Traction Sutures Allow Endoscopic Staples to Be Used Safely During Thoracoscopic Pulmonary Lobectomy in Children Weighing Less Than 15 Kg

Purpose: During thoracoscopic pulmonary lobectomy (TPL) in larger children (> 15 kg), an endoscopic stapler (ES) and endoscopic clipper (EC) are used during dissection and division of the pulmonary vessels (PVs) and bronchus. However, in smaller children (< 15 kg), ES/EC cannot be used because of limited space. We report our technique for thoracoscopic dissection and division of the PVs and bronchus in smaller children. Subjects and Methods: Fifteen cases of sequestration/congenital cystic adenomatoid malformation weighing less than 15 kg (range, 8-15 kg; mean, 11 kg) were the subjects for this review. With the patient under single-lung ventilation in the lateral decubitus position, four ports ranging from 5 to 12 mm were placed. After the PVs and bronchus were exposed, thick silk was used to encircle them as a traction suture. By applying traction, the PVs and bronchus could be exposed, and ES/EC were used safely by applying countertraction. Results: All cases had uneventful TPL (upper in 3 patients, middle in 3 patients, and lower in 9 patients). ES/EC were easy to use. Mean operative time was 220 minutes. Conclusions: Our technique allows the PVs and bronchus in children weighing less than 15 kg to be divided safely using ES/EC. We strongly recommend our technique, although simple, be used during TPL in smaller children.