Lung Lesions

An interactive discussion about pediatric lung lesions between Todd Ponsky, MD and Steve Rothenberg, MD. Dr. Rothenberg is Chief of Pediatric Surgery and the Chairman of the Department of Pediatrics at the Rocky Mountain Hospital for Children in Denver, CO. He is also faculty at Columbia University, College of Physicians and Surgeons in the Division of Pediatric Surgery as a Senior Consultant in Pediatric Minimal Access Surgery. Table of Contents 00:00 Introduction 02:46 Prenatal evaluation 04:11 Role of fetal MRI 04:30 Fetal imaging features 05:11 Choice of delivery location 06:01 Role of fetal intervention 07:09 Administration of corticosteroids 07:49 Cyst volume ratio 08:32 Spectrum of CPAM 11:16 Routine neonatal care 13:45 Role of neonatal MRI 15:15 Institutional variations in management 17:41 Decision to operate 20:10 Too small for thoracoscopic surgery? 21:59 Preoperative preparation 23:31 Anesthetic considerations 25:15 Avoidance of over-ventilation 26:36 Avoidance of high peak ventilator pressures 28:28 Patient positioning 30:02 Port placement 32:56 Instrument selection 35:17 Technique for vessel sealing 35:51 Vascular control 37:12 Vessel sealing devices 41:28 Left lower lobe technique 42:01 LLL-Take down inferior pulmonary ligament 42:31 LLL-Exposure of inferior pulmonary vein 42:44 LLL-Major fissure 43:46 LLL-Exposure of pulmonary artery 44:53 LLL-Dissection of superior segmental branch 45:11 LLL-Dissection of trunk to basal segments 45:33 LLL-Division of trunk 47:26 LLL-Division of the bronchus 49:33 LLL-Dissection of the pulmonary vein 50:33 Key point-Do not divide the trunk near the pericardium 51:02 Right lower lobe technique 51:46 Left upper lobe technique 52:17 LUL-Retraction 52:48 LUL-Identification of the pulmonary trunk 53:23 LUL- Exposure of the superior pulmonary vein 53:59 LUL- Isolation of venous supply to the lingula 54:25 LUL-Attention to the fissure 54:33 LUL-Lingular artery 54:54 LUL-Bronchus 55:12 LUL-Overview 55:40 Right middle lobe technique 56:43 RML-Pulmonary artery 57:05 Lobectomy technical pearls 57:38 Popping of lung cysts 58:33 Extralobar sequestration technique 59:48 Never use vessel sealer and clips on the same vessel 01:01:01 Alternative to resection of extralobar pulmonary sequestration 01:02:33 Role of segmental resection 01:04:41 Lobectomy post-operative course 01:05:50 Conclusion Intro track is adapted from "I dunno" by grapes, featuring J Lang, Morusque. Artist URL: ccmixter.org/files/grapes/16626 License: creativecommons.org/licenses/by/3.0/