Video-assisted thoracoscopic surgery in the paediatric population.

Abstract

Video-assisted thoracoscopic surgery (VATS) is now widely practised in adults but there are few publications on its application in the paediatric population. Retrospective review of the authors' experience with VATS in children under 16 years old during an 18 month period in a university teaching hospital. From September 1993 to March 1994, VATS was attempted in 14 patients. Five were unsuccessful because of pleural symphysis or inability to collapse the upper lung. Ten cases of VATS were successfully performed in the remaining nine patients (eight males, one female; age range from 22 days to 15 years old). These included two drainages and limited decortications for loculated pleural effusion, one guided drainage of pericardial effusion, one thymectomy for thymic hyperplasia, three wedge resections for metastatic pulmonary osteosarcoma and three bleb excisions and pleurodesis for primary spontaneous pneumothoraces. There were no intra-operative complications. There was one death from dysrhythmia following an uneventful wedge resection. The mean duration of chest tube drainage was 1.4 days and postoperative hospital stay 2.6 days excluding two patients who stayed for further medical treatment. VATS is a useful approach in selected cases but further development of this approach awaits refinement of anaesthetic technique and endoscopic instrumentation.