Pediatric laparoscopic approach of a hydatid cyst of the lung

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Pediatric laparoscopic approach of a hydatid cyst of the lung

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Type de vidéo

Vidéo chirurgicale

Durée

04'10''

Publication

2006-03

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E-publication

WeBSurg.com, Mar 2006;6(03).
URL: http://www.websurg.com/doi-vd01en1912.htm

Pediatric laparoscopic approach of a hydatid cyst of the lung

1. Start of procedure 00'12''

Hydatid cyst of the inferior lobe of the left lung. This is the case of a young child presenting with hydatid cyst of the inferior lobe of the left lung complicated by superinfection. Exploration helps to identify the protruding dome with its pleural adhesions. These adhesions are to be left in place at the beginning of the procedure in order to maintain the lobe perfectly stable. A 10% hypertonic saline solution is instilled into the pleural cavity to prevent any potential spillage. And prior to dissection, the endocyst is punctured through the thoracic wall using a Palmer needle in order to aspirate fluids contained in the internal germinal membrane and replace it with physiological saline. The saline is left in place for 15 minutes before surgically approaching the cyst. The area surrounding the cyst is opened in order to approach the internal germinal membrane.

2. Trocar placement 01'23''

The patient is in a right lateral decubitus position. The trocars are in the axillary line and the surgeon stands anterior to the patient. The thoracoscopy unit is placed posteriorly. Intrapleural carbon dioxide insufflation contributes to the collapse of the lung. This is maintained in a pressure of 4mm Hg.

3. Extraction of internal germinal membrane 01'53''

The internal germinal membrane can be seen here. It is now being reduced as it being placed into the bag. The lung is maintained collapsed by selective endobronchial intubation in order to ensure that the right lung maintains the ventilation and the left lung is collapsed to enable dissection to be performed. The 2nd step of the procedure mainly consists in identifying and suturing bronchial fistulae. To do so, the anesthetist removes air from the Fogarty balloon catheter in order to re-ventilate the inferior lobe of the left lung.

4. Test for bronchofistula 02'44''

Lavage of the pericystic cavity with saline helps to identify any bubbles and facilitates suturing of the bronchial fistulas. Capitonnage of the roof and floor of the pericystic cavity is performed with a double objective, first of all, to hand suture bronchial fistulae, and secondly to induce the collapse of the pericystic cavity.

5. Suturing of cavity 03'56''

Pleural adhesions are only removed at the end of the procedure. This is then followed by drainage of the pleural cavity using catheters placed through the former trocar sites, and this is performed under thoracoscopic control.