Abstract
Accurate division and sealing of lung parenchyma particularly in cases of total or near total incomplete fissure are crucial for preventing air leakage following thoracoscopic pulmonary lobectomy (TPL). However, conventional endoscopic stapling devices cannot be used during TPL in small children because of limited space. Consequently, Ligasure (LS) and Enseal (ES) devices are being used instead. We are the first to compare LS and ES for efficacy and efficiency during TPL. Of 26 TPL (6 upper, 3 middle, and 17 lower) performed for congenital adenomatoid malformation (n = 16) and sequestration (n = 10), incomplete fissure was found in 14. TPL (LS = 11; ES = 15) was performed conventionally in the lateral decubitus position with single lung ventilation using four 5 mm trocars. All cases had a chest tube inserted intraoperatively that was left in situ. Patient demographics, location of pathology, incidence of incomplete fissure, mean age/weight at TPL, mean blood loss, and mean operative time were all similar. However, duration of chest tube insertion was significantly shorter in ES because there was less postoperative air leakage (1.3 vs. 3.9 days; p < 0.05). ES would appear to seal lung parenchyma more effectively during TPL based on the shorter duration of chest tube insertion.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Rothenberg SS (2007) Thoracoscopic pulmonary surgery. Semin Pediatr Surg 16:231–237
Ure BM, Schmidt AI, Jesch NK (2005) Thoracoscopic surgery in infants and children. Eur J Pediatr Surg 15:314–318
Bignon H, Buela E, Martinez-Ferro M (2010) Which is the best vessel-sealing method for pediatric thoracoscopic lobectomy? J Laparoendosc Adv Surg Tech A 20:395–398
Rothenberg SS, Kuenzler KA, Middlesworth W et al (2011) Thoracoscopic lobectomy in infants less than 10 kg with prenatally diagnosed cystic lung disease. J Laparoendosc Adv Surg Tech A 21:181–184
Smaldone MC, Gibbons EP, Jackman SV (2008) Laparoscopic nephrectomy using the Enseal Tissue Sealing and Hemostasis System: successful therapeutic application of nanotechnology. JSLS 12:213–216
Koga H, Suzuki K, Nishimura K et al (2013) Traction sutures allow endoscopic staples to be used safely during thoracoscopic pulmonary lobectomy in children weighing less than 15 kg. J Laparoendosc Adv Surg Tech A 23:81–83
Rothenberg SS (2008) First decade’s experience with thoracoscopic lobectomy in infants and children. J Pediatr Surg 43:40–44 discussion 45
Rothenberg SS (2003) Experience with thoracoscopic lobectomy in infants and children. J Pediatr Surg 38:102–104
Rothenberg SS (2005) Thoracoscopy in infants and children: the state of the art. J Pediatr Surg 40:303–306
Person B, Vivas DA, Ruiz D et al (2008) Comparison of four energy-based vascular sealing and cutting instruments: a porcine model. Surg Endosc 22:534–538
Sahin DA, Kusaslan R, Sahin O et al (2007) Histopathological effects of bipolar vessel sealing devices on liver parenchyma and comparison with suture method: an experimental study. Eur Surg Res 39:111–117
Box GN, Lee HJ, Abraham JB et al (2009) Comparative study of in vivo lymphatic sealing capability of the porcine thoracic duct using laparoscopic dissection devices. J Urol 181:387–391
Newcomb WL, Hope WW, Schmelzer TM et al (2009) Comparison of blood vessel sealing among new electrosurgical and ultrasonic devices. Surg Endosc 23:90–96
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Koga, H., Suzuki, K., Nishimura, K. et al. Comparison of the value of tissue-sealing devices for thoracoscopic pulmonary lobectomy in small children: a first report. Pediatr Surg Int 30, 937–940 (2014). https://doi.org/10.1007/s00383-014-3567-x
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00383-014-3567-x