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Abu Akar et al. Mini-invasive Surg 2020;4:25 I http://dx.doi.org/10.20517/2574-1225.2019.66 Page 5 of 6

Figure 5. Postoperative chest X-Ray showing good inflation of the lung with no abnormalities

known that VATS can significantly reduce complications and surgical trauma, contribute to earlier recovery
[13]
and expedite the return to normal life for patients .

There are additional benefits of thoracoscopic surgery, especially in children, such as the avoidance of
scoliosis and preventing breast asymmetry in females due to the damage that may occur in chest wall
muscles from traditional open thoracotomy [14-16] . Therefore, the thoracoscopic approach to these pediatric
cases is much more desirable and should be strongly encouraged. There are still some obstacles that may
limit the applicability of this technique in children however, with the learning curve being particularly
steep. The operative field available in the child’s pleural space is limited, which can lead to extreme
challenges with instrumentation. Another difficulty that one may face during surgery is the complexity of
lung isolation due to the unavailability of the double-lumen tube for all ages, which poses a challenge to the
surgeon and anesthesiologist. This is on top of the lack of instruments specially designed for pediatrics. We
[11]
usually use traditional instruments to perform uniportal VATS in infants , or those designed for adults in
older children.

In conclusion, we strongly believe in the value and benefits of uniportal VATS surgery, especially in
pediatric patients. Complex operations via the uniportal VATS approach as described is feasible in
children. However, experience in uniportal VATS is necessary, and these operations must be performed
in specialized and high-volume centers that contain all the necessary facilities. There is a need to develop
specialized equipment specific for children for such operations to make it more manageable.

DECLARATIONS
Authors’ contributions
Conception and design of the study, and performed data analysis and interpretation: Abu Akar F, Shaqqura
B
Performed data acquisition, as well as provided administrative, technical, and material support: Abu Akar F,
Rumman N, Soultanis KM