Thoracoscopy in

children
Dr. Sanjay Oak

Dean & Prof of Paediatric Surgery

T.N. Medical College & B.Y.L.Nair Hospital
Mumbai, India

VATS Vs. Laparoscopy

Equipment

- Short Trocars

Ergonomics

- No fixed position

Vision
CO2 Insufflation
Rigid Chest wall

Indications for VATS in children

Decortication
Lung biopsy
Mediastinal lymph node biopsy
Lobectomy/Segmentectomy
Resection of bullae
Repair of Diaphragmatic hernia
Diaphragmatic plication
TEF Repair

VATS - Advantages
No morbidity of Thoracotomy
Cosmetic
Reduced Post-op. pain
Repeatable

Difficulties in VATS
Visibility
2. Bleeding
3. Fallacious High ET CO2
1.

Iatrogenic Trauma
5. Inadequate Toiletting
4.

Diagnostic VATS Blunt chest trauma

Eventration of diaphragm

Diaphragmatic
hernia repair

VATS lung biopsy in children

Saves operative time
Good visualisation
Definitive diagnosis yield not compromised

Indications
Non-resolving pneumonia
Interstitial lung disease
Indeterminate pulmonary nodules

VATS in pulmonary hydatid

VATS excision
VATS assisted minithoracotomy
VATS lung resection

VATS excision of hydatid

Surgical treatment
of empyema

(International Paediatric Endosurgery Group, 2002)

Failure of intravenous antibiotics to

improve pulmonary pathology
2. Cases in which pleural fluid can not be
aspirated by needle or drained by tube
thoracostomy
3. Patients with ESS score of 2
1.

Suspected Empyema
CXR / CT Scan
Diagnostic thoracocentasis

Early Empyema
< 15 days history
Symptomatic
ICD
VATS

Organized
> 15 days history

Asymptomatic
Primary
VATS

Open decortication

Surgical Management
Decortication
Early

Vs. Late

Open

Vs. Video Assisted Thoracoscopic

Surgery (VATS)

PRE OP PICTURE

POST OP PICTURE

IMMEDIATE POST OP X RAY

AFTER REMOVAL OF ICD

6 MONTHS POST OP

VATS in empyema

1. Three Trocar Technique

2. Two Trocar Technique
3. VATS with open instruments
4. VATS with minithoracotomy

1. Primary
2. After ICD Insertion

S3

S1

S
2

S
2

Ergonomics for Thoracoscopy

VATS - Contraindications
Chronic Empyema
Bronchopleural Fistula; Large air leaks
Coagulation disorders