J.Jpn. Surg. Soc.. 126(1): 27-31, 2025

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Feature topic

THE IDEAL STATE OF PEDIATRIC SURGERY FROM A THORACIC SURGEON’S PERSPECTIVE

Pediatric surgeons must perform surgical treatments that cover almost the entire body. Their anatomic knowledge must be extensive. From a technical standpoint, operating on children, where both the working space and organs are small, is extremely challenging. Additionally, there are many physiological limitations, such as the lower acceptable blood loss. Moreover, there are situations where one-lung ventilation, which is routinely performed in adults, is difficult to achieve in terms of airway management. Unlike adults, children require skin incisions and surgical approaches that take into account their subsequent growth. Therefore, minimally invasive surgery becomes crucial. It is not hard to imagine that the relationship between family and pediatric patients is distinctly different from adult parent–child relationships. To comprehensively address these issues, highly advanced training as a pediatric surgeon is required. Surgeries in specialized environments like the thorax often require expert knowledge, necessitating support from thoracic surgeons. Considering that the experience required of an experienced thoracic surgeon is necessary for such judgments, it may be worth considering limiting pediatric surgery for thoracic diseases to a few high-volume centers. Generally, several hundred lung resections are needed for a thoracic surgeon to become essentially independent, but it is nearly impossible to demand this of pediatric surgeons.

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