Abstract: Background: A minimally invasive surgery such as video-assisted thoracic surgery
(VATS) has been used for diagnostic and therapeutic procedure in children for
the last decade. This study described the
VATS surgical technique used in the treatment of pediatric thoracic cases and highlighted
the benefit of surgical treatment for thoracic problems in pediatric, mainly in
empyema thoracis, pneumothorax, and congenital diaphragmatic hernia.
Result: We used thoracoscopic
approach, which is video-assisted thoracic surgery (VATS) as the surgical
approach for cases such as recurrent primary spontaneous pneumothorax (PSP),
recurrent empyema thoracis, and congenital diaphragmatic hernia (CDH) in our
institution. All children received general anaesthesia. Selective ventilation
of the left or right bronchus was used to allow ipsilateral lung collapse for
better visualization. The patient was positioned in swimmer position or lateral
decubitus position with the ipsilateral side up and in a slight reverse Trendelenburg
position. A 5 mm incision was made on the ipsilateral of the apex of scapula,
and a 5 mm trocar was used. For empyema thoracis we used two trocars, which
were 5 mm for camera and 3 mm trocar. The fibrotic tissue was excised and the
pleural space was debrided. In recurrent pneumothorax case, we used the 5mm
trocar for the camera. An fibrotic tissue excision was done to facilitate
better drainage for the chest tube. We used the VATS approach for the CDH case
in a full-term neonates, using 5 mm and 3 mm trocars with low flow
insufflation.
Conclusion: The use of minimally invasive surgery such as
video-assisted thoracoscopic surgery can be a valuable choice in the management
of selected thoracic conditions. There is evidence that VATS provides an
advantage compared to thoracotomy. It is beneficial to minimalized the surgical
wound and shortened the time of operation.
