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Endoscopic Resection for Vascular Anomalies in Children - A New Standard.

Annals of Surgery 2023 Februrary 25
OBJECTIVE: To report an innovative endoscopic surgery for subcutaneous vascular malformations and intramuscular FAVA at our center.

SUMMARY BACKGROUND DATA: Historically, open surgical resection has been the treatment of choice. Recent advances in minimal invasive surgery have led to the successful application of endoscopic resection techniques for the surgical management of diseases of the soft tissue.

METHODS: Patients who underwent endoscopic resection of vascular anomalies were included in this retrospective review. Data was extracted from our Vascular Anomalies Center database between September 2019 and October 2022, including sex, age, symptoms, diagnosis, sites of surgery, previous treatment, surgery, and follow-up.

RESULTS: There were 13 female and 15 males in the current study, age ranging from 1 to 17 years. The diagnoses included microcystic lymphatic malformation (n=8), Klippel-Trénaunay syndrome (n=7), venous malformation (n=6), FAVA (n=6), and mixed cystic lymphatic malformation (n=1). Surgical sites included the lower extremity (n=24), abdominal wall (n=2), the upper extremity (n=1), and thoracic wall (n=1). Five patients had an intramuscular lesion (FAVA). Endoscopic technique used 2 or 3 small ports in a gas inflation fashion. Surgery included thrombectomy, radical resection and debulking of vascular anomalies. Postoperative sclerotherapy with bleomycin was performed via drainage tube in 6 patients with microcystic LM. Technical success was obtained in 27 patients. The conversion to open surgery was performed in one patient owing to the deep location of lesion. No wound-related complication was observed.

CONCLUSIONS: Endoscopic surgery is a minimal invasive, effective, and safe treatment for subcutaneous vascular malformations and intramuscular FAVA. This approach can set a new standard that minimizes wound complications and reduces recovery time in patients undergoing resection for benign soft-tissue lesions.

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