin Wetzke
- Department of Pediatric Pulmonology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany
| | - Nagoud Schukfeh
- Center of Pediatric Surgery Hannover, Hannover Medical School and Bult Children's Hospital Hannover, Hannover, Germany
| | - Benno M Ure
- Center of Pediatric Surgery Hannover, Hannover Medical School and Bult Children's Hospital Hannover, Hannover, Germany
| | - Jens Dingemann
- Center of Pediatric Surgery Hannover, Hannover Medical School and Bult Children's Hospital Hannover, Hannover, Germany
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Nadlonek NA, Acker SN, Deterding RR, Partrick DA. Intraoperative chest tube removal following thoracoscopic lung biopsy results in improved outcomes. J Pediatr Surg 2014; 49:1573-6. [PMID: 25475796 DOI: 10.1016/j.jpedsurg.2014.04.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Revised: 03/25/2014] [Accepted: 04/22/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Traditionally, chest tubes are left following video assisted thoracoscopic surgery (VATS) to treat a potential air leak or significant drainage. Recognizing the potential complications, our aim was to determine if intraoperative chest tube removal in children undergoing VATS lung biopsy is safe and if outcomes differ from when a chest tube is left in place. METHODS We identified all children who underwent VATS lung biopsies from 2009 to 2013 and performed a retrospective review of the medical records. Pulmonary resection patients were excluded as were those with an air leak present in the operating room. RESULTS A total of 90 VATS lung biopsies were performed. 41 children had a postoperative chest tube left in place (Group A), and 49 children had it removed intraoperatively (Group B). Mean age was 9 ± 6.4 years. One child in Group A and 2 children in Group B required replacement of a chest tube (p=NS). Group B patients had a lower postoperative pain score on day one, fewer postoperative chest X-rays, and a shorter length of postoperative stay. CONCLUSIONS These data suggest that intraoperative chest tube removal is safe and may be associated with improved outcomes following lung biopsy in children.
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Affiliation(s)
- Nicole A Nadlonek
- Department of Pediatric Surgery, Children's Hospital Colorado, Aurora, CO 80045, USA
| | - Shannon N Acker
- Department of Pediatric Surgery, Children's Hospital Colorado, Aurora, CO 80045, USA.
| | - Robin R Deterding
- Deparment of Pediatric Pulmonology, Children's Hospital Colorado, Aurora, CO 80045, USA
| | - David A Partrick
- Department of Pediatric Surgery, Children's Hospital Colorado, Aurora, CO 80045, USA
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Malkan AD, Loh AH, Fernandez-Pineda I, Sandoval JA. The Role of Thoracoscopic Surgery in Pediatric Oncology. J Laparoendosc Adv Surg Tech A 2014; 24:819-26. [DOI: 10.1089/lap.2014.0252] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Alpin D. Malkan
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Amos H.P. Loh
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, Tennessee
| | | | - John A. Sandoval
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, Tennessee
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11
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Martínez Criado Y, Pérez Bertólez S, Cabello Laureano R, de Agustín Asensio JC. Instilación de azul de metileno guiado por tomografía axial computarizada para localizar y resecar mediante toracoscopia un nódulo pulmonar. Cir Esp 2014; 92:139-41. [DOI: 10.1016/j.ciresp.2012.02.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2011] [Accepted: 02/14/2012] [Indexed: 10/27/2022]
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Kurland G, Deterding RR, Hagood JS, Young LR, Brody AS, Castile RG, Dell S, Fan LL, Hamvas A, Hilman BC, Langston C, Nogee LM, Redding GJ. An official American Thoracic Society clinical practice guideline: classification, evaluation, and management of childhood interstitial lung disease in infancy. Am J Respir Crit Care Med 2013; 188:376-94. [PMID: 23905526 DOI: 10.1164/rccm.201305-0923st] [Citation(s) in RCA: 277] [Impact Index Per Article: 25.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND There is growing recognition and understanding of the entities that cause interstitial lung disease (ILD) in infants. These entities are distinct from those that cause ILD in older children and adults. METHODS A multidisciplinary panel was convened to develop evidence-based guidelines on the classification, diagnosis, and management of ILD in children, focusing on neonates and infants under 2 years of age. Recommendations were formulated using a systematic approach. Outcomes considered important included the accuracy of the diagnostic evaluation, complications of delayed or incorrect diagnosis, psychosocial complications affecting the patient's or family's quality of life, and death. RESULTS No controlled clinical trials were identified. Therefore, observational evidence and clinical experience informed judgments. These guidelines: (1) describe the clinical characteristics of neonates and infants (<2 yr of age) with diffuse lung disease (DLD); (2) list the common causes of DLD that should be eliminated during the evaluation of neonates and infants with DLD; (3) recommend methods for further clinical investigation of the remaining infants, who are regarded as having "childhood ILD syndrome"; (4) describe a new pathologic classification scheme of DLD in infants; (5) outline supportive and continuing care; and (6) suggest areas for future research. CONCLUSIONS After common causes of DLD are excluded, neonates and infants with childhood ILD syndrome should be evaluated by a knowledgeable subspecialist. The evaluation may include echocardiography, controlled ventilation high-resolution computed tomography, infant pulmonary function testing, bronchoscopy with bronchoalveolar lavage, genetic testing, and/or lung biopsy. Preventive care, family education, and support are essential.
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Seong YW, Kang CH, Kim JT, Moon HJ, Park IK, Kim YT. Video-Assisted Thoracoscopic Lobectomy in Children: Safety, Efficacy, and Risk Factors for Conversion to Thoracotomy. Ann Thorac Surg 2013; 95:1236-42. [DOI: 10.1016/j.athoracsur.2013.01.013] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2012] [Revised: 01/10/2013] [Accepted: 01/11/2013] [Indexed: 11/28/2022]
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Naumann H, Pittaway A, Lynn AM, Vo NJ. CT-guided percutaneous lung biopsy under general anesthesia: a pediatric case series and literature review. Paediatr Anaesth 2012; 22:469-75. [PMID: 22211910 DOI: 10.1111/j.1460-9592.2011.03773.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We describe 14 consecutive children who received computed tomography-guided percutaneous lung biopsy (CT-PLB) under general anesthesia over an 18-month period at our institution. Pulmonary hemorrhage (occurring in 36%) and pneumothorax (29%) were the two most common complications; the overall complication rate was 64%. When complications did occur, immediate airway management was facilitated by the presence of an endotracheal tube (ETT). We conclude as follows: (i) CT-PLB in our series is associated with a high risk of both overall and severe complications; (ii) risk of complications is increased by both patient and procedure-related factors; (iii) airway management with ETT may be preferable should a complication arise; (iv) severe complications may necessitate ICU admission, which should be available before proceeding.
