Pulmonary Malformation Clinical Trial
Official title:
Can Pre-operative Flexible 3D Models of Pulmonary Malformations Facilitate Thoracoscopic Resection
The National Rare Diseases plans, the ongoing MALFPULM PHRC and thoracoscopic advents in
children, are remarkable improvements in understanding and managing lung malformations. The
resection of these malformations is now proposed in most cases to avoid infections which are
difficult to treat and to diagnose or to avoid exceptional tumors. Procedures are ideally
performed around the age of 5-6 months to take advantage of the lung growth that continues
during the first two years of life. The surgical strategies depend of the malformation size,
the tumor risk and surgeon choice: conservative surgery with removal of part of the lobe may
be preferred over complete resection of the concerned lobe.
If possible, thoracoscopic resection is carried out. The open thoracotomy is more painful and
leads to complications such as thoracic deformities, larger scars, blood loss. However, in
infants the thoracoscopic work space is small, lung exclusion is challenging and the anatomy
(normal or malformative) is difficult to understand in space. The rate of thoracoscopy
without conversion to thoracotomy ranges from 98% in one American center with a more radical
approach , to 48% in a national cohort. Pulmonary exclusion failure, complexity and size of
malformations and intra-operative complications are factors of conversion to thoracotomy .
These factors can lead surgeons to perform thoracotomy without attempting thoracoscopy.
3D printing is a thriving research field for its educational or therapeutic potential
optimization of management, prosthesis, and organ replacement. 3D printing is particularly
adapted to pediatrics, which suffers from the rarity of its pathologies and a large spectrum
of size and morphology prohibiting the mass production of models. 3D printing models of
complex pulmonary pathologies will allowed for a better anesthetic and surgical approach. The
modeling of bronchial, vascular and even parenchymatous anatomy permits a better
understanding of the anatomical particularities of each patient. This, in turn, avoids the
intra-operative conversions to thoracotomy with a direct benefit for the patient.
n/a