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Thoracoscopic excision of antenatal diagnosed lung malformations

J. Lemelle, G. de Miscault, P. Droulle, M. Schmitt.

Department of Pediatric Surgery, Children Hospital, CHU Nancy, France

 

ABSTRACT

Objective: Asymptomatic lung malformations (ALM) are discovered by ultrasonography in pregnant woman. The excision is performed to avoid the possible infectious or tumour complications. Our target is to evaluate the thoracoscopic excision.

Material and methods: Between 2007-2009, 7 patients aged less than 9 months (from 5,5 months to 2,5 years old) have been treated for ALM by thoracoscopy. 2 cases represented extralobar sequestration (ES), 3 cases represented congenital cystic adenomatoid malformation (CCAM) of the superior lobe and 2 cases represented inferior right intralobar sequestration in association with CCAM. The treatment consisted of 5 lobectomies and 2 excision of extralobar sequestration. For the lobectomies, selective intubation under fibroscopic control was necessary; on the left side radioscopic confirmation was necessary. In all cases an intra-thoracic low pressure insufflation was performed (5 mm Hg) with low flow rate. The average follow-up after surgery was 9 months (from 1 to 19 months).

Results: The need for completing the lung fissures was constant in lobectomies. The blood vessels were ligatured or treated by thermofusion in the last 2 cases with important economy of time and good security. The bronchias were ligatured. The surgical specimens were removed by enlarging a trocar incision, in the axillary pit. The operative timing was from 45 min for the ablation of the extralobar sequestration to 4 hours for the lobectomy. There were no intra-operative complications. A patient presented a postoperative pneumothorax treated by thoracoscopy (suture of the lung parenchyma). The hospitalization was between 4 and 12 days. There were no other late complications.

Conclusions: Our experience confirms the legitimacy of the thoracoscopic treatment of ALM limiting the trauma of the thoracotomy. This procedure underlines the importance of the thermofusion that allow the section of the lung parenchyma and the lung vessels hemostasis.

 

Key words: asymptomatic lung malformations, thoracoscopic excision, thermofusion