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Affiliation(s)
- Heather Naumann
- Department of Anesthesiology & Pain Medicine, Seattle Children's Hospital, Seattle, WA 98105, USA
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Rothenberg SS. Thoracoscopic Lung Surgery in Infants and Children: The State of the Art. PEDIATRIC ALLERGY, IMMUNOLOGY, AND PULMONOLOGY 2011; 24:139-144. [DOI: 10.1089/ped.2011.0100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Steven S. Rothenberg
- Clinical Professor of Surgery, Columbia University College of Physicians and Surgeons, New York, New York
- Chief of Pediatric Surgery, The Rocky Mountain Hospital for Children, Denver, Colorado
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Clement A, Nathan N, Epaud R, Fauroux B, Corvol H. Interstitial lung diseases in children. Orphanet J Rare Dis 2010; 5:22. [PMID: 20727133 PMCID: PMC2939531 DOI: 10.1186/1750-1172-5-22] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2009] [Accepted: 08/20/2010] [Indexed: 12/30/2022] Open
Abstract
Interstitial lung disease (ILD) in infants and children comprises a large spectrum of rare respiratory disorders that are mostly chronic and associated with high morbidity and mortality. These disorders are characterized by inflammatory and fibrotic changes that affect alveolar walls. Typical features of ILD include dyspnea, diffuse infiltrates on chest radiographs, and abnormal pulmonary function tests with restrictive ventilatory defect and/or impaired gas exchange. Many pathological situations can impair gas exchange and, therefore, may contribute to progressive lung damage and ILD. Consequently, diagnosis approach needs to be structured with a clinical evaluation requiring a careful history paying attention to exposures and systemic diseases. Several classifications for ILD have been proposed but none is entirely satisfactory especially in children. The present article reviews current concepts of pathophysiological mechanisms, etiology and diagnostic approaches, as well as therapeutic strategies. The following diagnostic grouping is used to discuss the various causes of pediatric ILD: 1) exposure-related ILD; 2) systemic disease-associated ILD; 3) alveolar structure disorder-associated ILD; and 4) ILD specific to infancy. Therapeutic options include mainly anti-inflammatory, immunosuppressive, and/or anti-fibrotic drugs. The outcome is highly variable with a mortality rate around 15%. An overall favorable response to corticosteroid therapy is observed in around 50% of cases, often associated with sequelae such as limited exercise tolerance or the need for long-term oxygen therapy.
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Affiliation(s)
- Annick Clement
- Pediatric Pulmonary Department, Reference Center for Rare Lung Diseases, AP-HP, Hôpital Trousseau, Inserm UMR S-938, Université Pierre et Marie Curie-Paris 6, Paris, F-75012 France.
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Gamba P, Midrio P, Betalli P, Snijders D, Leon FF. Video-assisted thoracoscopy in compromised pediatric patients. J Laparoendosc Adv Surg Tech A 2010; 20:69-71. [PMID: 19811063 DOI: 10.1089/lap.2009.0040] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The use of video-assisted techniques (VATs) in the paediatric field has become increasingly more frequent, based on reports of prompter recovery following VATs in respect to standard techniques. Specific advantages have been documented, in particular for pediatric patients undergoing chemioradiotherapic treatment. We retrospectively reviewed data of severely compromised patients who underwent VAT for lung wedge resections and biopsies carried out in our center over a 7-year period. As far as the area of therapeutic tumor resection is concerned, the present data are consistent with the view that thoracoscopy is both an effective and safe tool in diagnostic procedures.
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Affiliation(s)
- Piergiorgio Gamba
- Pediatric Surgery, Department of Pediatrics, University of Padua, Padova, Italy.
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Langston C, Dishop MK. Diffuse lung disease in infancy: a proposed classification applied to 259 diagnostic biopsies. Pediatr Dev Pathol 2009; 12:421-37. [PMID: 19323600 DOI: 10.2350/08-11-0559.1] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Thoracoscopic and open lung biopsies are being performed with increasing frequency in neonates and infants and are an important component of the diagnostic evaluation of respiratory compromise in these very young children. Diffuse lung disease in infancy includes a wide spectrum of developmental, genetic, inflammatory, infectious, and reactive disorders. The majority of the entities diagnosed in infancy (68%) in this retrospective lung biopsy series are seen almost exclusively in this age group and not in older children and adults. These include primary disorders of pulmonary and pulmonary vascular development, secondary disorders affecting prenatal and/or postnatal lung growth, genetic disorders of surfactant function, pulmonary interstitial glycogenosis, and neuroendocrine cell hyperplasia of infancy. Although the diagnostic approach to infant lung biopsies is guided primarily by the clinical history and imaging findings, all cases require careful assessment of alveolar growth, vascular architecture, interstitial cellularity, and histologic patterns associated with genetic abnormalities of surfactant metabolism. Recognition of one or more of these processes assists not only in treatment planning but also in further diagnostic evaluation and prognostication and may have implications for subsequent siblings and other family members. In this study, we have applied a classification system developed by a North American multicenter multidisciplinary group to lung biopsies seen at our institution and have used this material to describe and illustrate the spectrum of diffuse lung disease in infancy.
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Affiliation(s)
- Claire Langston
- Department of Pathology, Baylor College of Medicine and Texas Children's Hospital, 6621 Fannin Street, Houston, TX 77030, USA.
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Federici S, Ratta A, Mordenti M, Domenichelli V, Pelusi G, Italiano F, Cavagna E, Biagi LD. Successful Thoracoscopic Resection of Pulmonary Metastasis Less Than 1 cm in Size Utilizing Preoperative CT-Guided Wire Localization. J Laparoendosc Adv Surg Tech A 2009; 19 Suppl 1:S171-3. [DOI: 10.1089/lap.2008.0162.supp] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Silvana Federici
- Department of Pediatric Surgery, Infermi Hospital, Rimini, Italy
| | - Alberto Ratta
- Department of Pediatric Surgery, Infermi Hospital, Rimini, Italy
| | | | | | - Gabriella Pelusi
- Department of Pediatric Surgery, Infermi Hospital, Rimini, Italy
| | | | - Enrico Cavagna
- Department of Radiology, Infermi Hospital, Rimini, Italy
| | - Lorenzo De Biagi
- Department of Pediatric Surgery, Infermi Hospital, Rimini, Italy
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Federici S, Ratta A, Mordenti M, Domenichell V, Pelusi G, Italiano F, Cavagna E, De Biagi L. Successful thoracoscopic resection of pulmonary metastasis less than 1 cm in size utilizing preoperative CT-guided wire localization. J Laparoendosc Adv Surg Tech A 2008. [PMID: 19061363 DOI: 10.1089/lap.2008.0162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Preoperative computer tomography (CT) guidance localization utilizing a percutaneous guidewire before thoracoscopic resection is safe and beneficial in children with pulmonary nodules less than 1 cm in size or located deep in the pleural surface. This paper describes a successful thoracoscopic resection of a little subpleural pulmonary metastasis of a Wilm's tumor in a 5-year-old child utilizing preoperative CT-guided wire localization of the lesion. The thoracoscopic procedure was performed with the use of two ports, the nodule was easily localized,and the pulmonary wedge resection was made by the use of an endo-GIA linear stapling device after guidewire removal. The operating time was 45 minutes and the chest tube was removed after 48 hours. The postoperative course was uneventful, and the child was discharged on postoperative day 5. This technique allows the surgeon to resect little pulmonary nodules, avoiding the need of more invasive procedures as standard thoracotomy without adjunctive morbidity and with good cosmetic results.
