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Thoracoscopic Lobectomy in Infants and Children Utilizing a 5 mm Stapling Device
Purpose: Thoracoscopic lobectomy for congenital cystic lung disease has become an accepted and in many institutions the preferred technique. However, the technical challenges are many. Previous endoscopic staplers (12 mm) used commonly in adults are too large for use in infants This study evaluates...
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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Mary Ann Liebert, Inc.
2016
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Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5165674/ https://www.ncbi.nlm.nih.gov/pubmed/27705088 http://dx.doi.org/10.1089/lap.2016.0334 |
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author | Rothenberg, Steven |
author_facet | Rothenberg, Steven |
author_sort | Rothenberg, Steven |
collection | PubMed |
description | Purpose: Thoracoscopic lobectomy for congenital cystic lung disease has become an accepted and in many institutions the preferred technique. However, the technical challenges are many. Previous endoscopic staplers (12 mm) used commonly in adults are too large for use in infants This study evaluates the safety and efficacy of using a 5 mm stapling device to seal and divide major pulmonary structures. Methods: From July 2014 to March 2016, 26 patients of age 6 weeks to 13 months underwent thoracoscopic lobectomy for CPAM or sequestration. Weights ranged from 3.2 to 11.4 kg. There were 7 upper lobectomies, 2 middle, and 17 lower lobectomies. In each case, the 5 mm stapler (Justright Surgical; Louisville, Colorado) was the primary device for vessel and bronchial sealing and division. It is 4.8 mm in diameter with an anvil length of 25 mm and lays down four rows of staples and divides between them. A 3 mm sealing device was used for dissection and to take smaller segmental vessels as necessary. Stump lines were evaluated for bleeding or air leak in all cases. Results: All procedures were accomplished successfully thoracoscopically. The stapler was used on the main lobar artery cases and vein in 24 cases, a large systemic sequestration vessel in 5 cases, and the bronchus in all 26. The stapler was also used to complete the minor fissure in 1 case and the major fissure in 1 case. A total of 96 staple loads were fired. Operative times ranged from 35 to 135 minutes. There was no significant bleeding of any vascular stump. In 1 case, the edge of the bronchial stump had to be reinforced, this was thought to be secondary to too much tissue being enclosed in the jaws. There were no postoperative complications. Conclusion: The use of a 5 mm stapling device appears to be safe and effective in thoracoscopic lobectomy in infants. It allows for safe management of major pulmonary vessels and bronchi in the confined chest of an infant through a single 5 mm port. |
format | Online Article Text |
id | pubmed-5165674 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2016 |
publisher | Mary Ann Liebert, Inc. |
record_format | MEDLINE/PubMed |
spelling | pubmed-51656742017-01-11 Thoracoscopic Lobectomy in Infants and Children Utilizing a 5 mm Stapling Device Rothenberg, Steven J Laparoendosc Adv Surg Tech A Full Reports Purpose: Thoracoscopic lobectomy for congenital cystic lung disease has become an accepted and in many institutions the preferred technique. However, the technical challenges are many. Previous endoscopic staplers (12 mm) used commonly in adults are too large for use in infants This study evaluates the safety and efficacy of using a 5 mm stapling device to seal and divide major pulmonary structures. Methods: From July 2014 to March 2016, 26 patients of age 6 weeks to 13 months underwent thoracoscopic lobectomy for CPAM or sequestration. Weights ranged from 3.2 to 11.4 kg. There were 7 upper lobectomies, 2 middle, and 17 lower lobectomies. In each case, the 5 mm stapler (Justright Surgical; Louisville, Colorado) was the primary device for vessel and bronchial sealing and division. It is 4.8 mm in diameter with an anvil length of 25 mm and lays down four rows of staples and divides between them. A 3 mm sealing device was used for dissection and to take smaller segmental vessels as necessary. Stump lines were evaluated for bleeding or air leak in all cases. Results: All procedures were accomplished successfully thoracoscopically. The stapler was used on the main lobar artery cases and vein in 24 cases, a large systemic sequestration vessel in 5 cases, and the bronchus in all 26. The stapler was also used to complete the minor fissure in 1 case and the major fissure in 1 case. A total of 96 staple loads were fired. Operative times ranged from 35 to 135 minutes. There was no significant bleeding of any vascular stump. In 1 case, the edge of the bronchial stump had to be reinforced, this was thought to be secondary to too much tissue being enclosed in the jaws. There were no postoperative complications. Conclusion: The use of a 5 mm stapling device appears to be safe and effective in thoracoscopic lobectomy in infants. It allows for safe management of major pulmonary vessels and bronchi in the confined chest of an infant through a single 5 mm port. Mary Ann Liebert, Inc. 2016-12-01 2016-12-01 /pmc/articles/PMC5165674/ /pubmed/27705088 http://dx.doi.org/10.1089/lap.2016.0334 Text en © Steven Rothenberg 2016; Published by Mary Ann Liebert, Inc. This Open Access article is distributed under the terms of the Creative Commons Attribution Noncommercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author(s) and the source are credited. |
spellingShingle | Full Reports Rothenberg, Steven Thoracoscopic Lobectomy in Infants and Children Utilizing a 5 mm Stapling Device |
title | Thoracoscopic Lobectomy in Infants and Children Utilizing a 5 mm Stapling Device |
title_full | Thoracoscopic Lobectomy in Infants and Children Utilizing a 5 mm Stapling Device |
title_fullStr | Thoracoscopic Lobectomy in Infants and Children Utilizing a 5 mm Stapling Device |
title_full_unstemmed | Thoracoscopic Lobectomy in Infants and Children Utilizing a 5 mm Stapling Device |
title_short | Thoracoscopic Lobectomy in Infants and Children Utilizing a 5 mm Stapling Device |
title_sort | thoracoscopic lobectomy in infants and children utilizing a 5 mm stapling device |
topic | Full Reports |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5165674/ https://www.ncbi.nlm.nih.gov/pubmed/27705088 http://dx.doi.org/10.1089/lap.2016.0334 |
work_keys_str_mv | AT rothenbergsteven thoracoscopiclobectomyininfantsandchildrenutilizinga5mmstaplingdevice |