VATS IN CHILDREN

VIDEO ASSISTED THORACIC SURGERY IN CHILDREN : 

Dr. R. K. Bagdi Dr. Prakash Agarwal Consultant Pediatric Surgeons Apollo Children’s Hospital Chennai. INDIA. VIDEO ASSISTED THORACIC SURGERY IN CHILDREN

Slide 2: 

Video-assisted thoracic surgery (VATS) involves performance of intra-thoracic procedures through several small thoracostomies without a thoracotomy

Exponential increase in popularity and growth over the last decades : 

Exponential increase in popularity and growth over the last decades Reasons Availability of fine ports Smaller fine endoscopic instruments and clips Improvement in visual optics Precise energy sources Single lung ventilation techniques Better intraoperative visualization and exposure of the pleural surface as compared with limited thoracotomy incision.

Advantages : 

Advantages Avoids extensive muscle cutting and ribs spreading Reduced postoperative pain thereby lower postoperative narcotic requirement Improved postoperative pulmonary function Decreased levels of circulating inflammatory cytokines postoperatively Shorter hospital stay Improved cosmetic appearance. Potential reduction in musculoskeletal squealae i.e; winged scapula, asymmetry of the thoracic wall due to underlying atrophy of the serratus anterior muscle and severe scoliosis.

Disadvantage : 

Disadvantage Inability to manually palpate the lung parenchyma The potential of port site seeding with tumor cells Incomplete decortications Definite learning curve Well-equipped theaters with an experienced team

Indications : 

Indications Anterior spine fusion Aortopexy Cyst excision Decortication Diagnostic or hardware positioning (Nuss procedure) Diaphragmatic hernia repair, plication Esophageal atresia repair, myotomy, resection Foregut duplication resection Lobectomy Lung biopsy or resection Mediastianl biopsy or mass excision Patent ductus arteriosus ligation Pericardial window Pleurectomy Sequestration resection Sympathectomy Thoracic duct ligation Thoracic mass excision Thymectomy Tracheoesophageal fistula repair

Contraindications : 

Contraindications Late stages of empyema after the development of fibrosis with severe crowding of ribs (without any obvious space between ribs) Densely adherent tumor infiltrating chest wall

Anesthetic consideration: : 

Anesthetic consideration: Single-lung ventilation Difficult in the infant or small child Routine use of a low-flow (1 L/min), low-pressure (4 mm Hg) CO2 infusion during the procedure to help keep the lung compressed.

Our Experience : 

Our Experience

Surgical technique : 

Surgical technique Standard equipment for endoscopic surgery Camera Light source Insufflator Medical grade monitor Diathermy 5 mm and 10 mm telescopes are used The standard trocars used in laparoscopy (10, 5 and 3 mm) can be used

VATS for empyema : 

VATS for empyema

VATS lung biopsy : 

VATS lung biopsy

VATS- Duplication cyst excision : 

VATS- Duplication cyst excision

VATS - Pulmonary Hydatid disease : 

VATS - Pulmonary Hydatid disease

Conclusion : 

Conclusion VATS has scored over open thoracotomy due to distinct advantages. Certain procedures have become gold standard. MAS have become patient demand procedures. Distinct technological advantages should be passed on to the benefit of patients.