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Affiliation(s)
- Silvana Federici
- Departments of Pediatric Surgery, Infermi Hospital, Rimini, Italy
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Glüer S, Schwerk N, Reismann M, Metzelder ML, Nustede R, Ure BM, Gappa M. Thoracoscopic biopsy in children with diffuse parenchymal lung disease. Pediatr Pulmonol 2008; 43:992-6. [PMID: 18781651 DOI: 10.1002/ppul.20896] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Lung biopsy is necessary for establishing the diagnosis in patients with otherwise unclassified diffuse or localized parenchymal lung disease. This study aimed to assess the safety and accuracy of video-assisted thoracoscopic (VATS) lung biopsy in children with diffuse parenchymal lung disease (DPLD). In addition we aimed to evaluate the value of this technique with respect to the spectrum of diseases encountered, correlating histological diagnosis with treatment decisions and subsequent clinical outcome. Data from all patients (n = 21) who underwent surgical lung biopsy for suspected DPLD between March 2001 and August 2006 were collected prospectively. Median age was 3 years, 8 months (range 11 days to 15 years, 2 months). All lung biopsies were performed by VATS under general anesthesia. Median operative time was 45 min (range 25-100 min). Conversion to minithoracotomy due to cardiorespiratory difficulties was necessary in two young infants. There were no further intraoperative complications. In 8/21 children, a chest tube was inserted postoperatively for a median of 2 days (range 1-5 days). In one patient, prolonged air-leakage was managed thoracoscopically on postoperative day 9. There were no other postoperative complications. The specimens were of adequate volume and quality and a histopathological diagnosis was obtained for all patients. There was a broad spectrum of different diagnoses which led to specific therapeutic decisions. Subsequent medical treatment was beneficial in the majority of the patients. In conclusion, VATS is a safe and effective procedure for diagnosis of children with suspected DPLD. Diagnostic accuracy is high, morbidity rates are low, and patients may benefit from avoiding thoracotomy.
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Affiliation(s)
- Sylvia Glüer
- Department of Pediatric Surgery, Hannover Medical School, Hannover, Germany.
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Ponsky TA, Rothenberg SS. Minimally invasive surgery in infants less than 5 kg: experience of 649 cases. Surg Endosc 2008; 22:2214-9. [PMID: 18649102 DOI: 10.1007/s00464-008-0025-7] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2008] [Revised: 05/08/2008] [Accepted: 05/20/2008] [Indexed: 10/21/2022]
Abstract
INTRODUCTION With the development of advanced skills and the introduction of miniature laparoscopic tools, endoscopic procedures in infants and small children have become possible. This report documents our experience in minimally invasive surgery (MIS) in infants under 5 kg. METHODS A retrospective database review was performed from September 1993 to September 2007. All children weighing 5 kg or less that underwent a laparoscopic or thoracoscopic procedure were included. RESULTS A total of 649 cases were attempted. 43 different procedures were performed, the most common being Nissen fundoplication (310 cases, average operating room (OR) time 43 min, average time to full feeds 2 days), pyloromyotomy (104 cases, average OR time 12.5 min, average hospital days<1), patent ductus arteriosum (PDA) ligation (26 cases, average OR time 31 min, average hospital days<1), tracheoesophageal fistula (TEF) repair (22 cases, average OR time 83 min, average time to full feeds 7.8 days), duodenoduodenostomy (20 cases, average OR time 76 min, average time to full feeds 8.6 days), colonic pull-through for Hirschsprung's disease (18 cases, average OR time 109.6 min, average time to full feeds 3 days), colonic pull-through for imperforate anus (10 cases, average OR time 103 min, average hospital days 2), lung resection (12 cases, average OR time 66.8 min, average hospital days 1.75), congenital diaphragmatic hernia repair (10 cases, average OR time 62.5 min, average time to full feeds 4.75 days). There were no surgery-related deaths. The conversion rate to open was 1.2% (n=8). There were six intraoperative complication rate (0.9%) and the overall complication rate was 3% (20 complications overall). CONCLUSIONS The development of modern low-flow CO2 insufflators, smaller instruments and telescopes, as well as advanced techniques, has made MIS in neonates feasible and safe. The greatest challenge remains performing intestinal anastomosis in these confined spaces, and further technical advances will be required to make these techniques universally adopted.
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Affiliation(s)
- Todd A Ponsky
- Rocky Mountain Hospital for Children, Denver, CO, USA
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Tsao K, St Peter SD, Sharp SW, Nair A, Andrews WS, Sharp RJ, Snyder CL, Ostlie DJ, Holcomb GW. Current application of thoracoscopy in children. J Laparoendosc Adv Surg Tech A 2008; 18:131-5. [PMID: 18266592 DOI: 10.1089/lap.2007.0154] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The safety and efficacy of thoracoscopy for thoracic lesions and conditions in children is evolving. Our experience with thoracoscopy has expanded in recent years. Therefore, we reviewed our most recent 7-year experience to examine the current applications for thoracoscopy in children. METHODS A retrospective review of all patients undergoing a thoracoscopic operation at Children's Mercy Hospital (Kansas City, MO) between January 1, 2000, and June 18, 2007, was performed. Data points reviewed included patient demographics, type of operation, final diagnosis, complications, and recovery. RESULTS During the study period, 230 children underwent 231 thoracoscopic procedures. The mean age was 9.6 +/- 6.1 years with a mean weight of 36.6 +/- 24.1 kg. Fifty percent of the patients were male. The thoracoscopic approach was used for decortication and debridement for empyema in 79 patients, wedge resection for lung lesions in 37, exposure for correction of scoliosis in 26, excision or biopsy of an extrapulmonary mass in 26, operation for spontaneous pneumothorax in 25, lung biopsy for a diffuse parenchymal process in 15, lobectomy in 9, repair of esophageal atresia with a tracheoesophageal fistula (EA-TEF) in 8, clearance of the pleural space for hemothorax or effusion in 3, diagnosis for trauma in 1, and repair of bronchopleural fistula in 1. Conversion was required in 3 patients, all of whom were undergoing a lobectomy. Two of these were right upper lobectomies and the other was a left lower lobectomy with severe infection and inflammation. The mean time of chest tube drainage (excluding scoliosis and EA-TEF patients) was 2.9 +/- 2.0 days. There were no major intraoperative thoracoscopic complications. A correct diagnosis was rendered in all patients undergoing a biopsy. One patient required a second thoracoscopic biopsy to better define a mediastinal mass. Two patients developed postoperative atelectasis after scoliosis procedures. One patient had a small persistent pneumothorax after a bleb resection for a spontaneous pneumothorax. This subsequently resolved. CONCLUSIONS In pediatric patients with thoracic pathology, thoracoscopy is highly effective for attaining the goal of the operation, with a low rate of conversion and complications.
