Eur J Pediatr Surg 2021; 31(01): 054-064
DOI: 10.1055/s-0040-1716878
Original Article

Video-Assisted Thoracoscopic or Conventional Thoracic Surgery in Infants and Children: Current Evidence

1  Department of Pediatric Surgery, Hannover Medical School, Hannover, Niedersachsen, Germany
,
Christoph Zoeller
1  Department of Pediatric Surgery, Hannover Medical School, Hannover, Niedersachsen, Germany
,
Andrea Zanini
2  Department of Pediatric Surgery, University of Witwatersrand, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
,
Benno M. Ure
1  Department of Pediatric Surgery, Hannover Medical School, Hannover, Niedersachsen, Germany
,
1  Department of Pediatric Surgery, Hannover Medical School, Hannover, Niedersachsen, Germany
,
Joachim F. Kuebler
1  Department of Pediatric Surgery, Hannover Medical School, Hannover, Niedersachsen, Germany
,
Nagoud Schukfeh
1  Department of Pediatric Surgery, Hannover Medical School, Hannover, Niedersachsen, Germany
› Author Affiliations

Abstract

Introduction The pros and cons of video-assisted thoracoscopic versus conventional thoracic surgery in infants and children are still under debate. We assessed reported advantages and disadvantages of video-assisted thoracoscopy in pediatric surgical procedures, as well as the evidence level of the available data.

Materials and Methods A systematic literature search was performed to identify manuscripts comparing video-assisted thoracoscopic and the respective conventional thoracic approach in classic operative indications of pediatric surgery. Outcome parameters were analyzed and graded for level of evidence (according to the Oxford Centre of Evidence-Based Medicine).

Results A total of 48 comparative studies reporting on 12,709 patients, 11 meta-analyses, and one pilot randomized controlled trial including 20 patients were identified. More than 15 different types of advantages for video-assisted thoracoscopic surgery were described, mostly with a level of evidence 3b or 3a. Most frequently video-assisted thoracoscopic surgery was associated with shorter hospital stay, shorter postoperative ventilation, and shorter time to chest drain removal. Mortality rate and severe complications did not differ between thoracoscopic and conventional thoracic pediatric surgery, except for congenital diaphragmatic hernia repair with a lower mortality and higher recurrence rate after thoracoscopic repair. The most frequently reported disadvantage for video-assisted thoracoscopic surgery was longer operative time.

Conclusion The available data point toward improved recovery in pediatric video-assisted thoracoscopic surgery despite longer operative times. Further randomized controlled trials are needed to justify the widespread use of video assisted thoracoscopy in pediatric surgery.



Publication History

Received: 15 May 2020

Accepted: 16 August 2020

Publication Date:
07 October 2020 (online)

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany