A. Muñoz1, V. Pepper1, F. A. Khan1, A. Radulescu1 1Loma Linda University Children’s Hospital,Division Of Pediatric Surgery,Loma Linda, CA, USA
Introduction: Single-site laparoscopic surgery is gaining popularity both in the adult and pediatric populations. It is currently being used for a variety of common general abdominal pediatric procedures but not for thoracoscopic cases. We present here the case of a 16 year old male with a spontaneous right pneumothorax who underwent single-site video assisted thoracoscopic (VATS) bleb resection and pleurodesis.
Methods: Our patient is a 16 year old male without any significant medical or surgical history, who was seen at an outside facility for chest pain and shortness of breath. He was diagnosed with a spontaneous right sided pneumothorax, a chest tube was placed and he was transferred to our center for continuation of care. Due to the failed nonoperative management the decision was made to take him to the operating room for a single-site VATS bleb resection and pleurodesis. The patient was intubated, positioned in the standard left lateral decubitus position and then single lung ventilation was accomplished. The original chest tube site was used as the access point to the right chest cavity. The site was enlarged slightly to accommodate the width of the operating surgeon index finger. We used a GelPoint Mini (Applied Medical) containing two 10mm trocars and one 12mm trocar as shown in the attached image (Figure 1A). This access allowed us to easily identify the lung apex, resect the blebs with an endoGIA stapler and perform a thorough pleurodesis and partial apical pleurectomy. At the conclusion of the case the underlying chest wall muscle and skin were reapproximated around a 20 Fr chest tube (Figure 1B).
Results: Postoperative course was uneventful and the patient was discharged home after chest tube was removed on postoperative day 3.
Conclusion: Single site VATS is a safe surgical option for management of pneumothorax. It minimizes the number of incisions and thus the postoperative pain. It allows the same visualization and access to the apical lung as the conventional 3 port thoracoscopic procedure.
