Thoracoscopic Lung Resection

Thoracoscopic lung resection has become the preferred approach for congenital cystic lung lesions in experienced hands, with extremely low morbidity and mortality when performed by surgeons with advanced minimally invasive skills [e883-c23, e883-c24, e883-c46, e1391-c7, e1391-c8]. The technique is feasible even in small infants (3 months, 5 kg) using 3 mm instruments, with adequate working space and the ability to safely seal vessels up to 5 mm diameter [e643-c6, e643-c7, e1041-c2, e1041-c10]. Earlier resection (3 months) offers technical advantages over delayed surgery, as subclinical inflammation develops between 3–9 months, manifesting as enlarged lymph nodes and fissure inflammation that complicate dissection [e643-c4, e643-c5, e643-c8, e1041-c3, e1041-c4]. Operative time and complication rates are lower with early resection . However, thoracoscopic lobectomy has a difficult learning curve and should only be performed by experienced surgeons; mortality has occurred when performed by less experienced operators [e420-c16, e883-c22, e883-c45, e1391-c6]. In high-volume centers, the procedure can be performed with hospital stays of 2 days and complication rates limited to occasional transfusions or prolonged air leaks [e883-c47, e883-c48, e1391-c32, e1391-c33]. The ability to salvage massive hemorrhage may be reduced compared to open surgery [e883-c26, e1391-c9]. Centers unable to perform thoracoscopic resection safely should refer patients to experienced centers to avoid thoracotomy morbidity [e643-c16, e1041-c22].