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Affiliation(s)
- Kuojen Tsao
- Department of Surgery, Children's Mercy Hospital, Kansas City, Missouri, USA
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Ponsky TA, Rothenberg SS. Thoracoscopic lung biopsy in infants and children with endoloops allows smaller trocar sites and discreet biopsies. J Laparoendosc Adv Surg Tech A 2008; 18:120-2. [PMID: 18266589 DOI: 10.1089/lap.2007.0161] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Thoracoscopy is replacing open lung biopsies because it is less invasive. However, most surgeons obtain biopsies with an endostapler, which requires a 12-mm trocar and a minimum of 4.5 cm of intrathoracic space to open, making its use in patients less then 10 kg impractical. This report describes the use of the Endoloop (Ethicon Endosurgery, Cincinnati, OH) in small pediatric patients undergoing thoracoscopic lung biopsies. MATERIALS AND METHODS From 1993 to February 2007, 69 patients underwent thoracoscopic lung biopsy for diagnosis and therapy. Ages ranged from 2 weeks to 4 years and weight from 2 to 22 kg. One 5- and two 3-mm trocars were used in all cases. In all cases, two Endoloops were placed proximal to the segment of lung being biopsied and the lung was divided sharply distal to the Endoloops. The specimen was removed through the 5-mm trocar site. The lung was reexpanded and no chest drains were left in postoperatively. RESULTS All 69 procedures were successfully completed thoracoscopically. Two biopsy specimens were obtained, in most cases. Operative time ranged from 10 to 35 minutes (average, 20). There were no intraoperative complications. One patient required reintubation and ventilator support on postoperative day 1 and developed a pneumothorax on postoperative day 2, requiring a chest tube. There were no other complications. CONCLUSIONS The thoracoscopic approach to lung biopsy is the preferred method of obtaining lung tissue for diagnosis. The use of the Endoloop technique is a safe, effective technique in small pediatric patients, avoiding problems with the limited size of the chest cavity in patients less than 10 kg, and avoids the use of large incisions in a small child.
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Affiliation(s)
- Todd A Ponsky
- Department of Pediatric Surgery, Case Western Reserve University, Cleveland, Ohio, USA.
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Cheon CK, Jin HS, Kang EK, Kim HB, Kim BJ, Yu J, Park SJ, Hong SJ, Park JD. Epidemic acute interstitial pneumonia in children occurred during the early 2006s. KOREAN JOURNAL OF PEDIATRICS 2008. [DOI: 10.3345/kjp.2008.51.4.383] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Chong Kun Cheon
- Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyun-Seung Jin
- Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Eun Kyeong Kang
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Hyo Bin Kim
- Department of Pediatrics, Inje University Sanggye Paik Hospital, Seoul, Korea
| | - Byoung-Joo Kim
- Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jinho Yu
- Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seong Jong Park
- Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Soo-Jong Hong
- Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - June Dong Park
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
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Guye E, Lardy H, Piolat C, Bawab F, Becmeur F, Dyon JF, Marteau M, Lavrand F, Lefebvre F, Podevin G, Reinberg O, Varlet F. Thoracoscopy and Solid Tumors in Children: A Multicenter Study. J Laparoendosc Adv Surg Tech A 2007; 17:825-9. [DOI: 10.1089/lap.2007.0043] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Emmanuelle Guye
- Division of Pediatric Surgery, University of Saint-Etienne, North Hospital, France
| | - Hubert Lardy
- Division of Pediatric Surgery, University of Tours, France
| | | | - Fariz Bawab
- Division of Pediatric Surgery, University of Besançon, France
| | | | | | - Marion Marteau
- Division of Pediatric Surgery, University of Rennes, France
| | - Fédéric Lavrand
- Division of Pediatric Surgery, University of Bordeaux, France
| | | | | | - Olivier Reinberg
- Division of Pediatric Surgery, University of Lausanne, Switzerland
| | - François Varlet
- Division of Pediatric Surgery, University of Saint-Etienne, North Hospital, France
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Abstract
Thoracoscopy in infants and children has undergone a dramatic evolution in the last 30 years. From its infancy in the mid-1970s, limited procedures such as biopsy and pleural lysis, were pioneered by Rogers and others, and in the late 1990s, the most delicate of procedures, a tracheo-esophageal fistula repair, was performed thoracoscopically for the first time. During the last 20 years, it has become clear that the most commonly performed thoracic procedures in the pediatric age group, lung biopsy and resection, are clearly best performed using these advanced thoracoscopic techniques. New instrumentation and advanced skills now make thoracoscopic lung resection the preferred approach and help avoid the significant morbidity associated with thoracotomy in the pediatric age group.
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Affiliation(s)
- Steven S Rothenberg
- Department of Pediatric Surgery, The Rocky Mountain Children's Hospital, Denver, CO 80218, USA.
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Lacreuse I, Valla JS, de Lagausie P, Varlet F, Héloury Y, Temporal G, Bastier R, Becmeur F. Thoracoscopic resection of neurogenic tumors in children. J Pediatr Surg 2007; 42:1725-8. [PMID: 17923203 DOI: 10.1016/j.jpedsurg.2007.05.030] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE The aim of this study was to evaluate the feasibility of thoracoscopy in neurogenic tumors in infants and children. MATERIALS AND METHODS From January 2000 to October 2005, 21 patients aged 7 months to 14 years (mean, 6 years) underwent thoracoscopy for tumor resection in 5 French institutions. One 10-mm optical port and 2 operative 5-mm ports were needed. Selective intubation was required for 3 patients aged about 12 years. Tumor was removed with an endoscopic bag in all cases. RESULTS All procedures were completed successfully without any incomplete resection or recurrence. One conversion was necessary because of a huge mass. A chest tube was left for a mean of 2 days for 17 children. Two children had not had any drainage. Two postoperative chylothorax required chest drainage for 12 days. Only 5 of the 6 older patients (mean age, 12 years) needed a patient-controlled analgesia. The mean operative time was about 100 minutes. Hospital stay ranged from 4 to 12 days. Tumors were neuroblastoma or ganglioneuroblastoma in 16 cases and ganglioneuroma in the 5 other cases. CONCLUSION Thoracoscopy for resection of thoracic neurogenic tumors in children is a feasible, safe, and efficient procedure. The surgeon has a better visualization of the tumor and its anatomic connections. Resection can be as complete as an open procedure without having to complicate the operative technique in the same operating time. It avoids cosmetic and functional disorders because of thoracotomy. It allows a good cosmetic resection without spillage.
