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Thoracoscopic Tri-segmentectomy in One-year Old Child
최진호, 강창현, 박샘이나, 복진산, 황유화, 이현주, 박인규, 김영태
서울대학교 의과대학 서울대학교병원 흉부외과학교실
Background : Congenital cystic adenoid malformation (CCAM) can involve multiple lobes. Limited resection is a promising procedure in multifocal CCAM despite its technical challenges. We demonstrate a case of thoracoscopic tri-segmentectomy in one-year old child with CCAM.
Methods : One-year old female patient was diagnosed with CCAM by fetal ultrasonography. The patient had no history of pneumonia. CCAM involved three segments in left upper and lower lobes: apicoposterior segment in left upper lobe, superior and posterobasal segment in left lower lobe. Thoracoscopic tri-segmentectomy was planned instead of pneumonectomy which may cause developmental deformity and poor long-term survival.
Results : Single lumen endotracheal tube with endobronchial blocker was used for one-lung ventilation. Patient was positioned right lateral decubitus. A 1.5 cm sized working window was made in 6th intercostal space and two 3 mm sized ports were made at 8th intercostal space. Mini-thoracoscopy with 3 mm diameter was used during the operation. Lung parenchyme was divided by Harmonic scalpel and segmental pulmonary arteries and veins were individually divided. Segmental bronchus was divided by endoscopic stapler. There was no intraoperative event. Three segments including superior and posterobasal segment in lower lobe and apicoposterior segment in upper lobe was completely removed with en bloc resection. The patient was discharged in postoperative day 4 without any complication.
Conclusion : Thoracoscopic multi-segmentectomy can be safely performed in children with congenital cystic adenomatoid malformation involving multiple segments distributing more than a lobe.
Methods : One-year old female patient was diagnosed with CCAM by fetal ultrasonography. The patient had no history of pneumonia. CCAM involved three segments in left upper and lower lobes: apicoposterior segment in left upper lobe, superior and posterobasal segment in left lower lobe. Thoracoscopic tri-segmentectomy was planned instead of pneumonectomy which may cause developmental deformity and poor long-term survival.
Results : Single lumen endotracheal tube with endobronchial blocker was used for one-lung ventilation. Patient was positioned right lateral decubitus. A 1.5 cm sized working window was made in 6th intercostal space and two 3 mm sized ports were made at 8th intercostal space. Mini-thoracoscopy with 3 mm diameter was used during the operation. Lung parenchyme was divided by Harmonic scalpel and segmental pulmonary arteries and veins were individually divided. Segmental bronchus was divided by endoscopic stapler. There was no intraoperative event. Three segments including superior and posterobasal segment in lower lobe and apicoposterior segment in upper lobe was completely removed with en bloc resection. The patient was discharged in postoperative day 4 without any complication.
Conclusion : Thoracoscopic multi-segmentectomy can be safely performed in children with congenital cystic adenomatoid malformation involving multiple segments distributing more than a lobe.
책임저자: 강창현
서울대학교 의과대학 서울대학교병원 흉부외과학교실
연락처 : 최진호, Tel: 02-2072-2348 , E-mail : miracleho@gmail.com
