Thoracoscopic Management of Bilateral Congenital Pulmonary Airway Malformation with Systemic Blood Supply: Use of a Novel 5mm Stapler

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Author: American Pediatric Surgical Association
Published:
Specialties: Cardiothoracic Surgery, Pediatric Surgery
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Basic Info

from the APSA 2015 Annual Meeting proceedings

THORACOSCOPIC MANAGEMENT OF BILATERAL CONGENITAL PULMONARY AIRWAY MALFORMATION WITH SYSTEMIC BLOOD SUPPLY: USE OF A NOVEL 5MM STAPLER

Authors:

Sandra M. Farach, MD, Paul D. Danielson, MD, Nicole M. Chandler, MD.
All Childrenâs Hospital Johns Hopkins Medicine, Saint Petersburg, FL, USA.

Purpose:
Congenital pulmonary airway malformations (CPAM) and bronchopulmonary sequestrations (BPS) are two commonly discussed congenital lung malformations (CLM). We present a case of bilateral thoracoscopic lobectomy in a patient with bilateral, combined CPAM and BPS and report the novel use of a 5 mm linear stapling device.

Methods:
This is a retrospective review of a 9-month-old female patient with bilateral, combined CPAM and BPS who underwent bilateral thoracoscopic lower lobectomy.

Results:
The left lower lobectomy is demonstrated in this video. This was performed via a modified lateral position with the left side up using two 3 mm ports and two 5 mm ports. The lower lobe was resected cephalad. The systemic vessel was identified and secured. Polymer clips were placed, and the vessel was divided with a 5 mm stapling device. The pulmonary artery was divided with a vessel sealing instrument. The pulmonary vein was identified and was divided with the 5 mm stapler after endoscopic clips were placed. The bronchus was then identified and was divided with the 5 mm stapler. The most inferior port was
removed and the incision widened to allow for extraction of the specimen. A 12 French chest tube was inserted into the left chest cavity under direct visualization. Total operative time was 146 minutes. The patient did well and was discharged on post-operative day two. Pathology revealed intralobar pulmonary sequestration with pulmonary systemic and pulmonary artery hypertensive changes and congenital cystic pulmonary airway malformation Type I.

Conclusion:
The literature has reported good outcomes with thoracoscopic lobectomy for congenital airway malformations. We present a successful case of bilateral thoracocsopic lobectomy for a rare finding of bilateral, combined CPAM and BPS as well as the effectiveness and safety of using a 5 mm linear stapling device.

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