Unicentric report on thoracoscopic surgery 7 cases for congenital pulmonary airway malformation combined with ipsilateral mediastinal bronchogenic cyst in children

To evaluate the feasibility of thoracoscopic surgery for congenital pulmonary airway malformation (CPAM) with ipsilateral mediastinal bronchogenic cysts in children. From January 2019 to January 2025, our medical center performed a total of 462 surgeries on children with CPAM. Among them, 7 children who were diagnosed with CPAM with bronchogenic cysts underwent thoracoscopic surgery. A three-port approach via the lateral chest was adopted. Patients were placed in a lateral decubitus position (healthy side down). The observation hole is located at the junction of the scapular line and the 5th rib space, while the surgical hole is created using the 5-millimeter cannula through the endoscopic triangular method.CO₂ pneumothorax was maintained at 4 mmHg (flow rate: 2 L/min), adjusted intraoperatively as needed. Surgical incisions were primarily designed for pulmonary resection, prioritizing CPAM excision followed by bronchogenic cyst removal. Piecemeal resection was performed when necessary to avoid severe tracheal complications. Among the 7 cases of CPAM with bronchogenic cysts, 5 were type II (bronchiolar) and 2 were type III (bronchiolar/alveolar). All procedures were successfully completed thoracoscopically without conversion to open surgery. Operative time ranged from 90 to 191 min (median: 110 min), with intraoperative blood loss of 3–15 mL (median: 10 mL). Chest tubes were placed in all cases for 3–5 days (median: 4 days). During follow-up (median: 29 months; range: 2–59 months), no disease recurrence was observed on chest CT. CPAM in children may coexist with bronchogenic cysts. Preoperative imaging should be meticulously correlated with intraoperative findings to avoid missed diagnoses. Thoracoscopic surgery is a method that can be attempted for treating CPAM in children with ipsilateral mediastinal bronchogenic cysts.