The benefits of VATS technique for diagnostic and treatment of paediatric thoracic problems

Abstract

Background: A minimally invasive surgery such as video-assisted thoracic surgery (VATS) has been used for diagnostic and therapeutic procedure in children for the last decade. This study described the VATS surgical technique used in the treatment of pediatric thoracic cases and highlighted the benefit of surgical treatment for thoracic problems in pediatric, mainly in empyema thoracis, pneumothorax, and congenital diaphragmatic hernia. Result: We used thoracoscopic approach, which is video-assisted thoracic surgery (VATS) as the surgical approach for cases such as recurrent primary spontaneous pneumothorax (PSP), recurrent empyema thoracis, and congenital diaphragmatic hernia (CDH) in our institution. All children received general anaesthesia. Selective ventilation of the left or right bronchus was used to allow ipsilateral lung collapse for better visualization. The patient was positioned in swimmer position or lateral decubitus position with the ipsilateral side up and in a slight reverse Trendelenburg position. A 5 mm incision was made on the ipsilateral of the apex of scapula, and a 5 mm trocar was used. For empyema thoracis we used two trocars, which were 5 mm for camera and 3 mm trocar. The fibrotic tissue was excised and the pleural space was debrided. In recurrent pneumothorax case, we used the 5mm trocar for the camera. An fibrotic tissue excision was done to facilitate better drainage for the chest tube. We used the VATS approach for the CDH case in a full-term neonates, using 5 mm and 3 mm trocars with low flow insufflation. Conclusion: The use of minimally invasive surgery such as video-assisted thoracoscopic surgery can be a valuable choice in the management of selected thoracic conditions. There is evidence that VATS provides an advantage compared to thoracotomy. It is beneficial to minimalized the surgical wound and shortened the time of operation.