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Journal of Indian Association of Pediatric Surgeons
     Journal of Indian Association of Pediatric Surgeons
Official journal of the Indian Association of Pediatric Surgeons         
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 ORIGINAL ARTICLE
Year : 2023  |  Volume : 28  |  Issue : 6  |  Page : 508-513

Thoracoscopic resection of pulmonary lesions in Israel: The mentorship approach


1 Department of Pediatric Surgery, Meir Medical Center, Affiliated to Sackler School of Medicine, Tel Aviv University, Kfar Saba, Israel
2 Division of Pediatric Surgery, The Rocky Mountain Hospital for Children, Denver, Colorado, USA
3 Institute of Pulmonology, Schneider Children's Medical Center of Israel (Affiliated to Sackler School of Medicine, Tel Aviv University), Petah-Tiqwa, Israel
4 Department of Anesthesiology, Schneider Children's Medical Center of Israel, Petah-Tiqwa, Israel
5 Department of Pediatric and Adolescent Surgery, Schneider Children's Medical Center of Israel (Affiliated to Sackler School of Medicine, Tel Aviv University), Petah-Tiqwa, Israel
6 Department of Thoracic Surgery, Beilinson Hospital (Affiliated to Sackler School of Medicine, Tel Aviv University), Petah-Tiqwa, Israel

Correspondence Address:
Emmanuelle Seguier-Lipszyc
Department of Pediatric Surgery, Meir Medical Center, Affiliated to Sackler School of Medicine, Tel Aviv University, 59, Tchernihovski, Kfar Saba
Israel
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jiaps.jiaps_115_23

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Background: Most congenital pulmonary airway malformations (CPAMs) are detected antenatally. The majority of newborns are asymptomatic. Patients are prone to subsequent respiratory complications and to a lesser extent malignant transformation remains concerning. In Israel, until 2013, pediatric surgeries were performed by thoracotomy. To minimize its morbidity, we introduced thoracoscopy using a mentorship approach. We present our experience with thoracoscopic resections coordinated by the mentorship of a pediatric worldwide leader in his field and compare our results with resections performed by thoracotomy. Materials and Methods: A retrospective review of records of children operated between 2013 and 2020 was conducted. Data were compared using t-test for quantitative variables. Results: Fifty patients were operated by thoracoscopy with a median age of 4 years, a thoracoscopic lobectomy performed in 68%. There was no conversion with a median length of stay (LOS) of 3½ days. Thirty patients were operated by thoracotomy by a thoracic surgeon with a median age of 3.5 years. A lobectomy was performed in 87% with a median LOS of 7 days. Conclusions: Thoracoscopic lobectomy is a technically demanding procedure with a long learning curve, strongly related to the low volume of cases. The role of a mentorship program in acquiring those surgical skills is crucial through standardization of the technique applied and supervised by the mentor. Early thoracoscopy for congenital pulmonary lesions at an early age can be achieved with a low conversion rate and minimal complications creating a change in the paradigm of practice when considering surgery for CPAM in Israel.






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