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Asćerić M, Nadarević A, Avdić S, Vrabac-Mujcinagić M, Nukić S, Mujcinović Z. Hexagon TB for the rapid diagnosis of lung TBC in praxis. Bosn J Basic Med Sci 2007; 7:218-21. [PMID: 17848145 PMCID: PMC5736111 DOI: 10.17305/bjbms.2007.3047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Hexagon TB is intended for the rapid diagnostics of tuberculosis. Tuberculosis is a contagious and epidemic disease. According to the data published by WHO, 3-4 millions of patients are diagnosed with this disease annually. In 2004, 107 new cases were discovered in the area of Tuzla Municipality. Annual incidence of this disease is 62,9 per 100 000 inhabitants in Bosnia and Herzegovina; 28,9 in Slovenia; 33,2 in FYRM; 48,5 in Croatia; 41,8 in Serbia and Montenegro. Western European countries have a rather low rate of the disease--5-10 cases per 100 000 inhabitants. Efficiency of Hexagon TB examination method was tested on 100 patients. The subjects were patients with clinical symptoms of active TBC infection, persons who were in contact with TBC patients and persons earlier cured of TBC. All the subjects were tested with Hexagon TB, and the results were compared against lungs X-rays and sputum test for BK and LOW. Hexagon TB is intended for rapid, qualitative detection of IgG, IgA, IgM antibodies against M. tuberculosis and mycobacterium in human serum, plasma or whole blood as an aid in the early diagnostics of tuberculosis infections for professional use. Hexagon TB was positive in 11 of the examined patients. 10 patients had changes suggesting TBC. 1 patient was directly positive for BK and 3 patients were positive for LOW. Of all the examined patients, 3 were positive for all tests positive. According to our results, Hexagon TB has significant importance in practice of rapid TBC diagnostics compared to lungs X-ray and examination of sputum for BK and LOW.
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Affiliation(s)
- Mensura Asćerić
- Department of Pharmacology and Toxicology, University of Tuzla, School of Medicine, Univerzitetska 1, 75000 Tuzla, Bosnia and Herzegovina
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Thomas H, Risma KA, Graham TB, Brody AS, Deutsch GH, Young LR, Joseph PM. A Kindred of Children With Interstitial Lung Disease. Chest 2007; 132:221-30. [PMID: 17625084 DOI: 10.1378/chest.06-2476] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Childhood interstitial lung disease (ILD) is a spectrum of diseases including many different rare lung conditions. We present a family with an unusual presentation of ILD in association with rheumatologic and immunologic abnormalities. METHODS Eight children with a common father were evaluated for evidence of lung disease in association with rheumatologic findings. All underwent routine history and physical examination, hematologic evaluation, and chest radiography and/or CT scan of the chest. Seven children underwent a more extensive immunologic evaluation. Those who were able underwent pulmonary function testing, and four children underwent lung biopsy. RESULTS Six of eight children with a common father were found to have radiographic findings consistent with ILD. These children also had evidence of autoimmune disease with joint symptoms, alopecia, rheumatoid factor production, and hypergammaglobulinemia. Open-lung biopsy in four children revealed a spectrum of pulmonary lymphoid proliferations ranging from reactive lymphoid hyperplasia to lymphoid interstitial pneumonia. CONCLUSION The findings of ILD and autoimmunity in a kindred of children suggest a novel genetic disorder of autosomal dominant pattern and variable penetrance. Although the precise pathogenesis remains unclear, these cases provide valuable insight into childhood ILD.
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Affiliation(s)
- Heather Thomas
- Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Cincinnati, OH 45267-0564, USA
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Esposito C, Lima M, Mattioli G, Mastroianni L, Riccipetitoni G, Monguzzi G, Zanon G, Cecchetto G, Settimi A, Jasonni V. Thoracoscopic surgery in the management of pediatric malignancies: a multicentric survey of the Italian Society of Videosurgery in Infancy. Surg Endosc 2007; 21:1772-5. [PMID: 17356939 DOI: 10.1007/s00464-007-9246-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2006] [Revised: 10/11/2006] [Accepted: 10/25/2006] [Indexed: 10/23/2022]
Abstract
BACKGROUND Few reports have elucidated the role of minimally invasive surgery (MIS) for pediatric malignancies. This study aimed to review the results of a multicenter study on the management of thoracic tumors in children using MIS. METHODS A 5-year retrospective review of all MIS procedures for the treatment of pediatric malignancies performed in seven centers belonging to the Italian Society of Videosurgey in Infancy is reported. The data from 145 pediatric oncologic patients (80 girls and 65 boys) ages 30 days to 17 years (median, 7.2 years) were analyzed. Of the procedures performed, 87 were laparoscopies (60%), 55 were thoracoscopies (38%), and 3 were lumboscopies (2%). This study focused only on the results of the 55 thoracoscopic procedures performed for diagnostic purposes in 19 cases (34.6%) and for therapeutic purposes in 36 cases (65.4%). RESULTS The duration of surgery was 15 to 180 min (median, 65 min). Metastasectomies were performed for various etiologies in 31 of the 55 cases. Of the 55 patients, 5 underwent resection of a mediastinal tumor, and 19 underwent a diagnostic thoracoscopy. During a mean follow-up period of 25.6 months, 2 (3.6%) of the 55 patients experienced perioperative complications. CONCLUSIONS The role of MIS in tumor resection for children is currently limited, but may be used in individual cases when the preoperative workup shows it to be feasible. Its indication is strictly dependent on the thoracoscopic experience of the surgeon and the tumor site for preoperative imaging techniques. When the indication for thoracoscopy is correct, this approach has high therapeutic applicability (65.4% in our series). Our preliminary experience shows that careful patient selection and an appropriate level of technical skill make thoracoscopy a reasonable and safe option for the treatment of pediatric malignancies.
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Affiliation(s)
- C Esposito
- Pediatric Surgical Unit, Magna Graecia University, Catanzaro, Piazza degli Artisti 7/c, 80129, Naples, Catanzaro, Italy.
