J.Jpn. Surg. Soc.. 124(6): 500-506, 2023

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CURRENT STATUS OF THORACOSCOPIC SURGERY FOR CONGENITAL CYSTIC LUNG DISEASES IN CHILDREN

Since the first thoracoscopic lobectomy for congenital cystic lung disease (CCLD) was reported in children in 2000, thoracoscopic pulmonary resection has spread rapidly and has been performed in about 200 cases (60％ of the total) in Japan. Eighty percent of CCLDs are diagnosed in the fetal stage. Symptomatic newborns are operated on early, and thoracoscopic surgery can be performed safely in all but the most severe cases. Although the question of whether and when to operate on asymptomatic children remains controversial, in our department surgery is performed within the first 6 months of life. Thoracoscopic surgery does not increase intraoperative and postoperative complications compared to open thoracotomy and resulted in more rapid drain removal and shorter hospital stays in several meta-analyses. It has been suggested that thoracoscopic surgery should be performed after acute inflammation such as pneumonia has subsided, and that increased surgeon proficiency decreases the incidence of open conversion. It has been shown that patient age and cystic size are not associated with open conversion. With advances in endoscopic surgical equipment, thoracoscopic surgery can be performed safely on neonates and infants, provided that the thoracoscopic surgical team and surgeon have the technical skills to perform the procedures.

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