medigraphic.com
Boletín Médico del Hospital Infantil de México

2012, Number 4

<< Back Next >>

Bol Med Hosp Infant Mex 2012; 69 (4)

Use of ultrasonic scalpel for pulmonary biopsy by thoracoscopy in pediatric patients with interstitial lung disease

Villalpando CR, Piedra BME, Medel MIB, Morales JE, Reyes GG, Solórzano SF

Language: Spanish
References: 28
Page: 271-276
PDF size: 107.50 Kb.


ABSTRACT

Background. Diagnosis of interstitial lung disease (ILD) in children is challenging. Open lung biopsy was long considered to be the best procedure to obtain lung tissue in children. Thoracoscopic biopsy may be equally effective and less aggressive. In this report we analyze the results of the use of ultrasonic scalpel with the placement of three 5-mm trocars (one for thoracoscope and two working ports) for lung biopsy through thoracoscopy.
Methods. We present a retrospective case series of children undergoing lung biopsy through thoracoscopy using three working ports and ultrasonic scalpel. The study was carried out from January 2011 to January 2012 in a third-level pediatric hospital.
Results. A total of five patients aged 1 to 13 years were included. There were no complications in the five cases analyzed. The sample obtained was sufficient in all cases for histopathological study. During surgery, bleeding was reported on average of 4.3 ml (range: 0.5–10 ml). Operative time ranged from 2 to 3 h. Two cases required chest tube placement. These were removed 2 to 3 days after the surgical event, and patients were discharged without complications.
Conclusions. Feasibility is confirmed of a technique for lung biopsy using an ultrasonic scalpel, which is easily reproducible in any hospital with the necessary resources to perform thoracoscopy. In this series there were no complications, bleeding was low and there was opportune placement of transpleural chest tube.


REFERENCES

  1. Barbato A, Panizzolo C, Cracco A, de Blic J, Dinwiddie R, Zach M. Interstitial lung disease in children: a multicentre survey on diagnostic approach. Eur Respir J 2000;16:509-513.

  2. Glaspole I, Conron M, Du Bois RM. Clinical features of diffuse parenchymal lung disease. Eur Respir Mon 2000;14:1-14.

  3. Sondheimer HM, Lung MC, Brugman SM, Ikle DN, Fan LL, White CW. Pulmonary vascular disorders masquerading as interstitial lung disease. Pediatr Pulmonol 1995;20:284-288.

  4. Fan LL, Deterding RR, Langston C. Pediatric interstitial lung disease revisited. Pediatr Pulmonol 2004;38:369-378.

  5. Fan LL, Kozinetz CA. Factors influencing survival in children with chronic interstitial lung disease. Am J Respir Crit Care Med 1997;156:939-942.

  6. Hilman BC. Interstitial lung disease in children. En: Hilman BC, ed. Pediatric Respiratory Disease: Diagnosis and Treatment. Philadelphia: WB Saunders; 1993.

  7. Villa Asensi JR. Diagnóstico de la enfermedad pulmonar intersticial en la infancia. An Pediatr (Barc) 2001;54(suppl 2):9-13.

  8. Wert SE, Whitsett JA, Nogee LM. Genetic disorders of surfactant dysfunction. Pediatr Dev Pathol 2009;12:253-274.

  9. Balasubramanyan N, Murphy A, O’Sullivan J, O’Connell EJ. Familial interstitial lung disease in children: response to chloroquine treatment in one sibling with desquamative interstitial pneumonitis. Pediatr Pulmonol 1997;23:55-61.

  10. Whitsett JA, Wert SE, Weaver TE. Alveolar surfactant homeostasis and the pathogenesis of pulmonary disease. Annu Rev Med 2010;61:105-119.

  11. Katzenstein AL, Gordon LP, Oliphant M, Swender PT. Chronic pneumonitis of infancy. A unique form of interstitial lung disease occurring in early childhood. Am J Surg Pathol 1995;19:439-447.

