-Original-

Thoracoscopic Surgery in Children

Kiyoshi Koizumi¹, Shuji Haraguchi², Tomomi Hirata¹, Kyoji Hirai¹, Iwao Mikami¹, Hirohiko Kubokura³, Shigeki Yamagishi¹, Tetsuo Kawashima¹, Naoyuki Yoshino³, Miho Maeda⁴ and Kazuo Shimizu¹

¹Division of Thoracic Surgery, Department of Surgery II, Nippon Medical School
²Department of Surgery, Nippon Medical School Second Hospital
³Department of Thoracic Surgery, Nippon Medical School Chiba-Hokuso Hospital
⁴Department of Pediatrics, Nippon Medical School

Purpose: A minimally invasive thoracoscopic surgery offers several options in diagnosis and surgical treatment in the field of pediatric surgery. We would like to review our surgical experience and to assess the clinical outcomes and problems encountered during thoracoscopic surgery in children and adolescents focusing on children less than 6 years old.
Patients and Methods: In 1992 and 2003, 977 patients underwent thoracoscopic surgery for chest diseases. Among them, from 1994 to 2003, 71 children and adolescents underwent thoracoscopic surgery. The thoracoscopic surgical procedures were classified into thoracoscopic surgery (TS) and video-assisted thoracic surgery (VATS). TS was performed through three or four trocar ports. VATS was performed through a small chest incision (minithoracotomy) with one or two trocar ports.
Results: There was no morbidity or mortality associated with the thoracoscopic surgical procedures. None of the patients required a conversion to standard thoracotomy. The thoracoscopic surgical procedures were feasible in 71 children and adolescents with chest diseases including spontaneous pneumothorax, pulmonary nodules, diffuse pulmonary disease, pulmonary sequestration, and mediastinal tumors, and in those with palmar hyperhidrosis. TS was performed on two of five children with benign diseases including diffuse pulmonary disease and mediastinal bronchogenic cyst. VATS was performed on three children with pulmonary sequestration, lymphoid interstitial pneumonia and mediastinal Ewing's sarcoma. In one child with lymphoid interstitial pneumonia, the thoracoscopic surgery was converted to VATS because adhesion did not allow TS. The TS allowed rapid histological diagnosis and surgical treatment for benign pulmonary diseases and mediastinal cyst. Patients who were suffering from disease-related symptoms obtained complete relief with an uneventful postoperative course and quickly returned to their normal life. A boy who underwent lobectomy showed a normal growth rate for 4 years postoperatively. In the case of malignant chest diseases, the combination of chemotherapy and VATS was an effective treatment strategy.
Conclusions: We considered that the thoracoscopic approach is a rapid and simple method in the therapeutic diagnosis and surgical treatment of children and adolescents, even in children less than 6 years old. Cosmetic benefits were also obtained for girls. However, the most important consideration is the decision on a treatment strategy made by both pediatrician and thoracic surgeon.

J Nippon Med Sch 2005; 72: 34-42

Keywords
children, infant, chest disease, video-assisted thoracic surgery, thoracoscopic surgery

Correspondence to
Kiyoshi Koizumi, MD, Division of Thoracic Surgery, Department of Surgery II, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan
sirakami@nms.ac.jp

Received, September 14, 2004
Accepted, November 2, 2004