Thoracoscopic Approaches to Congenital Lung Lesions

Congenital pulmonary lesions encompass congenital pulmonary airway malformations (CPAMs), bronchopulmonary sequestration (BPS), and congenital lobar emphysema (CLE). These lesions are typically diagnosed prenatally, and prognosis is related to the size of the lesion and the associated physiologic sequelae. Postnatally, cross-sectional imaging consisting of computed tomography or magnetic resonance imaging (MRI) is advantageous to look at the extent of the lesion as well as for multifocal disease. CLE management is solely based upon the presence of symptoms and does not require surgical resection in the asymptomatic patient. Current recommendations are for resection of CPAM and BPS even in the asymptomatic patient. Lobectomy has become the cornerstone of surgical treatment due to the risk of recurrent pneumonia, respiratory disease, and malignancy. Over the last decade and a half, thoracoscopic resection has gained favor and has been proven to be a technically feasible and safe alternative to thoracotomy. More recently, segmental resection has been recognized as a potential treatment for congenital pulmonary lesions. In this chapter we briefly describe the pathophysiology and preoperative workup for patients with congenital pulmonary lesions. We further describe the operative approach for thoracoscopic resection of congenital pulmonary lesions.