Serial improvement of quality metrics in pediatric thoracoscopic lobectomy for congenital lung malformation: an analysis of learning curve

Park, Samina; Kim, Eung Re; Hwang, Yoohwa; Lee, Hyun Joo; Park, In Kyu; Kim, Young Tae; Kang, Chang Hyun

doi:10.1007/s00464-017-5425-0

Cited by 21 publications

(14 citation statements)

References 33 publications

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“…Difficulty in such surgical technique is still a problem because low patient numbers in most hospitals inhibit quick accumulation of experiences. Long learning curve must be overcome, and some reports have shown stable results after the first 33 to 50 cases of VATS resection [33,34].…”

Section: Discussionmentioning

confidence: 99%

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Uniportal Thoracoscopic Lobectomy for Congenital Lung Malformations in Children

Chou¹,

Huang²,

Yeh³

et al. 2018

J Surg

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Introduction: Single-incision paediatric endosurgery is gaining popularity, especially for abdominal operations. However, few reports in the literature support the feasibility of uniportal thoracoscopic surgery for congenital lung malformations in paediatric patients. This paper presented the initial experience with uniportal thoracoscopic surgery and compared the surgical outcomes with multiport Video-Assisted Thoracoscopic Surgery (VATS) and traditional thoracotomy. Materials and Methods: From January 2009 to January 2018, a retrospective review of all patients (less than 18 years old) who underwent surgery for congenital lung malformations at our institution was performed. General data, operative data, anaesthesia parameters and surgical outcomes were collected. Results were analysed with one-way ANOVA and chi-square tests for continuous and categorical data. Results: Twenty-one patients with congenital lung malformations underwent surgery at our institution. The number of patients enrolled in thoracotomy, multiportal VATS and uniportal VATS groups was 8, 6 and 7, respectively. No difference in age, body weight, post-operative stay and drainage period was observed among the groups. A considerably high conversion rate (3/6, 50%) was observed in the multiportal VATS group. After the introduction of endobronchial blocker for one lung ventilation, all multi-portal and uniportal VATS procedures could be performed safely without residual lesion or mortality. Conclusions: VATS is feasible in the paediatric population, and it needs experienced surgical skills and unique anaesthetic requirements. For small infants with congenital lung malformations, uniportal VATS with endobronchial blocker is preferred.

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Section: Discussionmentioning

confidence: 99%

“…The first reported case was an extralobar pulmonary sequestration removed from a 3-cm-long incision of a 14-month-old patient [11]. The largest case series, 19 patients, thus far was reported by Park in 2017 [33]. Uniportal VATS is generally considered more technically challenging than multiportal VATS.…”

Section: Discussionmentioning

confidence: 99%

Uniportal Thoracoscopic Lobectomy for Congenital Lung Malformations in Children

Chou¹,

Huang²,

Yeh³

et al. 2018

J Surg

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“…A learning curve of 50 patients to obtain stable postoperative results has been reported but the 110th case was the turning point for stable outcomes with a short operation time. 12…”

Section: What Instruments Should Be Used To Help the Resection?mentioning

confidence: 99%

Thoracoscopic Lobectomy for Congenital Pulmonary Airway Malformation: Where Are We in 2019?

Bonnard

2020

Eur J Pediatr Surg

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Thoracoscopic surgery for congenital pulmonary airway malformation (CPAM) is still a matter of debate and used by approximately 50% of the surgeons in Europe. Several questions need to be addressed about CPAM. The adequate treatment, the surgical approach, and the follow-up are few of them. A review of recent articles published in the literature over the past 5 years is done in trying to respond to these questions. A multidisciplinary team is required to follow these patients since approximately 10 to 15% will develop a chronic lung disease and asthma. In the case of conservative management, computed tomography scan should be perform to monitor the evolution of the CPAM. Minimally invasive surgery should be used whenever possible, although the advantages of pulmonary function tests are not clearly defined, allowing a postoperative fast-track management.

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“…The most commonly performed technique in children with thoracoscopic surgery is lobectomy, but the learning curve is prolonged. An analysis of the learning curve in pediatric thoracoscopic lobectomy for congenital pulmonary malformations required a minimum of 50 cases of experience to obtain stable results with video-assisted thoracic surgery in pulmonary resections [6] . This factor is one of the key obstacles for the thoracoscopic technique to be applied more widely in the world in the pediatric population.…”

Section: Introductionmentioning

confidence: 99%

Thoracic surgery by minimally invasion robot-assisted in children: “experience and current status”

Navarrete-Arellano¹

2020

Mini-invasive Surg

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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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Serial improvement of quality metrics in pediatric thoracoscopic lobectomy for congenital lung malformation: an analysis of learning curve

Cited by 21 publications

References 33 publications

Uniportal Thoracoscopic Lobectomy for Congenital Lung Malformations in Children

Uniportal Thoracoscopic Lobectomy for Congenital Lung Malformations in Children

Thoracoscopic Lobectomy for Congenital Pulmonary Airway Malformation: Where Are We in 2019?

Thoracic surgery by minimally invasion robot-assisted in children: “experience and current status”

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