Abstract
Video-assisted thoracoscopic surgery (VATS) has gained broad acceptance among pediatric
surgeons. Today, VATS can be regarded as a routine approach for various conditions
in neonates and infants. However, there is a lack of information concerning the complications
of thoracoscopic pulmonary surgery in neonates and infants. We aimed to review the
available data. A systematic review of the literature was performed using PubMed.
All publications reporting on VATS for pulmonary procedures in neonates and infants
up to the age of 1 year were included. Articles were reviewed in detail for occurrence
of perioperative complications and their treatment. Nine case series were eligible
for analysis. Entities treated included lung sequestration, congenital pulmonary airway
malformation, congenital lobar emphysema, and bronchogenic cyst. Case series reported
on a total number of 135 patients. Complications occurred in 14 patients (10.4%).
The major complication was an accidental transection of the middle lobar bronchus
that concluded in a later resection of a prior unaffected lung lobe. Other relevant
complications reported were bleeding in four patients (3.0%) and persistent air leak
in four cases (3.0%). Infectious complications were reported in four patients (3.0%).
Additionally, iatrogenic phrenic nerve paralysis occurred in one patient. There were
no deaths related to the VATS technique. In 11 cases (8.1%), conversion to thoracotomy
had been necessary. General recommendations on the treatment of complications could
not be derived due to small patient numbers and lack of details of the complications
reported. Reports on major complications of pulmonary VATS in neonates and infants
below 1 year of age are scarce. As severe complications such as accidental bronchus
transection have been described, feasibility of neonatal/infant VATS cannot be unequivocally
confirmed. No literature-based recommendation can be given on the treatment of complications.
Keywords
VATS - complications - pulmonary surgery - thoracoscopy - neonates and infants