Surgical techniques of video-assisted thoracic surgery for congenital pulmonary airway malformation in a 1-year-3-month-old (8.6 kg) infant

We herein report a 1-year-3-month-old boy (8.6 kg) with asymptomatic congenital pulmonary airway malformation (CPAM). The patient had been prenatally diagnosed with CPAM. Since his neonatal condition was stable, surgery was electively planned once he reached 1 year of age. Preoperative chest computed tomography (CT) revealed a multiseptated air-filled cystic lesions in the left lower lobe. Complete video-assisted thoracic surgery (C-VATS) with left lower lobectomy was performed (operation time: 182 min, blood loss: 10 mL). The patient was discharged on postoperative day 7 with no complications. The pathological examination revealed a type 2 CPAM (Stocker’s classification). Although we believe VATS lobectomy for CPAM in infants is feasible, there are some specific hints and pitfalls to be aware of when performing pediatric thoracic surgery: (I) study and improve upon the ligation technique of vessels and bronchus, (II) be aware of the anatomical location of vessels and bronchus, and (III) adjust the position of the bronchial blocker for differential ventilation. When the condition of patients is stable without any symptoms or infection, we recommend that they undergo surgery after the age of one to ensure appropriate growth. In addition, we propose that C-VATS lobectomy may be feasible if patients are older than 18 months old or weigh more than 10 kg from the perspective of vessel/bronchial dissection technique and differential ventilation during anesthesia.