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Prestridge A, Wooldridge J, Deutsch G, Young LR, Wert SE, Whitsett JA, Nogee L. Persistent tachypnea and hypoxia in a 3-month-old term infant. J Pediatr 2006; 149:702-706. [PMID: 17095348 DOI: 10.1016/j.jpeds.2006.07.032] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2006] [Revised: 06/01/2006] [Accepted: 07/14/2006] [Indexed: 11/26/2022]
Affiliation(s)
- Adrienne Prestridge
- Department of Pediatrics, Division of Pulmonary Medicine, Northwestern University Feinberg School of Medicine, Children's Memorial Hospital, Chicago, IL 60614, USA.
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Pursnani SK, Rausen AR, Contractor S, Nadler EP. Combined use of preoperative methylene blue dye and microcoil localization facilitates thoracoscopic wedge resection of indeterminate pulmonary nodules in children. J Laparoendosc Adv Surg Tech A 2006; 16:184-7. [PMID: 16646714 DOI: 10.1089/lap.2006.16.184] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The ability to biopsy indeterminate pulmonary lesions in children has evolved with advances in minimal access surgery. Recent advances in preoperative localization including image-guided dye injection or wire implantation have expanded the types of lesions that are accessible via minimal access surgery. We present a case of a 13-year-old boy who underwent preoperative localization using both methylene blue dye and microcoil labeling, and a subsequent thoracoscopic pulmonary wedge resection under the same anesthesia. The combined use of both dye and microcoil localization provides the advantage of superior intraoperative visualization of the lesion and the ability to use fluoroscopy to confirm the presence of the nodule in the surgical specimen. We recommend this technique for the biopsy of indeterminate pulmonary lesions that would not otherwise be accessible via a minimally invasive approach.
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Affiliation(s)
- Seema K Pursnani
- Division of Pediatric Surgery and Department of Surgery, New York University School of Medicine, New York, New York 10016, USA
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Langston C, Patterson K, Dishop MK, Askin F, Baker P, Chou P, Cool C, Coventry S, Cutz E, Davis M, Deutsch G, Galambos C, Pugh J, Wert S, White F. A protocol for the handling of tissue obtained by operative lung biopsy: recommendations of the chILD pathology co-operative group. Pediatr Dev Pathol 2006; 9:173-80. [PMID: 16944976 DOI: 10.2350/06-03-0065.1] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2006] [Accepted: 04/24/2006] [Indexed: 11/20/2022]
Abstract
This is the first of a series on pediatric pulmonary disease that will appear as Perspectives in Pediatric Pathology over the coming months. The series will include practical issues, such as this protocol for handling lung biopsies and another on bronchoalveolar lavage in childhood, as well as reviews of advances in various areas in pediatric pulmonary pathology. It has been 11 years since the last Perspectives on pulmonary disease. Much has happened since then in this area, and this collection will highlight some emerging and rapidly advancing areas in pediatric lung disease. These will include a review of molecular mechanisms of lung development, and another of mechanisms of pulmonary vascular development. The surfactant system and its disorders, as well as recent advances in the biology of the pulmonary neuroendocrine system and mechanisms of respiratory viral disease, will be addressed. Articles on pulmonary hypertension, pulmonary neoplasia, and pediatric lung transplantation, with their implications for the pediatric pathologist, are also planned. The contributors to this series are a diverse group with special interests and expertise in these areas. As Dr. William Thurlbeck noted in his foreword to the previous volume, Pulmonary Disease, volume 18 of Perspectives in Pediatric Pathology, pediatric pathology had been largely concerned with phenomenology, rather than with mechanisms, model systems, and experimental investigation. I think he would have been pleased to see the changes that have occurred over the past 10 years in pediatric lung biology and pathology in particular, because these were particularly favored interests of his later years.
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Affiliation(s)
- Claire Langston
- Department of Pathology, Texas Children's Hospital, Houston, and Division of Surgical Pathology, Washington University School of Medicine, St. Louis, MO, USA.
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Koontz CS, Oliva V, Gow KW, Wulkan ML. Video-assisted thoracoscopic surgical excision of cystic lung disease in children. J Pediatr Surg 2005; 40:835-7. [PMID: 15937825 DOI: 10.1016/j.jpedsurg.2005.01.052] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE Video-assisted thoracoscopic surgical (VATS) technique for resection of cystic lung disease (CLD) may offer some advantages when compared with thoracotomy in children. METHODS From September 1999 to August 2004, 6 pediatric patients underwent VATS for CLD. Patients were chosen for VATS based upon surgeon's choice. Data are expressed as mean +/- SD. The Children's Healthcare of Atlanta institutional review board approved this study. RESULTS The types of lesions included congenital cystic adenomatoid malformations (n = 1), extrapulmonary sequestrations (n = 3), congenital lobar emphysema (n = 1), and bronchogenic cyst (n = 1). The extent of resection included lobectomy (n = 2) and excision (n = 4). Age and weight were 11.8 +/- 18 months (range 6 days to 4 years) and 7.5 +/- 3.6 (range 4.0-14.0) kg, respectively. Operating time was 103 +/- 70 (range 38-223) minutes. Chest tube duration was 1.2 +/- 0.8 (range 0-2) days. Morphine use on the first postoperative day was 0.2 +/- 0.3(range 0.05-0.20) mg/kg. Length of stay was 2.5 +/- 1.9 (range 1-6) days. There were no conversions to thoracotomy and no complications. CONCLUSION VATS technique appears to be a safe and effective technique in managing CLD in children of all ages. More patients, however, need to be studied.
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Affiliation(s)
- Curt S Koontz
- Division of Pediatric Surgery, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA 30322, USA
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Optimizing the surgical management of lung nodules in children with osteosarcoma. Surg Endosc 2004. [DOI: 10.1007/bf02637141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Abstract
The spectrum of pediatric interstitial lung disease (PILD) includes a diverse group of rare disorders characterized by diffuse infiltrates and disordered gas exchange. Children with these conditions typically present with tachypnea, crackles, and hypoxemia. Recent advances have been made in the identification of different types of PILD that are unique to infancy. More exciting has been the discovery of genetic abnormalities of surfactant function, now described in both children and adults. A systematic evaluation of the child presenting with diffuse infiltrates of unknown etiology is essential to the diagnosis. Most often, lung biopsy is required. Current treatment options remain less than satisfactory, and morbidity and mortality remain considerable.
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Affiliation(s)
- Leland L Fan
- Pediatric Pulmonary Section, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston 77030-2399, USA.
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Castagnetti M, Delarue A, Gentet JC. Optimizing the surgical management of lung nodules in children with osteosarcoma: thoracoscopy for biopsies, thoracotomy for resections. Surg Endosc 2004; 18:1668-71. [PMID: 15931485 DOI: 10.1007/s00464-003-9315-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2003] [Accepted: 05/26/2004] [Indexed: 11/26/2022]
Abstract
BACKGROUND The goal of this study was to assess the role of thoracoscopy (TS) and thoracotomy (TT) in the management of lung nodules in children with osteosarcoma. METHODS Charts of 16 osteosarcoma patients undergoing surgery for lung nodules were retrospectively analyzed for a correlation between nodule localization at CT scan, findings at surgery, and pathology. RESULTS Fourteen TSs were performed in 10 children, eight of which were converted: two for technical problems, and six for inconsistency between CT scan and intraoperative findings. In three converted cases, TT allowed detection of more nodules than CT scan and/or TS. Eight TTs were performed as primary intention in seven children, in one as secondary surgery after a previous TS. In three cases, TT detected more nodules than CT scan. Overall, TT detected more nodules than CT scan in seven of 16 cases (sensitivity, 56.2%), six of whom had a predicted bilateral involvement. Neoplastic tissue was present in lung samples of all but three patients (86.4%). CONCLUSIONS Lung nodules in osteosarcoma patients are usually metastases. CT scan is unreliable in detecting all the nodules, especially in the case of predicted bilateral involvement. If excision of all metastases is considered the goal of surgery, a TT approach should be chosen in patients with more than one thoracic nodule.
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Affiliation(s)
- M Castagnetti
- Department of Paediatric Surgery, Hopital d'Enfant de la Timone, Rue Saint-Pierre 264, 13385 Cedex 5, Marseille, France.
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Abstract
Chronic interstitial lung disease (ILD) in infants and children is a challenging diagnostic clinical problem. There are many unresolved and controversial issues in the diagnosis of this heterogeneous group of uncommon disorders in children. Diagnosis requires a high index of suspicion as the initial clinical manifestations are subtle, highly variable and non-specific. There is no consensus for the clinical diagnostic criteria of paediatric ILD. The spectrum of clinical findings is highly variable. The diagnostic evaluation of a child with suspected ILD includes a comprehensive history, physical examination, oxygen saturation (at rest, during exercise or during feeding), a plain chest x ray and a high-resolution thin-cut tomography scan of the chest. Pulmonary function studies can be useful in older children; these typically show a restrictive pattern with a decreased forced expiratory volume in 1 s (FEV(1)), forced vital capacity (FVC) and total lung capacity, but normal FEV(1)/FVC. A systematic approach to diagnosis is useful in the evaluation of an infant or child with suspected chronic ILD. Due to the rarity of most of these disorders, multi-centre collaboration is needed to improve our understanding of this orphan lung disease.
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Affiliation(s)
- Bettina C Hilman
- Department of Pediatrics, The University of Texas Health Center at Tyler, 11937 US Highway 271, Tyler, TX 75708-3154, USA.
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Abstract
PURPOSE Small intercostal spaces and limited pleural space significantly limits the use of 12-mm stapling devices in pediatric thoracoscopic surgery. The goal of this study was to compare sealing of lung tissue by the 5-mm Ligasure (Valley Lab, Boulder, CO) device to a standard 12-mm Endo-GIA stapler (US Surgical, Norwalk, CT). METHODS Institutional Animal Care and Use Committee (IACUC) approval was obtained (#A3-02). Sixteen 10-kg female swine were divided between 2 survival surgical groups. Lung biopsy sections of the lingula were taken by 2 methods: group A, left anterolateral thoracotomy employing a 12-mm Endo-GIA stapler and group B, left thoracoscopy employing the Ligasure 5-mm instrument. After a 7-day survival period, lung burst pressures were measured by flow-controlled insufflation into the trachea. RESULTS Burst pressure measurement reflects the first air leak. By Student's t test analysis there were no statistically significant differences between the burst pressures, biopsy weights, or operating times. Fifty percent (4 of 8) of the animals in group A (Endo-GIA), and 50% (4 of 8) of the animals in group B (Ligasure) developed the first air leak in the nonoperative lung. Two animals, one from each group, had evidence of intrapleural infections at the time of necropsy. These were asymptomatic and did not appear to affect burst pressure measurement. CONCLUSIONS After 7 days of healing, lung biopsy sites created with both the Ligasure and the Endo-GIA stapler have burst strengths equal to or greater than that of normal lung tissue in the swine survival model.
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Affiliation(s)
- Michael V Tirabassi
- Division of Pediatric Surgery, Baystate Medical Center Children's Hospital, Tufts University School of Medicine, Pioneer Valley Life Sciences Research Initiative, Springfield, MA, USA
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Hayes-Jordan A, Connolly B, Temple M, Chait P, Weitzman S, Njere I, Langer JC, Kim P. Image-guided percutaneous approach is superior to the thoracoscopic approach in the diagnosis of pulmonary nodules in children. J Pediatr Surg 2003; 38:745-8. [PMID: 12720185 DOI: 10.1016/jpsu.2003.50198] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND/PURPOSE Image-guided, percutaneous techniques are increasingly used in diagnosis of pulmonary disease in children. The aim of this study was to determine the diagnostic accuracy and clinical outcomes of thoracoscopic versus percutaneous lung biopsy in children. METHODS Sixty-three consecutive patients from January 1996 to December 2000 who had a thoracoscopic lung biopsy, a percutaneous ultrasound scan, or computed tomography (CT)-guided lung biopsy for well-defined and ill-defined lesions were analyzed. RESULTS Twenty-eight patients had a thoracoscopic lung biopsy (TLB), and 35 patients had a percutaneous image-guided lung biopsy (PLB). Age ranged from 6 months to 17 years (median, 8 years). There was no significant difference between groups with regard to age, depth of lung nodule biopsied, or prebiopsy diagnoses. Seventeen patients (60%) of TLB and 23 (65%) of PLB had well-defined pulmonary nodules suspicious for malignancy at the time of biopsy. Adequate tissue for pathologic diagnosis was obtained in 28 (100%) of TLB versus 26 (80%) of PLB patients. However, 8 (28%) thoracoscopic cases needed to be converted to an open procedure. In 3 (8.5%) PLB cases the percutaneous biopsy was insufficient, and a thoracoscopic or open biopsy was required. The median hospital stay was 3 days for TLB and 4 to 6 hours for PLB (P =.023). There were no complications in the PLB group. Five (18%) of TLB patients suffered a persistent air leak treated with continued chest tube drainage, and one patient died of other causes with a persistent air leak. CONCLUSIONS Percutaneous lung biopsy has a significantly shorter hospital stay and a lower complication rate than thoracoscopic lung biopsy. The authors propose that the percutaneous technique should be considered as the initial approach for children with pulmonary nodules.
