Pediatric Thoracoscopic Surgery is a minimally invasive surgical approach used to treat various intrathoracic conditions in infants and children. It uses a thoracoscope (a small camera) and specialized instruments introduced through small incisions, reducing the need for traditional open thoracotomy. This technique provides excellent visualization and improves patient outcomes.
Advantages of Pediatric Thoracoscopy
- Minimal surgical trauma and smaller scars
- Reduced postoperative pain and narcotic use
- Faster recovery and shorter hospital stay
- Lower risk of postoperative scoliosis or musculoskeletal deformities
- Better visualization of thoracic anatomy
Common Indications
- Tracheoesophageal fistula (TEF) and esophageal atresia (EA) repair
- Congenital diaphragmatic hernia (CDH) repair
- Excision of congenital pulmonary airway malformation (CPAM)
- Pulmonary sequestration resection
- Mediastinal mass biopsy or removal
- Empyema drainage and decortication
Instrumentation and Setup
- 3 mm or 5 mm thoracoscopic ports and instruments
- High-resolution, angled-lens endoscopic cameras
- Low-pressure CO2 insufflation (typically 3–5 mmHg)
- Specialized pediatric energy devices (e.g., vessel sealers)
Anesthetic and Perioperative Considerations
- Requires experienced pediatric anesthesia team
- Intraoperative monitoring of ventilation and CO2 levels
- One-lung ventilation may be used in older children
- Thermal support and careful fluid management
Outcomes and Limitations
- Excellent long-term outcomes in most cases
- Minimally invasive approach reduces recovery time
- High learning curve—requires experienced pediatric surgeons
- Conversion to open surgery may be needed in some complex cases
Conclusion
Pediatric thoracoscopic surgery is a safe and effective minimally invasive option for managing a wide range of thoracic pathologies in children. As expertise and technology continue to advance, it is increasingly becoming the standard of care in pediatric surgical centers worldwide.
