Thoracoscopic procedures in children [Çocuklarda torakoskopik girişimler]

Background/aim: Advances in minimally invasive surgical techniques has led to increasing use of thoracoscopic procedures in children. Patients who have been operated with this technique in our department were evaluated for the efficacy and the complications of thoracoscopic surgery. Method: Twenty three patients had 24 thoracoscopic procedures (17 right and 7 left) in the last two years. Mean age of the patients was 5 years (7 months-14 years). Selective intubation of contralateral main bronchus, obliteration of ipsilateral main bronchus by a Fogarty catheter or CO2 insufflation into the pleural space with 5-8 mmHg pressure were the methods used to collapse the ipsilateral lung. Number of trocars used during the procedures ranged between 2 and 4. Ten-mm telescope was used in two patients while 5 mm was preferred for the remaining. In 4 patients, two drains were placed into the pleural space while the remaining patients had only one drain postoperatively. Results: Fourteen debridements for empyma, 1 bronchopleural fistula ligation, 4 parenchymal biopsies, 1 exploration for thoracic trauma, 2 mediastinal lymph node biopsies, 1 resection of pulmonary cyst, and 1 Heller esophagomyotomy were performed. Mean operating time was 2.8 (0.5-6) hours. In only 1 patient (mediastinal lymph phadenopathy), the operation was converted to a thoracotomy because of bleeding. There were 5 bronchopleural fistulas (4 debridements for empyema and 1 parenchimal biopsy) as a complication, and these patients required prolonged tube thoracostomy (mean 17; 11-21 days). Three of these patients healed with conservative measures while one required a second thoracoscopy and the other required a thoracotomy for closure of the fistula. Mean time for tube thoracostomy in the remaining 18 patients was 3.8 (1-12) days. Conclusion: Thoracoscopic surgery is safe and effective in children. However, postoperative chest tube drainage may be prolonged due to bronchopleural fistulas in patients with severe parencymal damage.