Can Pre-operative Flexible 3D Models of Pulmonary Malformations Facilitate Thoracoscopic Resection
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.
Inclusion Criteria:

 -  Patients aged from 1 day to 24 months.

 -  Patients with pulmonary malformation eligible for surgery

 -  Parents agreement for surgical treatment

 -  Parents able to sign an informed consent form

 -  Patient benefiting from a social insurance system or a similar system

 Exclusion Criteria:

 -  Emergency surgeries (less than 15 days between scanner and surgery)

 -  Obvious extrapulmonary sequestration on tomographic scanning images

 -  Patients with other major malformation additionally to pulmonary malformation

 -  Parents unable to understand the purpose of the trial

 -  Patient already participating to another clinical trial that might jeopardize the
 current trial