Abstract
Introduction Video-assisted thoracoscopic surgery (VATS) has gained enormous acceptance among
pediatric surgeons. However, most studies on advantages of VATS do not reach a high
level of evidence. According to a recent classification of the Oxford Centre for Evidence-Based
Medicine (CEBM), studies can be classified into Levels 1 to 5 in order of descending
quality. We aimed to identify comparative studies investigating VATS versus open procedures
in pediatric surgery and to classify publications according to the CEBM criteria.
Materials and Methods Systematic review of comparative studies were identified using PubMed. Only studies
published in English, comparing pediatric VATS with the corresponding open operation
were included. End points were advantages and disadvantages of VATS as compared with
the open procedure. Levels of evidence were determined using the recent CEBM criteria.
Results A total of 3 meta-analysis (MA) and 18 retrospective comparative studies (RCS) investigating
5 different VATS procedures (repair of congenital diaphragmatic hernia [CDH], repair
of esophageal atresia/tracheoesophageal fistula (EA/TEF), lung resection, treatment
of pneumothorax, and resection of neuroblastoma) were included in this study. No studies
of CEBM Level 1 or Level 2 were identified. All studies were classified as CEBM Level
3. The advantages of VATS were less postoperative pain (CDH repair, EA/TEF repair,
and pneumothorax repair), shorter hospital stay (CDH repair, EA/TEF repair, lung resection,
and pneumothorax), shorter time of ventilation and lower Pco
2 (CDH repair), shorter duration of chest drain (lung resection), and less blood loss
(resection of neuroblastoma). However, disadvantages such as higher recurrence rates
(CDH repair), higher Pco
2 (EA/TEF repair), and longer operative times (CDH and EA/TEF repair) were also identified.
Conclusion Only RCS on pediatric VATS are available. Therefore, the best available evidence
is Level 3. Randomized controlled trials comparing VATS and the corresponding open
procedure are mandatory to obtain the highest possible evidence.
Keywords
VATS - thoracoscopy - pediatric - evidence-based medicine