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Smith TJ, Rothenberg SS, Brooks M, Bealer J, Chang J, Cook BA, Cullen JW. Thoracoscopic surgery in childhood cancer. J Pediatr Hematol Oncol 2002; 24:429-35. [PMID: 12218588 DOI: 10.1097/00043426-200208000-00004] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Recent advances in minimally invasive surgery, especially thoracoscopy, have allowed many new applications in children. The authors' purpose was to review their experience with thoracoscopic surgery in childhood cancer. They hypothesized that thoracoscopy can be efficacious, safe, and cost-effective and has the potential to change the way we care for children with cancer. PATIENTS AND METHODS The authors reviewed their thoracoscopic experience of the past 7 years. Thoracoscopic procedures performed included biopsy and resection of masses, resection of lung nodules, biopsy of infiltrates, and lobectomy. Some resections required conversion to open thoracotomy. RESULTS Sixty-three thoracoscopic procedures were performed on 52 children; 8 required conversion to open thoracotomy and 55 were completed by thoracoscopy alone. The overall success rate was 98.4%. There were three complications and no deaths. The mean surgery time was 1.2 hours, mean length of hospital stay was 1.9 days, and mean number of chest tube days was 0.7. CONCLUSIONS Thoracoscopic surgery in the treatment of children with cancer can be efficacious, safe, and cost-effective. Mediastinal masses can usually be biopsied and resected by thoracoscopy alone. Conversion to open thoracotomy for a more complete resection can be safely accomplished if needed. Thoracoscopic removal of lung nodules allows more accurate staging and early initiation of chemotherapy. Thoracoscopic biopsy of lung infiltrates can be safely performed in intubated, critically ill children and changed the treatment in all of these patients. Surgery time and days in hospital were decreased compared with historical thoracotomy data.
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Affiliation(s)
- Thomas J Smith
- Hospital for Infants and Children at Presbyterian St. Luke's Medical Center, Denver, Colorado 80218, USA
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Partrick DA, Bensard DD, Teitelbaum DH, Geiger JD, Strouse P, Harned RK. Successful thoracoscopic lung biopsy in children utilizing preoperative CT-guided localization. J Pediatr Surg 2002; 37:970-3; discussion 970-3. [PMID: 12077751 DOI: 10.1053/jpsu.2002.33820] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND/PURPOSE Although thoracoscopy in children is a well-accepted technique, there are limitations to this approach. Small lung nodules or those not located on the pleural surface often require an open thoracotomy. The purpose of this report is to evaluate the utility of computed tomography (CT) guided needle localization of lung nodules in children followed by thoracoscopic resection. METHODS From 1997 to 2000, 13 thoracoscopic procedures were performed on 12 children who presented with small pulmonary nodules (<1 cm) or nodules deep to the pleural surface. Preoperative needle localization was performed by injecting methylene blue under CT guidance. Patients then were taken directly to the operating room for thoracoscopic resection. RESULTS All 13 procedures were completed successfully thoracoscopically. Twelve yielded diagnostic pathologic findings as well as therapeutic resections in 7. All patients underwent extubation in the operating room, and chest tubes were removed within 36 hours. No thoracotomies were performed, and there were no complications. CONCLUSIONS Preoperative localization utilizing CT guidance is safe and beneficial in children with pulmonary nodules less than 1 cm in size and those located deep to the pleural surface. This technique allows the surgeon to perform thoracoscopy for diagnosis and therapeutic resection of these lesions rather than submitting patients to the morbidity of a thoracotomy.
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Affiliation(s)
- David A Partrick
- Department of Pediatric Surgery, The Children's Hospital, University of Colorado, Denver, CO 80218, USA
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Dunn JC, West KW, Rescorla FJ, Tres Scherer LR, Engum SA, Rouse TM, Smith JW, Grosfeld JL. The utility of lung biopsy in recipients of stem cell transplantation. J Pediatr Surg 2001; 36:1302-3. [PMID: 11479881 DOI: 10.1053/jpsu.2001.25799] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND/PURPOSE Pulmonary infiltrates in recipients of stem cell transplantation often present as diagnostic dilemmas. Although lung biopsy may establish the diagnosis of parenchymal disease, it remains unclear whether such a procedure results in a significant change in the patient's treatment and outcome. This study evaluates the efficacy of lung biopsy in recipients of stem cell transplantation. METHODS The medical records of 15 stem cell transplant recipients who underwent 18 lung biopsies were reviewed. The indications for stem cell transplantation were leukemia in 10 patients, lymphoma in 2, histiocytosis in 1, neuroblastoma in 1, and Ewing's sarcoma in 1. The results of the lung biopsies were correlated to the clinical management and outcomes. RESULTS The overall mortality rate was 67% (10 patients). Eight of the 9 patients who required mechanical ventilatory support at the time of lung biopsy died. The pathologic diagnoses were pneumonitis in 6 biopsies, fibrosis in 6, brochiolitis obliterans organizing pneumonia in 3, hemorrhage in 2, and infarction in 1. Therapy was changed in 1 patient who improved after a course of steroids for bronchiolitis obliterans organizing pneumonia. Lung biopsy cultures were positive in 6 patients but rarely resulted in changes in antibiotic therapy. CONCLUSIONS Results of very few lung biopsies performed in stem cell transplant recipients redirected therapy. Furthermore, the ultimate outcome of these patients were not improved by the results of lung biopsies.
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Affiliation(s)
- J C Dunn
- Section of Pediatric Surgery, Department of Surgery, Indiana University School of Medicine and the James Whitcomb Riley Hospital for Children, Indianapolis, IN 46202, USA
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Burns RC, McGahren ED, Rodgers BM. Thoracoscopic Approach to Pulmonary Parenchymal Lesions. ACTA ACUST UNITED AC 2001. [DOI: 10.1089/10926410152403075] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Abstract
BACKGROUND Endosurgery is difficult for the senior pediatric surgeon to master because the technique has a steep learning curve, lacks tactile sense, uses elongated instruments, and is ergonomically tiring. METHODS The senior author, starting at age 53, has performed more than 300 endoscopic procedures at both children and community hospitals. A full year was required to master laparoscopic Nissen fundoplications. Conversion to open procedures from bleeding and enterotomies were committed in the first year of endosurgery. Facility with endosurgery is gained by performing common and frequent procedures as appendectomies. CONCLUSION The advantages of endosurgery in pain control and shortened hospitalization make the technique deserving of commitment by the senior pediatric surgeon.
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Affiliation(s)
- J H Chang
- Hospital for Infants and Children at Presbyterian/St Lukes Hospital, Denver, CO, USA
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Abstract
Thoracoscopy is a minimally invasive thoracic surgical technique that is gaining widespread use for several surgical procedures. Although the complication rate is relatively low, there are definable risks associated with the technique. Careful attention to patient selection and an understanding of the complications associated with one-lung ventilation and video-assisted surgical techniques can help one to anticipate and prevent complications.
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Affiliation(s)
- P Latham
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, USA.
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