Thoracoscopic division of vascular ring

This is a highly advanced pediatric thoracoscopic procedure. The patient is a 6-month old child who suffers from tracheal and esophageal constriction by a vascular anomaly. The mediastinum is accessed by a left thoracoscopic approach and the vascular anomaly carefully isolated and divided.

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Thoracoscopic division of vascular ring

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Abstract

This is a highly advanced pediatric thoracoscopic procedure. The patient is a 6-month old child who suffers from tracheal and esophageal constriction by a vascular anomaly. The mediastinum is accessed by a left thoracoscopic approach and the vascular anomaly carefully isolated and divided.

Keywords

thoracoscopy, division, vascular ring

Media type

Surgical video

Duration

04'06''

Publication

2007-05

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E-publication

WeBSurg.com, May 2007;7(05).
URL: http://www.websurg.com/doi-vd01en2113.htm

Thoracoscopic division of vascular ring

1. Clinical data 00'12''

This is the case of a 6-month-old boy who suffered from wheezing and dysphagia. Anesthesia was made by esophageal posterior compression visible on barium swallow and confirmed by MRI and CT-scan. It was a right aortic arch with an apparent left subclavian artery and a left ligamentum arteriosum.

2. Esophagoscopy 00'40''

The preoperative esophagoscopy confirmed the posterior and left pulsating compression of the esophageal wall. The patient stays in a right lateral decubitus.

3. Patient installation 01'00''

A left thoracoscopic approach was performed using one 5mm trocar for telescope and two 3mm trocars for operating devices. After deflating and retracting the lung, the abnormal vessel was straight away visible under the pleura.

4. Pleural section 01'20''

The pleura was incised vertically.

5. Subclavian artery isolation 01'40''

The dissection of vascular structures began with the subclavian artery using a 3mm monopolar hook and taking great care not to injure the nerves. The vagus nerve was retracted first.

6. Esophageal dissection 02'00''

The left side of the esophagus was freed from the surrounding fibrous tissues. The esophageal wall was clearly in evidence when the anesthesiologist moved the nasogastric tube. Then the laryngeal nerve was progressively exposed and preserved.

7. Abnormal aortic arch isolated and divided 02'40''

The abnormal aortic arch was dissected free on about 1cm and half in order to get a sufficient length between the 2 intracorporeal sutures applied on each side. The left arch is divided totally exposing the lateral part of the trachea and the esophagus which were no longer compressed. Operating time was 50 minutes, no drain, no complication, length of hospital stay: 2 days. After 6 months of follow-up, symptoms have disappeared. In conclusion, thoracoscopic repair of some kinds of vascular rings seems to be safe and effective.