HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Lawal, T. A. Articles by Ure, B. M. Search for Related Content PubMed PubMed Citation Articles by Lawal, T. A. Articles by Ure, B. M. Related Collections Chest wall

---

Original Articles: General Thoracic

Thoracoscopy Versus Thoracotomy Improves Midterm Musculoskeletal Status and Cosmesis in Infants and Children

Department of Pediatric Surgery, Hannover Medical School, Hannover, Germany

Accepted for publication August 29, 2008.

^_* Address correspondence to Dr Lawal, c/o Prof Benno Ure, Department of Pediatric Surgery, Hannover Medical School Germany, 1 Carl-Neuberg Str., Hannover, 30625, Germany (Email: lawaltaiwosurgery{at}yahoo.com).

Background: It has been postulated that video-assisted thoracoscopic surgery (VATS) achieves a better biometric and aesthetic outcome than conventional thoracic surgery (CTS), but data are lacking. We aimed to compare the midterm effects of both approaches in children.

Methods: Sixty-two infants and children, who underwent VATS (34; 55%) or CTS (28; 45%) for benign thoracic conditions, were evaluated at follow-up after a mean of 3.8 years (1 to 7 years). The patients underwent standardized clinical assessment of the skeletal system and function. The intercostal spaces were investigated for rib fusion by ultrasound. Patients (± parents) themselves, as well as clinicians, subsequently assessed the scars.

Results: Comparing the operated versus nonoperated sides, chest asymmetry was significantly less frequent after VATS versus CTS in the horizontal plane (mean relative difference 0.996 ± 0.003 vs 0.964 ± 0.008, p < 0.001) and in nipple location (mean relative difference 0.985 ± 0.008 vs 0.949 ± 0.013, p = 0.047). The ranges of motion of the shoulder joints did not differ significantly. However, the incidence of scoliosis was lower in VATS patients (9% vs 54%, p < 0.001) and the intercostal spaces of the operated hemithoraces were narrower after CTS (p < 0.001). The Manchester scar assessment scores were in favor of VATS (mean 7.5 vs 13.1, p < 0.001). The visual analog scale scores recorded by patients-parents and independent observers were also significantly better after VATS. Patient satisfaction was less with CTS as 10% wanted to have the scar revised, compared with none in the VATS group.

Conclusions: The thoracoscopic versus conventional approach to the thoracic cavity in children is associated with significantly less midterm musculoskeletal sequelae and a better cosmetic outcome.