Thoracoscopic Left Upper Lobectomy for CPAM in a 4-Month-Old, 5 kg Infant

A 4-month-old, 5 kg infant with prenatally diagnosed CPAM underwent thoracoscopic left upper lobectomy.

An anterior approach was used with three ports: a 4 mm port in the posterior axillary line for the telescope and two 3 mm ports in the anterior axillary line, with the lower port later changed to 5 mm for the endoscopic clip applier.

A 3 mm sealer-dissector was used for the case.

The sealer was used to compress cysts in the left upper lobe to allow easier access to the pulmonary vessels.

The main trunk of the artery to the upper lobe was dissected out and sealed proximally and distally, then divided between the seals.

This technique (proximal and distal sealing before division) allows for a safe, effective, and reproducible method for sealing pulmonary vessels without risk of bleeding.

Each of the main branches of the superior pulmonary vein were individually isolated, dissected out, and sealed proximally and distally with division between the seals.

The major fissure was incomplete anteriorly.

The sealer was used to define the plane of the incomplete major fissure, and the lung between upper and lower lobes was sealed and divided.

A finger-fracture technique was used to divide the lung parenchyma and expose the artery as dissection continued posteriorly through the major fissure.

The superior and inferior branches of the pulmonary artery to the lingula were individually isolated, sealed, and divided using the 3 mm sealer.

The bronchus to the lingula was sealed with a 5 mm clip applier both proximally and distally and divided between the clips.

5 mm clips have proven to be an effective way to seal the bronchus in infants under 10 kg.

Each branch of the main bronchus to the upper lobe (apical-posterior and anterior) was individually sealed with a 5 mm clip and then divided.

The upper lobe was brought out through the lower trocar site in a piecemeal fashion.

The patient had a chest tube in for 24 hours and was discharged on the 2nd postoperative day.