Congenital pulmonary airway malformation (CPAM) is a condition that causes one or more cysts to form in a baby’s lung. “After childbirth, the cysts can compress the normal lung, affecting an infant’s ability to breathe,” says Steven S. Rothenberg, MD, chief of pediatric surgery at Rocky Mountain Hospital for Children (RMHC). As many as 4 in 10 children with CPAM develop recurrent pneumonias or other lung infections. In rare instances, the cysts can become cancerous.

Children with CPAM need surgery to remove the cysts. Families from around the world come to RMHC for this care. For close to three decades, Dr. Rothenberg has been the world expert in minimally invasive thoracoscopic lobectomies for infants and children with CPAM. He pioneered the approach, and has spent the past 30 years perfecting it, training other surgeons and developing instruments small enough to treat the tiniest patients.

“The traditional surgical approach, a thoracotomy, requires making a large incision into a baby’s chest, dividing the shoulder muscles and separating the ribs to reach the lung,” says Dr. Rothenberg. “This approach can lead to lifelong problems like chest wall deformities, scoliosis and shoulder muscle weakness.”

At RMHC, a thoracoscopic lobectomy takes place through three quarter-inch incisions in a child’s side. “We insert a small video camera device called a thoracoscope into one of the incisions, guiding it between the ribs to reach the affected lung,” says Dr. Rothenberg. The camera allows surgeons to view the procedure on a large monitor. Surgeons then insert tiny surgical instruments into the other two incisions to safely separate the diseased lobe from the rest of the lung and remove it. When Dr. Rothenberg couldn’t find instruments small and precise enough for the procedure, he helped develop them. 

In 2021, Dr. Rothenberg published an article in the Journal of Laparoendoscopic & Advanced Surgical Techniques highlighting the surgery’s highly successful track record. “We have never lost a child during this procedure,” he says. “It really should be the gold standard treatment for CPAM. There’s no reason to put a child through a longer, more difficult surgery.”

A child who undergoes a thoracoscopic lobectomy at RMHC spends about 90 minutes in the operating room (compared to three or more hours for traditional open surgery). And nearly all of them go home within 48 hours, which is a significant improvement over five to seven days of hospitalization after open surgery. “But the biggest win is that parents don’t have to worry about their child developing scoliosis, chest deformities or weak shoulders later on,” says Dr. Rothenberg. “We can cure the child without creating new problems.”

Visit our website for more information about congenital pulmonary airway malformation treatment at Rocky Mountain Hospital for Children or call (720) 754-7642.