4 thoracoscopy in pediatric surgery - sn oak
DESCRIPTION
thoracoscopyTRANSCRIPT
Thoracoscopy in children
Dr. Sanjay OakDean & Prof of Paediatric Surgery
T.N. Medical College & B.Y.L.Nair HospitalMumbai, 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
1. Visibility2. Bleeding3. Fallacious High ET CO2
4. Iatrogenic Trauma5. Inadequate Toiletting
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 treatmentof empyema (International Paediatric Endosurgery Group, 2002)
1. 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
Suspected Empyema
CXR / CT Scan
Diagnostic thoracocentasis
Early EmpyemaOrganized
< 15 days history > 15 days history
Symptomatic Asymptomatic
ICD Primary VATS Open
decortication
VATS
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 Technique2. Two Trocar Technique3. VATS with open instruments
4. VATS with minithoracotomy
1. Primary2. After ICD Insertion
S1
S2
S2
S3
Ergonomics for Thoracoscopy
VATS - Contraindications
Chronic Empyema
Bronchopleural Fistula; Large air leaks
Coagulation disorders