Uniportal video-assisted thoracoscopy in pediatrics-initial experience.

Background: It has become apparent that the endoscopic surgeries are rapidly developing, and they have become an essential part of every specialty of surgery. Single port thoracoscopic surgery is developing, enhancing the advantages of muti-portal video-assisted thoracoscopic surgery (VATS). Although becoming a well-recognised approach for adult patients, extremely limited literature exists concerning uniportal VATS among pediatric cases. This study aims to present our initial experience with this approach in a single tertiary hospital and extrapolate its feasibility and safety in this specific context. Methods: Perioperative parameters and surgical outcomes for all pediatric patients who underwent an intercostal or subxiphoid uniportal VATS surgery in our department in 2 years retrospectively reviewed. The median length of follow-up was 8 months. Results: Sixty-eight pediatric patients underwent different uniportal VATS operation for different types of pathology. The median age was (3.5 years). Median operating time was 116 minutes. Three cases converted to open. The mortality rate was zero. The median length of stay was 5 days. Three patients presented complications. Three patients lost from follow-up. Conclusions: Despite literature data heterogeneity, these results provide support to the feasibility and applicability of uniportal VATS in the pediatric population. Further studies are required to explore the benefit of uniportal over multi-portal VATS (including chest wall deformities, cosmesis and quality of life).

Rare case of horseshoe lung associated with scimitar syndrome in Palestine: a case report.

The caudal and basal parts of the lungs are fused together in a rare congenital bronchopulmonary anomaly known as horseshoe lung. The majority of horseshoe lung cases are associated with scimitar syndrome. Most patients present with nonspecific symptoms. Multidetector pneumoangiography can be used to diagnose horseshoe lung, which shows that the isthmus of the pulmonary parenchyma traverses the midline, connecting the two lungs together. Treatment and prognosis are usually determined depending on the presence of other concomitant anomalies and the degree of symptom severity. Case Presentation: A 3-month-old-male patient presented with respiratory symptoms and a history of chest infection. Chest imaging revealed anomalous venous drainage from the right lower lobe of the lung, right lung hypoplasia with mediastinal shift, and a parenchymal isthmus extending between the two lungs. The patient was diagnosed with horseshoe lungs associated with scimitar syndrome. He was also found to have extralobar sequestration to the right lower lobe of the lung. The patient underwent surgical management in the form of tunneling of the anomalous vein into the left atrium using pericardium autograft ligation of the sequestration artery. Clinical Discussion: Because of its common association with other congenital malformations such as scimitar syndrome and cardiovascular defects, clinicians should be meticulous in the investigation and workup process of patients with horseshoe lung in order not to miss any of these associated abnormalities. Conclusion: Although it is very rare, horseshoe lung should be considered in the differential diagnosis of respiratory distress symptoms, especially in children younger than 1 year.

Successful surgical resection of a complicated left ventricular diverticulum in a neonate presented with unexplained anemia: a case report.

Congenital left ventricular diverticulum (LVD) is a rare congenital cardiac anomaly and may be complicated by fatal adverse events such as diverticulum rupture. Most LVD cases are asymptomatic and often discovered incidentally. Herein, we describe an unusual and peculiar clinical presentation with felicitous surgical management of ruptured LVD. Case presentations: A 10-day-old male infant presented with severe, intractable, and unexplained anemia associated with respiratory distress. Upon admission, the patient was clinically shocked with a hemoglobin level of 6.0 g/dl. As chest imaging showed cardiomegaly, echocardiography was performed and revealed a 9×10 mm diverticulum arising from the posterolateral wall of the left ventricle along with blood and clot collection in the pericardium. The patient underwent an urgent surgical resection of the diverticulum. He was followed up for 2 years without any readmissions or cardiac complaints. Clinical discussion: Systemic thromboembolism, heart failure, infarction, and tachyarrhythmias have all been reported as complications of LVD. The most serious complication is diverticulum rupture, which can result in death. As a result, this congenital defect should be discovered early to determine the potential risks and plan appropriate treatment. Conclusion: Congenital heart defects such as LVD should be suspected in neonates presenting with unexplained and intractable anemia. To avoid the diagnosis confusion and risk of serious complications in LVD patients, such as spontaneous rupture of the diverticulum, we advocate immediate surgical management of LVD in children.

Uniportal video assisted thoracoscopy versus open surgery for pulmonary hydatid disease-a single center experience.

BACKGROUND: Although rare in the Western world, the incidence of hydatid disease is still prevalent and strikingly endemic among the Palestinians. Until 2017, surgical treatment of lung pathologies was performed through the traditional incision (open thoracotomy). Uniportal video-assisted thoracoscopic surgery (VATS) approach has recently been applied in the cases of the pulmonary hydatid cysts with very satisfactory results. METHODS: Between January 2010 and January 2019, 39 patients with pulmonary HC disease have been surgically treated. The cases divided into two cohorts: operations performed by thoracotomy classified as group A, (n=16). Operations performed by uniportal VATS classified as group B, (n=23). Prospectively collected data was analysed retrospectively, and the results compared between both groups. RESULTS: No significant statistical differences were noticed in terms of demographics and comorbidity. Laboratory tests were similar except haemoglobin level, which was higher in group A (P=0.001). Despite that, blood transfusion was higher in group A (P=0.016). Moreover, operation time was longer in group A (P=0.000). Chest drainage remained longer in group A (P=0.077). The level of postoperative pain was significantly higher in group A certainly in POD 1 (P=0.000). Patients in group B discharged earlier from the hospital (P=0.011) and experienced lower complications (P=0.060). No significant difference in length of ICU stay. Neither recurrence nor 30-day mortality recorded in either group. CONCLUSIONS: Uniportal VATS can be safely applied for pulmonary hydatidosis. It also seems to have a preference in several aspects compared to open Thoracotomy approach.

Modified repair of interrupted aortic arch utilizing retroesophageal right subclavian artery based on a neonatal hybrid approach in hypoplastic left heart complex.

OBJECTIVE: Interrupted aortic arch (IAA) combined with an aberrant right subclavian artery (ARSA) is frequently associated with a hypoplastic ascending aorta. Neonatal surgical therapy carries a high risk particularly for aortic arch obstructions during the further follow-up. METHODS: We performed a modified reconstruction of the aortic arch utilizing the ARSA as a natural substitute in a staged surgical approach. In a novel approach, the distal part of the ARSA is reimplanted into the brachiocephalic trunk. RESULTS: In three patients, a novel arch reconstruction was successfully performed during complete biventricular repair. In a follow-up of 60 to 87 months, the reconstructed aortic arch has grown without any signs of obstruction in all three patients. CONCLUSION: Utilizing the ARSA for surgical aortic arch repair is a satisfactory solution, when postnatal borderline left heart obstruction associated with IAA and ARSA is postponed by an initial hybrid approach.