From
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Panel Discussion: Pediatric Thoracic Surgery Part 1-Lung Lesions 2012
With Dr. Steven Rothenberg · hosted by Dr. Todd Ponsky
Educational content from recorded physician discussions — not medical advice. Talk to your (or your child's) care team about your situation.
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What the experts said
Taking a lobectomy from an infant gives normal pulmonary function when the child is older.
The risk of leaving CPAM disease behind by segmentectomy is relatively high.
Segmentectomy of segment 6 and segment 10 is very difficult to perform thoracoscopically.
For a superior-segment lower-lobe CPAM, the morbidity of segmentectomy is extremely low.
If you do 100 segmentectomy cases, the likelihood of missing disease is significantly higher than with lobectomy, and the likelihood of complications is higher.
Patients with spontaneous pneumothorax who undergo simple chest-tube placement have an upwards of 50% recurrence rate if they have bleb disease.
There is no study separating patients with blebs versus no blebs on first pneumothorax event to determine differential recurrence risk.
Almost all kids with spontaneous pneumothorax have some degree of bleb disease whether we define it early or not.
Bleb disease does not necessarily mean recurrence of pneumothorax.
Treating every kid with blebs on first pneumothorax results in a 50% rate of unnecessary pleurodesis.
For bilateral bleb disease, performing bilateral surgery prevents contralateral recurrence in the immediate postoperative period.
Performing apical pleurectomy limited to the third interspace avoids whole-chest adhesions, unlike talc pleurodesis.
Hydrostatic pleurectomy involves injecting saline under the pleura to dissect it off the chest wall, allowing removal of a larger area than apical pleurectomy alone.
Talc pleurodesis causes solid adhesions throughout the pleural space, making future thoracotomy difficult.
In hydatid cyst surgery, there is a good plane between the lung and the parasitic membrane, making thoracoscopic removal feasible before adhesions form.
Once the parasitic membrane is removed in hydatid cyst surgery, the patient is cured; subsequent bronchial fistulas are a mechanical closure problem.
Intracavitary thoracoscopic suturing of bronchial fistulas may work for small fistulas but is not appropriate for large fistulas.
Hem-o-lok clips are more reliable than metal clips for vascular and bronchial control.
Large-size Hem-o-lok clips (10 mm diameter) can be used for very wide and large bronchi, even in patients over 7 years old undergoing lobectomy.
Persistent air leak has not been a problem in infant lobectomies with incomplete fissures, even without tissue sealant.
A recent study from Saint Peter's in Kansas City found CT scan is very poor at defining bleb disease compared to subsequent thoracoscopy.