Video-assisted thoracoscopic surgery in children—experience of two pediatric hospitals

Abstract

Objective: To describe the indications, complications, and outcomes of minimally invasive video-assisted thoracoscopic surgery (VATS) in children by reviewing our institutional experience with VATS and comparing it with the existing literature. Methods: We conducted a retrospective observational study of 75 patients in the 1-month to 18-year age bracket undergoing VATS between February of 2020 and July of 2024 at either of two pediatric hospitals. Data were collected from medical records and analyzed for demographic and clinical variables, including sex, age, symptoms, underlying diseases, procedural indications, prior chest drainage, duration of hospitalization before VATS, culture results, postoperative chest tube duration, length of hospital stay, complications, and perioperative mortality. Results: Pleuropulmonary infections, predominantly empyema, accounted for most of the cases (89.3%). Primary VATS (without prior chest tube drainage) was performed in 26% of the patients with empyema. In cases of empyema, performing VATS within seven days of admission was not associated with a shorter postoperative chest tube duration when compared with a delayed intervention (10.8 days vs. 12.8 days; p = 0.511). However, the mean total hospital stay was significantly shorter in the early VATS group (25.5 days vs. 36.6 days; p < 0.001). The overall complication rate was 21.3%, with bleeding and subcutaneous emphysema being the most common. There were no conversions to thoracotomy and no perioperative mortality. Conclusions: Our study confirms that VATS is a safe and effective approach for managing thoracic conditions in children, particularly when performed by an experienced team. Further research