A very difficult paediatric surgery with a high intraoperative risk is one of the outstanding clinical achievements of the Paediatric Surgery Department of the Del Ponte Hospital in Varese, part of the Azienda Sanitaria (ASST) Sette Laghi. This involved a pulmonary lobectomy performed minimally invasively by thoracoscopy in a six-month-old baby, Giulia, who after undergoing the delicate surgery, was discharged in record time, the second day after surgery.

For Giulia’s mother, Denise, the road to surgery began in the fifth month of her pregnancy with a routine morphology ultrasound, when the gynaecologist at the Tradate Hospital noticed that something was wrong with the foetus, and a subsequent ultrasound at the Del Ponte Hospital confirmed the presence of a cyst in her right lung (congenital cystic adenomatoid malformation of the lung). The cyst must be removed after birth because it can cause serious problems, such as breathing difficulty from birth that need intensive care, or significant lung infections that could seriously damage the lungs and may degenerate, over the years, into a rare and aggressive tumor.

Dr. Valerio Gentilino, the Director of Paediatric Surgery, led a young team in performing the difficult operation, working closely with Dr. Luigi Andrea Ambrosoli, the Paediatric Anaesthetist.

The multidisciplinary team, including gynaecologists, neonatologists, psychologists, anaesthetists and paediatric surgeons, followed Denise throughout her pregnancy. In addition to subsequent morphological ultrasound scans in the last few months of pregnancy, two key examinations are essential to better identify the malformation and plan the operation: the MRI, carried out within a month of birth while the baby is sleeping spontaneously, and a CT scan with contrast, carried out between the second and third months while the patient is intubated. This last examination allows the surgeon to have all the anatomical details necessary for the operation.

The operation involved the removal of the middle lobe of the right lung by thoracoscopy, a minimally invasive technique that allows a better post-operative course but also requires specific technical skills.

This surgery typically lasts three hours and carries significant risk due to its proximity to the baby’s heart and aorta. The complexity of the procedure is heightened in a six-month-old newborn due to the precise millimeter distances involved. Additionally, a lengthy anaesthesia preparation is required. New peripheral anaesthesia techniques, employing ultrasounds, were successfully performed by paediatric anaesthesiologists, providing excellent pain management and leading to an unprecedented record time of discharge. 

After the surgery, Giulia spent a quiet night in Prof. Massimo Agosti’s neonatal intensive care unit, the drainage tube that is always placed after thoracic surgery was removed, and on the second day Giulia went home with her mum and dad. She now has an extraordinary life ahead of her, full of exceptional goals to achieve.

Giulia was amazing, but according to Dad Mattia, the credit for the successful outcome goes to the exceptional team at Hospital del Ponte. They earned our complete trust and then some!

References: Press release


Dr Valerio Gentilino, Head of Pediatric Surgery at Filippo Del Ponte Hospital, Varese, followed advanced courses in: “Medical and Interventional Thoracic Ultrasonography” at University of Milan; “Robotic Surgical Techniques” at the Harvard Medical School, Department of Urology of the Boston Children’s Hospital; “Minimally Invasive Pediatric Surgery” at University of Bologna.

Since November 2001, the Filippo Del Ponte Hospital has hosted the gynaecological-obstetrical and neonatal-pediatric departments of the Varese Hospital. It is attached to the Azienda Ospedaliera – Polo Universitario Ospedale di Circolo e Fondazione Macchi di Varese as per the Regional Law 31/1997. The Centre for Women, Infants, Children and Adolescents is well-coordinated and combines both healthcare and social services, serving as a regional point of reference.

Special attention is given to:
– Providing care for women to prevent, treat and rehabilitate all gynaecological health issues.
– Guiding families through the maternity and paternity process with interventions promoting overall health and well-being for the couple, newborn and their social environment.
– Attending to the needs of newborns, children and adolescents as unique individuals with specific requirements, integrated into their families and society. – Expertise in specialised healthcare activities;
– Capability to create coordinated healthcare plans across different fields and professional abilities to address emerging health needs in the specific region;
– High standard of service provided;
– Incorporation of research and educational pursuits with healthcare activities.

The Hospital’s Cultural Mediation Service can be accessed at Ospedale di Circolo, Ospedale del Ponte, or by phone or email for the entire hospital.
The cultural mediator acts as an intermediary between patients and all health care professionals. This makes it easier for foreigners to integrate into the community and access our services.