Thoracoscopic surgery

Abstract

Thoracoscopy is a technique that has been in use since the early 1900s but has undergone an exponential increase in popularity over the last decade. The first experience in humans was reported by Jacobeus in 1910 who used a cystoscope inserted into the pleural space through a rigid trocar to lyse adhesions to allow complete collapse of a lung as treatment for tuberculosis. He later reported the first significant experience with a series of over 100 patients.1 During the next 70 years thoracoscopy gained some favor, primarily in Europe, for the biopsy of pleural-based tumors and limited thoracic explorations in adults; however, widespread acceptance was minimal.2,3 In the 1970s and 1980s the first significant experience in children was reported by Rodgers.4,5 Equipment modified for pediatric patients was used to perform biopsies, evaluate various intrathoracic lesions, and perform limited pleural debridement in cases of empyema.6 During this period there was an increasing recognition of the morbidity associated with a standard thoracotomy, especially in small infants and children, including scoliosis, muscle girdle weakness, and chest wall deformity.7 This clear documentation of the effects of thoracotomy on children led to attempts to minimize the morbidity by various muscle-sparing approaches but all of these limited exposure and were still associated with large thoracotomy scars.8 It was not until the early 1990s with the dramatic revolution in technology associated with laparoscopic surgery in adults that more advanced diagnostic and therapeutic procedures began to be performed in children.9'11 The development of high-resolution microchip and, more recently, digital cameras, smaller instrumentation, and better optics has enabled pediatric surgeons to perform even the most complicated intrathoracic procedure thoracoscopically.12,13 Now every thoracic lesion from empyema to esophageal atresia has been approached and successfully managed using a thoracoscopic approach, drastically reducing the pain, recovery, and long-term morbidity of these procedures.