Thoracoscopic resection of mediastinal masses in infants and children: An evaluation of technique and results

Background: Thoracoscopy has been accepted as a technique in pediatric surg ery for diagnosis of thoracic pathology, but there has been little experien ce using it as a therapeutic modality as well. The purpose of this report i s to describe and critically evaluate a 7-year experience with thoracoscopi c diagnosis and resection of mediastinal masses in infants and children. Methods: From February 1993 to June 2000, 39 patients presented with medias tinal masses and no tissue diagnosis. Age ranged from 5 months to 18 years old and weight from 3.6 to 110 kg. Twelve children had anterior mediastinal masses, 27 posterior. The patients were positioned in a modified prone or supine position, and single lung ventilation was performed on the contralat eral side. Three or 4 valved trocars were utilized with 3 and 5 mm instrume ntation. Results: A total of 38 of 39 procedures were completed successfully endosco pically. The procedure in 1 patient with a sarcoma was converted to thoraco tomy because of extensive disease. Operating times ranged from 20 to 185 mi nutes. Diagnosis was obtained in all cases, and complete excision was perfo rmed in 33. All children were extubated in the operating room; 8 chest tube s were placed but removed within 24 hours. Hospital stay ranged from 12 hou rs to 4 days. Pathology included 12 foregut duplications, 7 ganglioneuromas , 6 neuroblastomas, 6 lymphomas, 3 teratomas, 2 sarcomas, and 3 other lesio ns. Conclusion: Thoracoscopy is a safe and effective method to evaluate, biopsy , and in most cases resect lesions of the anterior and posterior mediastinu m in infants and children. J Pediatr Surg 36:1165-1167. Copyright (C) 2001 by W.B. Saunders Company.