Thoracoscopic Lingulectomy for Congenital Pulmonary Airway Malformation: Video Comparison Between Two Different Timing and Ventilation Strategies

Abstract

Introduction:

Thoracoscopy is generally considered the approach of choice for the treatment of uncomplicated congenital pulmonary airway malformation (CPAM) in infants and children. ^{1 –3} There is, however, an ongoing discussion about the timing ⁴ of surgery and single vs double lung ventilation. ⁵ This video highlights some of the issues regarding this debate.

Materials and Methods:

We retrospectively compare two cases of lingulectomy for segmental CPAM in two different centers. Case 1 was a 2 months old infant operated on with a main stem intubation of the right main bronchus ventilation. Case 2 was operated on at 2 years of age because of late referral and under tracheal intubation according to anesthesiologist preference. A 5 mm capnothorax was induced to achieve enough working space and isolate the lung. A video comparison is presented. Data on length of surgery, intraoperative complications, timing of chest tube removal, and length of hospital stay are analyzed.

Results:

The video shows how case 2 was particularly challenging because of left lung inflation during the procedure and chronic lung inflammation, of the left upper lobe, despite the fact that the parents reported no previous airway infections. Both of these issues contributed to the significantly longer operative time (120 minutes) in case 2 as compared with 75 minutes in case 1. In case 1, the 5 mm stapler easily controlled the division of the parenchyma, but in case 2, because of the larger size and thickness of the tissue, this was more challenging and required multiple firings of the stapler. Chest tube was removed on day 1 in case 1 and on day 4 in case 2. Length of hospital stay was 2 days in case 1 and 5 days in case 2. Anatomopathologic study confirmed the complete excision of the malformation with clear margins.

Conclusions:

Chronic inflammation, patient's age, and double lung ventilation may represent a challenge and interfere with instrument effectiveness.

This study is original and has not been published elsewhere, nor is it currently under consideration for publication elsewhere. Dr. Steven Rothenberg is a consultant for Just Right Surgical. His role is not in conflict with any aspect of this video submission. Just Right Surgical has not had (and will not have) any impact on this video preparation. No competing financial interests exist for the other authors.

Runtime of video: 5 mins 28 secs