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Pediatric lung transplantation is performed in highly experienced centers due to the peculiar population characteristics. The literature is limited and not representative of individual countries' differences. The purpose of this study was to analyze the Italian experience.A multicentric retrospective analysis was performed on 110 pediatric patients (18 years old) who underwent lung transplantation from 1992 to 2019 at 9 Italian centers. Heart-lung transplantations and lung retransplantations were excluded.The population was composed of 44 male and 66 female patients, with a median age of 15 years. The most frequent indication was cystic fibrosis (83%). One quarter of patients were transplanted in an emergency setting. Median donors' Oto score and age were 1 and 15 years, respectively, with 43% of adult donors. In 17% of patients a graft reduction was performed. Postoperatively, the median duration of mechanical ventilation, intensive care unit, and in-hospital stay were 48 hours, 11 and 35 days, respectively. Thirty-day mortality was 6%, and 1-, 5-, and 10-year survival was 72%, 52%, and 33%, respectively. Risk factors for mortality were Oto score and recipients' body mass index.The outcomes of pediatric lung transplantation in Italy are comparable with current literature. Particular attention should be paid to the Oto score and recipient body mass index. Conversely, adult donors and graft reductions can be safely used to expand the donor pool.

Objectives The aim of this study was to evaluate a new self-expanding tract sealant device, designed to prevent pneumothorax after computed tomography (CT)-guided lung biopsy, as an intraoperative marker for small pulmonary nodules or ground-glass opacities during minimally invasive thoracic surgery. Methods Three patients with pulmonary nodules underwent CT-guided biopsies in our radiology department. During the same procedure, using a 19-gauge coaxial needle, a self-expanding tract sealant device was positioned in the lung nodule to be used not only for the prevention of pneumothorax but also as an intraoperative marker. A few days later, conventional thoracoscopic surgery was scheduled. A visual examination was performed. The site of the deployment of the BioSentry device was determined by checking for the proximal end of it beyond the visceral pleura. Thoracoscopic wedge resections using endoscopic staplers were performed to confirm histological characteristics, surgical margins and correct placement of the plug. Results Three consecutive patients underwent CT-guided placement of this self-expanding tract sealant device (BioSentry) before surgery, without complications. The thoracoscopic resection was performed with success. The plug was easy to visualize with the scope, and all removed nodules had surgical free margins and the plug was correctly positioned in all patients. Conclusions The self-expanding tract sealant device was created for the reduction of pneumothorax and chest tube placement rates after percutaneous lung biopsy. We used it for the first time for intraoperative localization of peripheral small solid nodules or ground-glass opacities with good results.

Pulmonary sequestration (PS) is a rare congenital malformation of the respiratory tract. Two main variants are described, the intralobar and the extralobar PS. Clinical manifestations vary from accidental findings to life threatening complications. Surgical resection is the definitive and indicated treatment of PS. The operation could be performed through an open thoracotomy or video-assisted thoracic surgery approach. We report the management of two patients with diagnosis of extralobar PS in the first case and intralobar PS in the second case. Both patients underwent uniportal video-assisted thoracic surgery resection of PS with success. In our experience, we confirm that uniportal video-assisted thoracic surgery is a safe and feasible approach for extralobar and intralobar PS.

Primary spontaneous pneumothorax has been defined as the disease of the 'young and healthy'. There are multiple possible therapies and in recent years, surgery has evolved towards the use of the uniportal thoracoscopic approach. The objective of our study is to describe and present an innovative approach to access to the thoracic cavity in patients with spontaneous pneumothorax. The surgery was performed using a single access of 20 mm at the level of the 8th intercostal space. For the isolation and suspension of any dystrophic area, we use a 'loop' of non-absorbable braided suture inserted through the IV intercostal space and successive wedge resection using an endoscopic 10 mm mechanical stapler. Using this access, we were able to visualize and dissect the pulmonary ligament and perform complete pleural abrasion. We had no complications. The operative time was 60 min, the chest tube was removed the 2th postoperative day and the patient was discharged the day after. The operation we propose permits the reduction of the dimension of the access to the thoracic cavity. We were able to resect blebs without problems, the recovery was excellent and no complications related to the procedure were reported.