Comparison of thoracoscopy vs. thoracotomy on musculoskeletal outcomes of children with congenital pulmonary airway malformation (CPAM).

BACKGROUND: It has been postulated that video-assisted thoracoscopic surgery (VATS) is superior than conventional thoracotomy for resection of congenital pulmonary airway malformation (CPAM) in terms of shorter hospital length of stay, reduced post-operative complication and better long-term pulmonary outcome. However, there is limited available data concerning the effect of VATS and conventional thoracotomy on musculoskeletal aspects in patients with CPAM. This study aims to compare the long-term effects of both surgical techniques on musculoskeletal outcomes in this group of patients. METHODS: Thirty-five patients with mean age of 11.38 years old who underwent VATS or conventional thoracotomy for CPAM resection were recruited in this study. The mean follow-up time was 10.42 years (5.48 to 17.71 years). Musculoskeletal examination included screening of musculoskeletal deformities (elevation of shoulder, asymmetry of nipple level, breast/ pectoral muscle maldevelopment, winging of scapula, scoliosis), measurement of bilateral chest wall in relation to anatomical parameter, and testing of shoulder range of motion and power. RESULTS: The prevalence of winged scapula was significantly lower in patients who underwent VATS than thoracotomy (13% vs 58%, p = 0.008). There is also a smaller reduction in operated-side chest wall vertical distance in VATS patients (0.982 vs 0.956, p = 0.058). There were no significant difference in prevalence of other musculoskeletal deformities, other chest wall measurements, shoulder range of motion and power between two groups. CONCLUSION: Thoracoscopy decreases the incidence of scapular winging but has no effect on effect on other musculoskeletal deformities.

Long-term pulmonary function after lobectomy for congenital pulmonary airway malformation: is thoracoscopic approach really better than open?

INTRODUCTION: Congenital pulmonary airway malformation (CPAM) is the most common lung pathology diagnosed antenatally. Thoracoscopic lobectomy has shown increasing popularity, but the long-term result is still lacking. In this study we compared long -term pulmonary function after thoracoscopic and open lobectomy. METHODS: All CPAM patients with lobectomy between 2000 and 2008 were recruited into the study. Pulmonary function test (PFT) was performed at least 7 years after operation. Demographic data and PFT results were analyzed. Comparison was made between the thoracoscopic and open group. RESULTS: Twelve patients were included in each group. PFT was performed at a mean age of 9.8 (thoracoscopic) and 12.2 years (open), respectively (p = 0.17). The thoracoscopic group showed better performance in forced vital capacity (FVC) (98.9 vs 84.3% predicted, p = 0.03), forced expiratory volume in 1 s (FEV1) (88.5 vs 76.1% predicted, p = 0.04), and alveolar volume adjusted diffusion capacity of carbon monoxide (106.4 vs 91.4% predicted, p = 0.03). FEV1 to FVC ratio, total lung capacity, and residual volume showed no statistical difference. CONCLUSION: The long term PFT result following thoracoscopic lobectomy is better than open lobectomy. This may be due to impaired respiratory musculature after thoracotomy. Further study with larger sample size is necessary to determine this hypothesis. LEVEL-OF-EVIDENCE: III.

Thoracoscopic Resection of Congenital Cystic Adenomatoid Malformation in a Patient With Fused Lung Fissure Using Hookwire.

Thoracoscopic resection is being used more commonly for the treatment of congenital cystic adenomatoid malformation in neonates and infants. However, in the rare case of congenital cystic adenomatoid malformation with congenital absence of lung fissure, thoracoscopic lobectomy cannot be performed safely. Moreover, if the lung lesion is deep-seated and cannot be visualized on the pleural surface, wedge resection may result in residual lesion. Here, we reported our approach of thoracoscopic resection under hookwire guidance to tackle this problem.

Medium Term Pulmonary Function Test After Thoracoscopic Lobectomy for Congenital Pulmonary Airway Malformation: A Comparative Study with Normal Control.

INTRODUCTION: Congenital pulmonary airway malformation (CPAM) is a major indication of lobectomy in children. Early lobectomy had been proposed for the advantage of compensatory lung growth. Despite the increasing use of thoracoscopic lobectomy its effect on postoperative lung function was still not well established in the literature. This study was therefore performed to study the result of postoperative pulmonary function test (PFT) on a medium term basis. MATERIALS AND METHODS: All patients who underwent thoracoscopic lobectomy for CPAM between 2006 and 2010 were recruited into the study. PFT was performed 5 years after the operation. Age-matched healthy individuals with similar body size were recruited for PFT as the control group. Demographic data and PFT results were extracted for statistical analysis. Test result less than 80% of predicted value was considered abnormal. RESULTS: Fifteen consecutive patients were identified in the study period, 8 boys and 7 girls. The PFT was performed at a mean age of 9 years. None of the patients had respiratory symptoms. The forced vital capacity (FVC) (99.6% versus 97.0% predicted, P = .56), forced expiratory volume in 1 second (FEV1) (86.0% versus 89.1% predicted, P = .52), FEV1 to FVC ratio (96.6% versus 98.7% predicted, P = .60), total lung capacity (92.5% versus 94.5% predicted, P = .68), and alveolar volume adjusted diffusion capacity of carbon monoxide (106.4% versus 100.4% predicted, P = .35) showed no statistical difference from the control group. CONCLUSION: Patients who underwent thoracoscopic lobectomy have normal lung function 5 years after the operation. Further study is necessary to confirm the long-term result.

Pneumovesical ureteric reimplantation using T-fastener: A modification for bladder wall anchorage.

INTRODUCTION: Bladder anchoring during pneumovesical ureteric reimplantation (PUR) can be difficult. Here we describe our new technique using a T-fastener (Kimberly Clark, Irving, TX, USA) to tackle this problem. METHODS: A T-fastener has been applied to all patients who underwent PUR in our center since 2011. RESULTS: Seventeen consecutive cases were performed between 2011 and 2015. No bladder dislodgement or air leak was observed in any of the operations. No morbidity or mortality has been associated with the use of T-fasteners. CONCLUSION: In our experience, this technique is simple to learn and transferrable. It decreases intraoperative complications and helps to climb the learning curve.

Pneumovesical Ureteric Reimplantation in Pediatric Patients: An Intermediate Term Result.

INTRODUCTION: Pneumovesical ureteric reimplantation has gained increasing popularity for the treatment of vesicoureteric reflux (VUR) and vesicoureteric junction obstruction (VUJO) in pediatric patients. In this study we reviewed our experience at an intermediate term basis. METHODS: A retrospective review of all patients with pneumovesical ureteric reimplantation performed in a tertiary referral center between 2005 and 2015 was carried out. Patients' demographics, operative measures, and postoperative outcomes were recorded. RESULTS: Thirty-one patients were identified during the study period. Twenty-three patients had VUR and 8 patients had VUJO. A total of 42 ureteric reimplantation procedures were carried out. The mean age at operation was 6.1 years old. The mean operative time was 221 minutes. On average the length of hospital stay was 7.4 days. Four patients required conversion to open approach. Four patients had low-grade residual VUR after the operation and all of them were treated conservatively. There was no major complication or mortality. CONCLUSION: Pneumovesical ureteric reimplantation is safe and effective for pediatric patients. Intermediate term result confirmed its reliability and low recurrence rate. It has good potential to become the preferred approach of choice in the future.