Thoracoscopic treatment of primary spontaneous

pneumothorax in children

Maria MarciniakStudents' Scientific Society at the Department of Surgery and

Oncology of Medical University in LodzTutor: J. Jablonski, MD

Head of Pediatric Surgery and Oncology Clinic: Prof. E. Andrzejewska, MD, PhD

PneumothoraxThe accumulation of free air within the

pleural cavity with subsequent collapse of the lung

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PNEUMOTHORAX

Traumatic Idiopathic Iatrogenic

SecondaryPrimary

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Primary spontaneous pneumothorax

Subpleural emphysema bubbles burst

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Guimaraes CVA i wsp. CT findings for blebs and bullae in children with spontaneous pneumothorax and comparison with findings in normal age-matched controls. Pediatr Radiol. 2007

Guimaraes CVA i wsp. CT findings for blebs and bullae in children with spontaneous pneumothorax and comparison with findings in normal age-matched controls. Pediatr Radiol. 2007

The formation of subpleural emphysema bubbles

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Treatment of PSP

Conservative

SurgicalDrainage passive / active

Puncture and aspiration

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SURGICAL TREATMENT

Thoracotomy Thoracoscopy

Excision of pulmonary emphysema bubbles

Pleurodesis

Pleurectomy

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THORACOSCOPY

Effective diagnostic and therapeutic tool

Is considered by many authors as „gold standard" in the treatment of

PSP

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PSP treatment in children

None of the guidelines for the PSP differentiate pediatric patients

A small number of reports on the treatment of PSP in children (1985-2010 r. - 23 reports)

There is no optimal algorithm

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40-61% 40-61% of children have recurrent pneumothorax after drainage of the first

episode of PSP

Small amount of relapses

Shortening the duration of hospitalization

Lower costs

EarlierEarlier thoracoscopythoracoscopy

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Pneumothorax in children

Lack of lung expansion after drainage

Recurrence of pneumothorax on the opposite side

Air leak > 5-7 days

Simultaneous bilateral pneumothorax

The first episode of pneumothorax

The second episode of pneumothorax on the same side

Drainage of the pleural cavity

Thoracoscopy

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Thoracoscopic treatment of spontaneous pneumothorax

in the Department of Pediatric Surgery and Oncology

• 3 patients (4 operations) 2007-2010

• all patients showed the presence of emphysema bubbles at the top of the lungs

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Chest pain, shortness of breath n = 3Radiological examination

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Computed tomography n = 2

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Boy 16 year old• Episode I of pneumothorax on the left side –

successful drainage of pleural cavity, discharged after 11 days of treatment

• Episode II (after 4 weeks) - drainage of pleural cavity

• Episode III (after 6 weeks)• CT - emphysema bubble at the top of the

lung• thoracoscopy in the 3rd day of

hospitalization, discharged after 10 days of treatment

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Boy 15 year old• Episode I - spontaneous pneumothorax on

the left side• indications - the persistent air leak after the

insertion of pleural drainage• thoracoscopy in 9th day of treatment• discharged at 4th day after surgery• Episode II - pneumothorax on the right side 8

weeks after recovery of the left pneumothorax

• thoracoscopy with resection of the pulmonary emphysema at the top of the right lungdischarged after 3 days

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Girl 17 year old

• pneumothorax on the right side - pleural drainage

• indications - persistent air leak after a period of improvement

• thoracoscopy in the 20th day of treatment - resection of pulmonary emphysema bubbles located at the top of the lung

• discharged after 7 days

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Summary

• in all patients treated with thoracoscopy we obtained a good result

• there were no complications

• there were no recurrences - the period of observation 6 - 12 months

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MOVIE

Conclusion

1. The high relapse rate in children treated with drainage of the pleural cavity due to the PSP supports the eligibility of these patients

prior to thoracoscopy

2. Thoracoscopy in children with PSP is an effective and safe therapeutic procedure

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Epidemiology of PSP - Children

The average age 13 years (13-17)

Incidence:?

No simultaneous bilateral pneumothorax - 27%

Simultaneous bilateral pneumothorax - 6 - 9%

THORACOSCOPY

Minimally invasive method

Very good visualization of lesions

Shorter hospitalization

Rapid return to full physical activity