Video assisted thoracic surgery in children

Abstract

Thoracoscopic surgery, i.e., video assisted thoracic surgery (VATS) has been in use in children for last 98 years. Its use initially was restricted to the diagnostic purposes. However, with the improvement in the optics, better understanding of the physiology with CO2 insufflation, better capabilities in achieving the single lung ventilation and newer vessel sealing devices have rapidly expanded the spectrum of the indication of VATS. At present many complex lung resections, excision of mediastinal tumors are performed by VATS in the experienced centre. The VATS has become the standard of care in empyema, lung biopsy, Mediastinal Lymphnode biopsy, repair of diaphragmatic hernia, etc. The article discusses the indications of VATS, techniques to achieve the selective ventilation and surgical steps in the different surgical conditions in children.

A multicenter study on the utility and safety of EBUS‐TBNA and EUS‐B‐FNA in children

“…The initial procedure in its investigation is generally ultrasound or computed tomography (CT)‐guided transthoracic fine needle aspiration (FNA) . When it is non‐diagnostic, the next step is either mediastinoscopy, video‐assisted thoracic surgery, or thoracotomy . Due to a high complication rate and morbidity associated with these procedures in adults, there has been a shift towards minimally invasive bronchoscopic procedures.…”

Anesthetic management of thoracoscopic resection of lung lesions in small children

“…Antenatal diagnosis of congenital pulmonary malformations is increasing and leads to presentation for resection in early infancy. Video‐assisted thoracoscopic surgery is now the technique of choice in both adult and pediatric thoracic surgery because of smaller chest incisions, reduced postoperative pain and more rapid recovery compared with thoracotomy . This change in surgical technique has influenced anesthetic management.…”

“…Video-assisted thoracoscopic surgery is now the technique of choice in both adult and pediatric thoracic surgery because of smaller chest incisions, reduced postoperative pain and more rapid recovery compared with thoracotomy. 5,6,14 This change in surgical technique has influenced anesthetic management. Although video-assisted thoracoscopic surgery can be performed by creating a capnothorax, via insufflation of carbon dioxide into the pleural cavity, one-lung ventilation of the nonoperative lung optimizes surgical exposure.…”

“…However, over the last decade, technology for video‐assisted thoracoscopic resection for congenital lung malformations has dramatically improved and has now become the standard technique. The advantages of video‐assisted thoracoscopic surgery compared with open thoracotomy include smaller chest incision, reduced postoperative pain, more rapid recovery, and shorter hospital stay . Moreover, long‐term musculoskeletal complications associated with posterolateral thoracotomy, such as asymmetric chest wall, scoliosis, and winged scapula, are avoided…”

“…The advantages of video-assisted thoracoscopic surgery compared with open thoracotomy include smaller chest incision, reduced postoperative pain, more rapid recovery, and shorter hospital stay. 4,5 Moreover, long-term musculoskeletal complications associated with posterolateral thoracotomy, such as asymmetric chest wall, scoliosis, and winged scapula, are avoided. 6 Video-assisted thoracoscopic procedures in children require one-lung ventilation to facilitate clear visualization of thoracic contents and reduce lung injury from the use of retractors.…”