IPEG 2020 TOP ABSTRACT: Thoracoscopic lingulectomy for a Prenatally diagnosed CPAM in a 3 month old infant
With Dr. Steve Rothenberg
Chapter 1 of 6 · Diagnosis & Workup
Prenatal diagnosis
Prenatal diagnosis and preoperative imaging
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What the experts said
CPAM was diagnosed by prenatal ultrasound at 26 weeks
MRI at 29 weeks confirmed the CPAM diagnosis
Repeat ultrasound at 36 weeks showed an enlarging CPAM
CT scan at 3 months of age showed persistence of the CPAM in the lingula
An incomplete fissure was found upon entering the left chest
The fissure was developed using the 3 millimeter vessel sealer
The fissure can be taken in a systematic fashion with minimal blood loss and no injury to surrounding structures despite being quite incomplete
The 3 millimeter vessel sealer is used to take vessels with two separate seals placed at least 3 to 4 millimeters apart, then the vessel is divided between the seals
Partial division is accomplished first to ensure that the seals are intact, and once the lumen is seen, then the division is completed
Segmental resection of the lingula is accomplished fairly easily once all vascular and bronchial structures are taken
Hyperinflation of the lingula persists even though the rest of the lung is collapsed because of right main stem intubation
In this case, the bronchus to the lingula lies on top of the artery
The bronchus, because of its small size, is taken with a singular 5 millimeter clip
After bronchus and artery division, a line of demarcation begins to be seen between the lingula and the rest of the upper lobe
Separation between the lingula and the superior segment of the upper lobe is started with the 3 millimeter sealer and completed with the 5 millimeter stapler once the plane is clearly seen
Three applications of the 5 millimeter stapler are used to completely divide the lingula from the remnant of the upper lobe
No air leak was present after resection with lower lobe and upper lobe clearly inflating
Chest tube was removed on postoperative day one and the patient was discharged home