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Video Assisted Thoracic Surgery (VATS) in Pediatrics
Objective:
To review our practice and feasibility of VATS in the Pediatric population.
Methods:
Patients undergoing VATS surgery from July 2010 to December 2014 were reviewed. Data was collected regarding patient demographics, disease profiling, preoperative, intraoperative and postoperative and follow up clinical data in Hospital information clinical database.
Results:
55 / 1878 patients were in the pediatric age group (age 1 year to 16 years). The disease pathology included: empyema (pyogenic & tuberculosis), Mediastinal cysts & tumours, Thymectomy for myasthenia, congenital Bronchiectasis, cystic malformations, arteriovenous fistulae, Thoracic outlet tumours, Kartagener’s syndrome, aspergilloma, kyphoscoliosis, Sympathectomy for Intractable Ventricular tachycardia & Endobronchial tumours.
Single lung isolation was achieved by double lumen intubation in patient upto age 10 (size 26 French). Isolation in younger patients was achieved by using endobronchial blockers and selective intubation of opposite lung. CO2 insufflation helped deflation. VATS was performed using staplers for ligating vessels and bronchus. 53/55 patients were extubated in OR. All patients were sent overnight to intensive care unit. Mean drain dwell time was 1 day. One patient developed systemic fungaemia requiring prolonged intubation and subsequently passed. No blood transfusion was required. No wound infections were reported. Pain score was 2/10 using intravenous and subsequently oral analgesia. Hospital stay was 4 days.
Conclusion:
VATS (Thoracoscopy) is a feasible option in pediatric age group with good clinical and cosmetic outcomes. A VATS pediatric program including a trained pediatric anesthetist, intensivist and thoracic surgeon can ensure good outcomes with low morbidity and mortality.