Correction of Vascular Rings: Do We Still Need an Incision?

Background: To compare a totally thoracoscopic approach to conventional left posterolateral thoracotomy or median sternotomy for correction of vascular rings in pediatric patients.

Method: An overall of 13 patients underwent correction of vascular ring. Classic left posterolateral thoracotomy or median sternotomy was used in 8 patients (Group A) and a totally thoracoscopic approach in 5 patients (Group B) between 01/17 and 07/22. For the thoracoscopic procedure, we placed the children in a right lateral decubitus position, inserted two 5-mm and one 3-mm trocar, and used a 5-mm 30-degree endoscope with CO₂-insufflation at 4–6 mm Hg. To our knowledge, this is the first series of thoracoscopic treated patients in Germany.

Results: Median age and weight for both groups respectively were 7 months (IQR: 0–47 months) versus 18 months (IQR: 7–182 months) and 8 kg (IQR: 1.7–16.9 kg) versus 11.5 kg (IQR: 7.5–62 kg). Double aortic arch was often present in Group A—6 patients (75%) versus 3 patients (60%) in Group B. Exclusion criteria for thoracoscopic treatment would be concomitant procedure or weight under 3 kg but not the surgical anatomy. Successful correction of vascular ring was achieved in all patients, endoscopic visualization before extubation confirmed improvement of tracheal and/or esophageal compression. Although the median operating time was shorter in the group of patients operated with a classic approach—90 minutes (IQR: 50–148 minutes) versus 138 minutes (IQR: 105–191 minutes) the median hospital length of stay was slightly shorter in the thoracoscopic group 7 days (IQR: 6–13 days) vs 8.5 days (IQR: 7–42 days). Wound dehiscent/infection was found in two patients in Group A versus 0 patients in Group B. The number of patients with chylothorax in both groups was 1 patient and 2 patients respectively. All patients were doing well on latest follow up and no reoperations were needed regarding recurrence of significant tracheal and/or esophageal obstruction.

Conclusion: To our knowledge, this is the first series of thoracoscopic correction of vascular rings in Germany. It appears to be a safe and effective treatment alternative for vascular rings, thus avoiding the well-known downsides and possible complications of a thoracotomy and leading to a much better cosmetic result.

Publication History

Article published online:
28 January 2023