Argon Beam Coagulator and Video-Assisted Thoracic Surgery in Children

Abstract

Pneumothorax and chylothorax are complications that often require surgical treatment. Closed tube thoracostomy is considered the first therapeutic approach in many cases, but this procedure is associated with a recurrence rate as high as 45%. In recent years, video-assisted thoracic surgery (VATS) combined with argon beam coagulation (ABC) has gained in popularity as the treatment of choice for various thoracic problems.

Materials and Methods

: From January 2000 to March 2001, five patients with thoracic diseases were referred to our department. Three patients presented with right chylothorax and dyspnea after liver transplantation. Three patients were referred for severe dyspnea secondary to recurrent right pneumothorax caused by ruptured subpleural blebs. All patients underwent VATS. In addition, the patients with chylothorax underwent ABC thermal pleurodesis, and the patients with pneumothorax underwent ABC thermal pleurodesis and ABC thermal ablation of the subpleural blebs.

Results

: All patients were treated successfully. The only recurrence was in a patient with chylothorax, who required a second VATS procedure. The mean duration of the procedure was 90 minutes (range, 60-180 minutes). The average postoperative hospital stay was 9 days (range, 3-7 days). No mortality and no intraoperative complication occurred. At 1-year follow-up, all the patients are well.

Discussion

: Because chest wall injury is minimal and recovery complete, VATS and ABC are ideal techniques to treat benign thoracic diseases such as pneumothorax and chylothorax in children. In comparison with traditional surgery, hospitalization is not reduced with this approach, but the cosmetic result is better. Postoperative pain lasted for only 24 hours and was well managed with a continuous peridural infusion of 0.25% bupivacaine. Although this is a small series with limited follow-up, we are delighted that the procedure resulted in clinical improvement in our patients, and we believe that in the future, VATS and ABC will provide still better results as the techniques are refined.