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Page 2 of 6 Abu Akar et al. Mini-invasive Surg 2020;4:25 I http://dx.doi.org/10.20517/2574-1225.2019.66

Figure 1. Bronchoscopic image showing a pedunculated mass occluding the left main stem bronchus

complications and an earlier return to normal life. Uniportal video-assisted thoracoscopic surgery
[1]
(VATS) is the latest development in thoracoscopic surgery . After a decade of developing and adapting
thoracoscopic surgery to a variety of thoracic conditions, it has now become possible to perform the most
[2-4]
complex procedures through this technique, especially in adults . However, this is still rarely utilized
in children due to the difficulty of instrumentation and the lack of experience. Neuroendocrine tumours
compose a small percentage of lung tumors not exceeding 2% of the general population. Neuroendocrine
[5]
tumors however, are considered the most common airway malignancy in children . It is well-known and
[5]
generally accepted that surgical resection is the ideal solution in these cases . The rarity of these tumors
usually results in a significant delay in their diagnosis and treatment, as it may be treated for a long time
[6]
as a chronic infection or foreign bodies in the respiratory tract . Since the first bronchial sleeve operation
was performed in the 1940s , these operations have evolved to become the preferred procedure to avoid
[7]
[8]
pneumonectomies , and have recently been performed via the uniportal VATS technique with excellent
results . Except in one case by Gonzalez-Rivas et al. , these operations have not been performed
[3,4]
[9]
[9]
previously with the uniportal VATS technique. In his article, Gonzalez-Rivas et al. performed a right
upper sleeve lobectomy and tracheoplasty in a 10-year-old child for a carcinoid tumor in the right main
bronchus. In the current study, we report the second successful case of bronchial sleeve resection in a child
through the uniportal VATS technique in the literature, and the first to be performed on the left main
bronchus in an 8-year-old child with satisfactory results.

CASE PRESENTATION
A previously healthy 8-year-old female patient with a six-month history of fever and recurrent chest
infections showed only partial improvement with antibiotics. A bronchoscopy was performed to rule
out the presence of a foreign body, and to obtain samples for microbiology. A highly vascularised
endobronchial mass arising from the left main bronchus and occluding the bronchus to the upper lobe was
found [Figure 1]. Transbronchial biopsy and bronchoalveolar lavage were performed. Pathological findings
revealed a typical carcinoid tumor and cultures grew Pseudomonas aeruginosa. i.v. antibiotics were given
according to culture sensitivities and a 68Ga DOTATATE PET-CT was performed to exclude mediastinal
and extrathoracic findings [Figure 2]. The case was discussed at the multidisciplinary team meeting and
surgery was recommended. To avoid pneumonectomy at this young age, a bronchial sleeve resection was
considered. Based on our experience in uniportal VATS operations in adults at a specialized and ultra-
[11]
[10]
high volume tertiary center , and after gaining further experience in paediatric patients , we decided