IPEG 2020 TOP ABSTRACT: Thoracoscopic lingulectomy for a Prenatally diagnosed CPAM in a 3 month old infant

CPAM was diagnosed by prenatal ultrasound at 26 weeks

MRI at 29 weeks confirmed the CPAM diagnosis

Repeat ultrasound at 36 weeks showed an enlarging CPAM

CT scan at 3 months of age showed persistence of the CPAM in the lingula

An incomplete fissure was found upon entering the left chest

The fissure was developed using the 3 millimeter vessel sealer

The fissure can be taken in a systematic fashion with minimal blood loss and no injury to surrounding structures despite being quite incomplete

The 3 millimeter vessel sealer is used to take vessels with two separate seals placed at least 3 to 4 millimeters apart, then the vessel is divided between the seals

Partial division is accomplished first to ensure that the seals are intact, and once the lumen is seen, then the division is completed

Segmental resection of the lingula is accomplished fairly easily once all vascular and bronchial structures are taken

Hyperinflation of the lingula persists even though the rest of the lung is collapsed because of right main stem intubation

In this case, the bronchus to the lingula lies on top of the artery

The bronchus, because of its small size, is taken with a singular 5 millimeter clip

After bronchus and artery division, a line of demarcation begins to be seen between the lingula and the rest of the upper lobe

Separation between the lingula and the superior segment of the upper lobe is started with the 3 millimeter sealer and completed with the 5 millimeter stapler once the plane is clearly seen

Three applications of the 5 millimeter stapler are used to completely divide the lingula from the remnant of the upper lobe

No air leak was present after resection with lower lobe and upper lobe clearly inflating

Chest tube was removed on postoperative day one and the patient was discharged home