Uniportal video-assisted thoracic surgery in a pediatric hospital: early results and review of the literature

Ugolini, S; Coletta, R; Lo Piccolo, R; Dell'Otto, F; Voltolini, L; Gonfiotti, A; Morabito, A

Abstract

Background: Uniportal video-assisted thoracic surgery (U-VATS) is an implemented technique in adult surgery that may aid to extend offer the benefits of thoracoscopy to a wide number of pediatric patients.

Materials and Methods: Consecutive cases treated between July 2019 and July 2021 were retrospectively analyzed. Simultaneously, a MEDLINE systematic search was conducted.

Results: Twelve patients (median age 13 years, median weight 44.5 kg) underwent 4 major procedures (n = 2 lobectomy, n = 2 segmentectomy) and 11 minor procedures (n = 1 bronchogenic cyst resection, n = 4 apical wedge resections and pleurodesis for pneumothorax, n = 4 wedge resections for lung nodules, and n = 2 debridement for empyema). The median observed operative time was 77 minutes. We recorded one conversion to biportal VATS. No intraoperative complications or 30-day morbidity–mortality was reported. A rate of 40% adverse postoperative events was observed (Clavien–Dindo grade I-IVa). Visual analog scale for postoperative pain recorded a median value of 0 on days 1, 2, and 3. The systematic review provided 15 full-text articles reporting 76 pediatric interventions (4 major and 72 minor procedures); among them, 1 biportal conversion, 3 mild postoperative complications, and 1 redo surgery are presented.

Conclusions: As emerged from the literature review, U-VATS remains scarcely adopted by pediatric surgeons. Its feasibility is supported by the four reported major lung resections plus the four cases added on by our series. Thanks to a more rapid learning curve over conventional VATS, the uniportal technique could be accessible to a wider number of centers.

Citation

Ugolini, S., Coletta, R., Lo Piccolo, R., Dell'Otto, F., Voltolini, L., Gonfiotti, A., & Morabito, A. (2022). Uniportal video-assisted thoracic surgery in a pediatric hospital: early results and review of the literature. Journal of Laparoendoscopic and Advanced Surgical Techniques, 32(6), 713-720. https://doi.org/10.1089/lap.2021.0180

• Journal Article Type: Article
• Publication Date: Jun 1, 2022
• Deposit Date: Sep 2, 2022
• Journal: Journal of Laparoendoscopic & Advanced Surgical Techniques
• Print ISSN: 1092-6429
• Electronic ISSN: 1557-9034
• Publisher: Mary Ann Liebert
• Volume: 32
• Issue: 6
• Pages: 713-720
• DOI: https://doi.org/10.1089/lap.2021.0180
• Publisher URL: https://doi.org/10.1089/lap.2021.0180