Experience with 144 consecutive pediatric thoracoscopic lobectomies

Objective: The early experience with the technique and short- term outcomes after pediatric thoracoscopic lobectomy were independently reported by the authors several years ago. This paper updates their combined experience, evaluating the safety, efficacy, and long- term outcomes. Methods: From January 1995 to May 2005, 144 consecutive patients underwent a thoracoscopic lobectomy. Preoperative diagnoses included cystic adenomatoid malformation/ sequestration ( n = 112), bronchiectasis ( n = 19), lobar emphysema ( n = 10), and malignancy ( n = 3). Ages ranged from 2 days to 18 years, and weight ranged from 2.8 to 78 kgs. Three or four valved ports were used with a controlled pneumothorax. Single- lung ventilation was used in all cases. Follow- up ranged from 1 to 10 years. Results: All but three procedures were completed thoracoscopically; one was converted to repair an injured upper lobe bronchus during a lower lobectomy, one resulting from bleeding, and another caused by what was believed to be a potentially inadequate margin during the resection of a large tumor. The operating time ranged from 35 to 220 minutes ( median, 125). There were 110 lower, 24 upper, and 10 middle lobe resections. There was one intraoperative complication - the compromise of a left upper lobe bronchus. There were four postoperative complications: pneumonia, pneumothorax, empyema, and prolonged chest tube drainage. There were no reoperations. The median duration of hospital stay was 2.8 days. A long- term follow- up revealed no cases of musculoskeletal deformity or weakness. Conclusions: The current techniques and equipment allow for the complete thoracoscopic resection of pulmonary lobes in any age or size of a child, with low morbidity and no mortality. Longterm outcomes support the efficacy of this technique that spares growing children a thoracotomy that has the potential for late musculoskeletal morbidity.