img
Dr. Prashant Jain

Dr. Prashant Jain
Sr. Consultant
Paediatric Surgery
BLK Centre of Neonatal,
Paediatric & Adolescent
Medicine
BLK Super Speciality
Hospital, New Delhi





Small Incision, Big Cure

Reaping Dividends of Advancement in Paediatric
Thoracoscopy

THE CASES

A two-year old boy was admitted in BLK Super Speciality Hospital with complaints of intermittent cough for about a month which had intensified in the past 3 days. The boy was not responding well to medical treatment. He also developed abnormal sounds (stridor) while breathing, suggestive of some severe form of obstruction in the large airway.

The child was previously diagnosed as a case of cystic lesion in the mediastinum during antenatal scans. The child after birth was asymptomatic and was hence under regular observation and follow-up.

On examination by the doctors at BLK, the boy was symptomatic with features suggestive of tracheal obstruction. MRI chest was done which revealed a well-defined cystic lesion in the posterior mediastinum insinuating between the trachea-esophageal groove of size 5.5 cm x 4 cm. The cyst had increased by almost 5 times from the previously known size and was causing compression over the trachea.

THE PROCEDURE

Preparation was made for Thoracoscopic Excision of the cyst. This is the procedure in which a surgeon views inside the chest cavity and dissects the lesion through a key-hole incision. The challenge was to separate the cyst from vital structures in the chest. Although, it is technically a very challenging procedure in small chests, if performed skillfully, it can prevent significant morbidity of an open surgery. The high resolution cameras help the surgeon to dissect the lesion without injuring the vital structure. The procedure is not only challenging for the surgeon but also for the anaesthetist. During the procedure, the carbondioxide gas is insufflated inside the chest cavity, causing a rise in the gas levels in the patient’s blood which can be fatal. A close monitoring is required for the patient’s safety.

The cyst was excised completely after separating it carefully from the windpipe and the foodpipe, with the help of Thoracoscopic procedure.

THE RESULT

The child was discharged after 48 hours of surgery. Histopathology confirmed the diagnosis of bronchogenic cyst. Due to availability of high resolution cameras and advancements in very fine miniature instruments designed exclusively for paediatric minimal access surgery, paediatric surgeons can also perform many such complex procedures safely and skillfully.