Thoracoscopic Lobectomy in Infants and Children Using A 5mm Stapling DeviceSteven S Rothenberg MD FACS FAAPThe Rocky Mountain Hospital for ChildrenColumbia University College of Physicians and Surgeons
Disclosures JustRight Surgical: Medical Director/ Ownership interest
Thoracoscopic Lobectomy First reported in children 1993. Technical difficulties do to large size of instruments and relatively small size of patient Surgical stapling relatively common in adult VATS In infants: vessel and airway management relied on suturing, vessel sealing, surgical clips Increased difficulty and operative time In the second quarter of 2014 a 5mm endoscopic surgical stapler became commercially available. A prospective study was launched to study safety and efficacy of the device
Methods From July 2014 to March 2016 all patients undergoing anatomic lobectomy for congenital cystic lung disease were evaluated for use of the 5 mm surgical stapler 26 patients included 6 weeks – 13 months Weight 3.2-11.4 Kg Lobes: 7 upper, 2 middle, 17 lower lobectomies
Methods 5 mm endoscopic stalper 4 rows of staples 2 mm staple, classic B formation 25 mm length
Pulmonary Artery
Pulmonary vein
Bronchus
Major Fissure
Results 96 staple loads used Main lobar artery and vein 24 cases Lobar Bronchus 26 cases Sequestration vessel 5 cases Major Fissure: 1 case Minor Fissure: 1 case
Results Operative time: 35-135 minutes Bleeding from vascular stump : 0 Bronchial stump separation: lateral edge 1 case ( 8kg LUL, closed with a single 4-0 PDS stitch) Post-operative complications: 0
Conclusion The use of a 5 mm surgical stapler for thoracoscopic lobectomy in neonates and infants is safe and effective The device can be used to control the main vascular bundles as well as lobar bronchi and parenchyma Tissue thickness can be an issue and can overcome the staples if too thick The size of the device facilitates it’s use in infants as small as 3 kg The ease of use facilitates the procedure and decreases operative time, especially with less experienced surgeons