Increasing adoption of minimally invasive surgery for congenital lung malformations in young infants: a single-center experience

Objectives Congenital lung malformations (CLM) encompass a heterogeneous group of conditions increasingly diagnosed prenatally. While surgical resection is widely adopted, the surgical approach is progressively shifting toward minimally invasive techniques. However, concerns persist regarding the feasibility of thoracoscopy in very young infants. This study aimed to compare thoracoscopic and open surgical resection of CLM and to evaluate temporal trends in surgical approach. Methods A retrospective review was conducted of all patients undergoing surgical resection for CLM at a tertiary pediatric referral center between January 2011 and December 2025. Patients were grouped according to surgical approach (thoracoscopy vs. thoracotomy). Temporal trends were assessed, and a subgroup analysis including patients undergoing elective anatomical lobectomy was performed to compare perioperative outcomes. Appropriate statistical tests were applied. Results A total of 219 patients were included. Thoracoscopic resection was performed in 90/219 (41.1%) cases and thoracotomy in 122/219 (55.7%), with a small proportion undergoing alternative approaches. Temporal trend analysis demonstrated a significant increase in thoracoscopic surgery over time, rising from 25.25% in 2011–2018 to 32.65% in 2019–2021 and reaching 77.78% in 2022–2025 ( p < 0.001). In the subgroup of patients undergoing anatomical lobectomy ( n = 138), thoracoscopy was associated with perioperative outcomes comparable to thoracotomy, with no significant differences in operative time, length of stay, or postoperative complications. Conclusion These findings support the progressive adoption of thoracoscopic surgery for CLM and demonstrate that, following an institutional learning curve, minimally invasive resection can be safely performed even in early infancy.