4 thoracoscopy in pediatric surgery - sn oak

Thoracoscopy in children

Dr. Sanjay OakDean & Prof of Paediatric Surgery

T.N. Medical College & B.Y.L.Nair HospitalMumbai, India

VATS Vs. Laparoscopy

Equipment - Short Trocars

Ergonomics - No fixed position

Vision

CO2 Insufflation

Rigid Chest wall

Indications for VATS in children

Decortication Lung biopsy Mediastinal lymph node biopsy Lobectomy/Segmentectomy Resection of bullae Repair of Diaphragmatic hernia Diaphragmatic plication TEF Repair

VATS - Advantages

No morbidity of Thoracotomy

Cosmetic

Reduced Post-op. pain

Repeatable

Difficulties in VATS

1. Visibility2. Bleeding3. Fallacious High ET CO2

4. Iatrogenic Trauma5. Inadequate Toiletting

Diagnostic VATS – Blunt chest trauma

Eventration of diaphragm

Diaphragmatic hernia repair

VATS lung biopsy in children Saves operative time Good visualisation Definitive diagnosis – yield not

compromised

Indications

Non-resolving pneumonia Interstitial lung disease Indeterminate pulmonary nodules

VATS in pulmonary hydatid

VATS excision

VATS assisted minithoracotomy

VATS lung resection

VATS excision of hydatid

Surgical treatmentof empyema (International Paediatric Endosurgery Group, 2002)

1. Failure of intravenous antibiotics to improve pulmonary pathology

2. Cases in which pleural fluid can not be aspirated by needle or drained by tube thoracostomy

3. Patients with ESS score of ≥ 2

Suspected Empyema

CXR / CT Scan

Diagnostic thoracocentasis

Early EmpyemaOrganized

< 15 days history > 15 days history

Symptomatic Asymptomatic

ICD Primary VATS Open

decortication

VATS

Surgical Management

Decortication

Early Vs. Late

Open Vs. Video Assisted Thoracoscopic Surgery (VATS)

PRE OP PICTURE

POST OP PICTURE

IMMEDIATE POST OP X RAY AFTER REMOVAL OF ICD

6 MONTHS POST OP

VATS in empyema

1. Three Trocar Technique2. Two Trocar Technique3. VATS with open instruments

4. VATS with minithoracotomy

1. Primary2. After ICD Insertion

S1

S2

S2

S3

Ergonomics for Thoracoscopy

VATS - Contraindications

Chronic Empyema

Bronchopleural Fistula; Large air leaks

Coagulation disorders