Arch-like thoracoscopic posterior and lateral basal segmentectomy for congenital lung malformations in children

To evaluate the safety, feasibility, and potential clinical value of “Arch” thoracoscopic posterior and lateral basal segmentectomy (S9–10) for congenital lung malformations (CLMs) in children. Clinical data from 77 children with CLMs who underwent thoracoscopic surgery between January 2019 and June 2023 were retrospectively reviewed. Patients were grouped according to thoracoscopic lobectomy (n = 22), conventional thoracoscopic S9–10 segmentectomy (n = 33), or “Arch” thoracoscopic S9–10 segmentectomy (n = 22). Perioperative outcomes, postoperative findings, and radiological follow-up were compared. Pairwise comparisons were adjusted using the Bonferroni method. All procedures were completed thoracoscopically, with no conversion to thoracotomy, reoperation, severe complication, or residual lesion. Lobectomy was associated with shorter operative time, chest tube duration, and postoperative hospital stay than either segmentectomy procedure. Compared with conventional segmentectomy, the “Arch” group had lower mean blood loss; however, the absolute difference was small. The difference in operative time between the two segmentectomy groups did not remain statistically significant after adjustment for multiple comparisons. Postoperative air leak occurred in one patient in each segmentectomy group and resolved with drainage. Two patients in the “Arch” group developed a loculated postoperative air collection, which resolved spontaneously by 3 months. In selected children with CLMs confined to S9–10, “Arch” thoracoscopic segmentectomy was feasible. No major complications were observed in the “Arch” group, and its observed perioperative event profile was similar to that of the other groups in this series. Its main potential value is preservation of the S6–basal segment connection and normal lung parenchyma. The small differences in perioperative outcomes should be interpreted cautiously, and prospective studies with long-term functional assessment are needed.