Pediatric Thoracoscopy (VATS)

Pediatric Thoracoscopy (VATS)

Thoracoscopy, also known as Video-Assisted Thoracoscopic Surgery (VATS), is a minimally invasive surgical technique used to diagnose and treat various thoracic conditions in children.

Key Concepts:

  • Minimally invasive approach to thoracic cavity
  • Uses small incisions with camera-guided visualization
  • Reduced post-operative pain and recovery time
  • Better cosmetic results compared to open thoracotomy
  • Requires specialized pediatric equipment and expertise

Indications & Contraindications

Primary Indications:

  • Diagnostic Procedures:
    • Lung biopsy
    • Mediastinal mass biopsy
    • Pleural biopsy
    • Evaluation of thoracic tumors
  • Therapeutic Procedures:
    • Empyema drainage and decortication
    • Lobectomy
    • Congenital lung malformations
    • Mediastinal cyst removal
    • Repair of congenital diaphragmatic hernia
    • Treatment of pneumothorax
    • Esophageal atresia repair

Contraindications:

  • Absolute:
    • Inability to tolerate single-lung ventilation
    • Severe coagulopathy
    • Severe pleural adhesions
    • Hemodynamic instability
  • Relative:
    • Previous thoracic surgery
    • Severe pulmonary dysfunction
    • Large thoracic masses
    • Morbid obesity

Procedure Details

Pre-operative Preparation:

  • Complete medical evaluation
  • Imaging studies (CT, MRI as indicated)
  • Laboratory tests
  • NPO status appropriate for age
  • Informed consent

Anesthetic Considerations:

  • General anesthesia with endotracheal intubation
  • Single-lung ventilation techniques:
    • Bronchial blockers
    • Double-lumen tubes (in older children)
    • Mainstem intubation
  • Temperature monitoring
  • Arterial line placement

Surgical Technique:

  1. Patient Positioning:
    • Lateral decubitus position
    • Proper padding and securing
    • Access for anesthesia
  2. Port Placement:
    • Typically 3-4 ports
    • Strategic triangulation
    • Size based on patient age/size
  3. Procedure Steps:
    • Initial exploration
    • Specific procedure execution
    • Hemostasis confirmation
    • Chest tube placement if needed

Equipment & Setup

Essential Equipment:

  • Imaging System:
    • HD camera system
    • Light source
    • Video monitors
    • Recording system
  • Surgical Instruments:
    • Pediatric thoracoscopic instruments
    • Energy devices
    • Endoscopic staplers
    • Suction/irrigation systems
  • Disposables:
    • Trocars (3-5mm)
    • Endoscopic bags
    • Chest tubes
    • Sutures

Room Setup:

  • Equipment positioning
  • Team positioning
  • Emergency equipment access
  • Conversion setup availability

Complications & Management

Intraoperative Complications:

Complication Management
Bleeding
  • Direct pressure
  • Conversion if needed
  • Blood product administration
Air leak
  • Identify source
  • Suture repair
  • Sealant application
Ventilation issues
  • Coordinate with anesthesia
  • Adjust port placement
  • Consider conversion

Post-operative Complications:

  • Prolonged air leak
  • Atelectasis
  • Infection
  • Chest wall pain
  • Port site issues

Post-Operative Care

Immediate Post-op Management:

  • Pain control
    • Regional techniques
    • Multimodal analgesia
    • Age-appropriate medications
  • Respiratory care
    • Chest physiotherapy
    • Incentive spirometry
    • Early mobilization
  • Chest tube management
    • Drainage monitoring
    • Air leak assessment
    • Removal criteria

Follow-up Care:

  • Wound care instructions
  • Activity restrictions
  • Follow-up schedule
  • Return precautions
  • Long-term monitoring plan

Expected Recovery Timeline:

  • Hospital stay: 2-5 days typical
  • Return to activities: 2-4 weeks
  • Full recovery: 4-6 weeks
  • Long-term outcomes monitoring
Further Reading


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