  12. Copley SJ, Coren M, Nicholson AG, Rubens MB, Bush A, Hansell DM. Diagnostic accuracy of thin-section CT and chest radiography of pediatric interstitial lung disease. AJR Am J Roentgenol 2000;174:549-554.

  13. Koh DM, Hansell DM. Computed tomography of diffuse interstitial lung disease in children. Clin Radiol 2000;55:659-667.

  14. Bokulic RE, Hilman BC. Interstitial lung disease in children. Pediatr Clin North Am 1994;41:543-567.

  15. Redding GJ, Fan LL. Idiopathic pulmonary fibrosis and lymphocytic interstitial pneumonia. En: Taussig LM, Landau LI, eds. Pediatric Respiratory Medicine. St. Louis: Mosby Inc; 1999. pp. 794-804.

  16. Chollet S, Soler P, Dournovo P, Richard MS, Ferrans VJ, Basset F. Diagnosis of pulmonary histiocytosis X by immunodetection of Langerhans cells in bronchoalveolar lavage fluid. Am J Pathol 1984;115:225-232.

  17. Martin RJ, Coalson JJ, Rogers RM, Horton FO, Manous LE. Pulmonary alveolar proteinosis: the diagnosis by segmental lavage. Am Rev Respir Dis 1980;121:819-825.

  18. Fan LL, Lung MC, Wagener JS. The diagnostic value of bronchoalveolar lavage in immunocompetent children with chronic diffuse pulmonary infiltrates. Pediatr Pulmonol 1997;23:8-13.

  19. Fan LL, Kozinetz CA, Deterding RR, Brugman SM. Evaluation of a diagnostic approach to pediatric interstitial lung disease. Pediatrics 1998;101:82-85.

  20. Coren ME, Nicholson AG, Goldstraw P, Rosenthal M, Bush A. Open lung biopsy for diffuse interstitial lung disease in children. Eur Respir J 1999;14:817-821.

  21. Hilman BC, Amaro-Galvez R. Diagnosis of interstitial lung disease in children. Paediatr Respir Rev 2004;5:101-107.

  22. Rothenberg SS, Wagner JS, Chang JH, Fan LL. The safety and efficacy of thoracoscopic lung biopsy for diagnosis and treatment in infants and children. J Pediatr Surg 1996;31:100-103; discussion: 103-104.

  23. Spencer DA, Alton HM, Raafat F, Weller PH. Combined percutaneous lung biopsy and high-resolution computed tomography in the diagnosis and management of lung disease in children. Pediatr Pulmonol 1996;22:111-116.

  24. Katzenstein AL, Fiorelli RF. Nonspecific interstitial pneumonia/fibrosis. Histologic features and clinical significance. Am J Surg Pathol 1994;18:136-147.

  25. Dishop MK, Askin FB, Galambos C, White FV, Deterding RR, Young LR, et al, for the chILD Network. Classification of diffuse lung disease in older children and adolescents: a multi-institutional study of the Children's Interstitial Lung Disease (chILD) pathology working group. Mod Pathol 2007;2:2878.

  26. Leslie KO, Viggiano RW, Trastek VF. Optimal processing of diagnositc lung specimens. En: Leslie KO, Wick MR, eds. Practical Pulmonary Pathology. A Diagnostic Approach. Philadelphia: Churchill Livingston; 2005. pp. 19-32.

  27. Langston D, Patterson K, Dishop MK, chILD Pathology Co-operative Group. A protocol for the handling of tissue obtained by operative lung biopsy: recommendations of the chILD pathology co-operative group. Pediatr Dev Pathol 2006;9:173-180.

  28. Ponsky TA, Rothenberg SS. Thoracoscopic lung biopsy in infants and children with endoloops allows smaller trocar sites and discreet biopsies. J Laparoendosc Adv Surg Tech A 2008;18:120-122.




2020     |     www.medigraphic.com