VIDEO-ASSISTED THORACOSCOPIC VASCULAR RING DIVISION IN INFANTS AND CHILDREN

Objectives. This study evaluated our early experience with video-assis ted thoracoscopic vascular ring division and compared this approach wi th division by means of a conventional open thoracotomy. Background. V ideo-assisted thoracoscopic techniques reduce surgical trauma and have been applied to several adult thoracic procedures; however, pediatric applications have been limited. We developed instruments and techniqu es for video assisted thoracoscopic vascular ring division in the pedi atric population. Methods. We compared patient characteristics, operat ive results and postoperative hospital courses of all patients undergo ing vascular ring division by a video-assisted approach with a histori cal control group of all patients undergoing division by an open thora cotomy between January 1991 and December 1992. Results. Eight patients (median age 5 months, range 40 days to 5.5 years; median weight 6.2 k g, range 1.8 to 17.1) underwent video-assisted thoracoscopic vascular ring division. Four had a double aortic arch with an atretic left arch and a left ligamentum, and four had a right aortic arch with aberrant left subclavian artery and a left ligamentum. All eight had successfu l ring division with symptomatic relief and no mortality. A limited th oracotomy was performed in three patients to divide patent vascular st ructures, and the hospital period was prolonged in one because of chyl othorax. These eight patients were compared with a historical cohort o f eight pediatric patients having vascular ring division performed by a conventional thoracotomy. The two groups did not differ in age, weig ht, intensive care unit or postoperative hospital stay, duration of in tubation or thoracostomy tube or hospital charges. Total operating roo m time was longer for the group undergoing video-assisted operation. C onclusions. Early results for video-assisted thoracoscopic vascular ri ng division are comparable to those of the conventional surgical appro ach. With further refinement in technique and instrumentation, video-a ssisted surgical intervention may became a viable alternative to open thoracotomy for management of the symptomatic vascular ring.