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Background. The incidence of chest injuries in the overall structure of combat surgical trauma is approximately 4 % in present-day military conflicts, and according to the data from Anti-Terrorist Operation/Joint Forces Operation in the Eastern Ukraine, it varies from 7.5 to 11.7 %. In case of penetrating chest injuries, the overall mortality reaches 10 %. Objective: to improve the treatment outcomes in chest injuries through the application of endovideosurgical technologies and local fibrinolytic therapy during the quaternary care in complications of combat thoracic trauma. Materials and methods. A clinical statistical analysis of the surgical outcomes was conducted in 103 victims with combat chest trauma, who received specialized thoracic surgical treatment for complications such as clotted hemothorax at the quaternary care level. The control group included 54 (52.4 %) casualties, and the experimental group included 49 (47.6 %). Results. According to the research findings, among the total number of chest injuries and traumas, lung injuries were the most common, accounting for 61.2 %. In the experimental group, lung injuries were identified in 27 cases. When analyzing the treatment of thoracic injuries and traumas in the control group, it was found that 21 (38.9 %) patients did not have sufficient pleural cavity drainage during the provision of primary medical and qualified care to eliminate hemo- and pneumothorax, and 33 (61.1 %) required various surgical procedures through thoracotomy accesses. Videothoracoscopy was performed in casualties with gunshot penetrating chest injuries, when metal fragments were located in the anterior mediastinum (between the sternum and ascending aorta) and posterior mediastinum (between the right main bronchus and esophagus, without damage to them). The removal of metal fragments from the mediastinum, sanitation, and drainage of the pleural cavity were performed. Among 26 casualties, who underwent pleural drainage, 4 patients have had unstable vacuum in the pleural cavity for three days. Conclusions. The implementation of the developed differentiated surgical approaches in the patients with chest injuries and clotted hemothorax contributed to a reduction in specific injury complications from 24.1 to 8.2 % and allowed for a decrease in the duration of hospital stay from 24 to 16 bed-days.

Introduction: Spontaneous pulmonary hernia is a very rare entity. It corresponds to the protrusion of the lung parenchyma and pleura through a chest wall defect. It is caused by increased intrathoracic pressure associated with wall weakness. Case Report: We present the case of an asthmatic patient diagnosed with spontaneous pulmonary hernia of the chest wall and its surgical resolution. Treatment varies according to the case and there is no consensus regarding conservative vs. surgical management or the surgical technique to be used. [ABSTRACT FROM AUTHOR]

Resumen: Introducción: En febrero de 2022, el Grupo Emergente de Cirugía Torácica de la Sociedad Española de Neumología y Cirugía Torácica inició un estudio multicéntrico sobre el manejo quirúrgico del neumotórax espontáneo primario (NEP). Como paso previo, se desarrolló esta encuesta cuyo objetivo fue conocer la situación actual en nuestro país, y así, concretar y dirigir dicho proyecto. Método: Se realizó un estudio descriptivo a partir de los resultados de esta encuesta lanzada a través de la plataforma Google Docs®. La encuesta se envió a todos los cirujanos torácicos nacionales en activo, un total de 319. Esta constaba de 20 preguntas que incluían datos demográficos, quirúrgicos y de seguimiento. Resultados: Se obtuvieron 124 respuestas (39% del conjunto de médicos especialistas y médicos en formación del territorio nacional). Las indicaciones más consistentes fueron: recidiva homolateral para 124 (100%), falta de resolución del episodio para 120 (96,7%), profesiones de riesgo para 104 (84%) y neumotórax bilateral para 93 (75%). El abordaje de elección para el 100% de los encuestados fue la videotoracoscopia. De estos, 96 contemplaban la resección pulmonar de las lesiones evidentes (77%). En relación con la técnica de pleurodesis, la abrasión pleural es la técnica más utilizada por 70 de los encuestados (56,7%), mientras que 49 (40%) realiza pleurodesis química con talco, bien sola, o en combinación con la pleurodesis mecánica. Conclusiones: Si bien hay cierta consistencia en algunos aspectos del manejo quirúrgico del NEP, esta encuesta hace evidente la variabilidad en cuanto a las técnicas de pleurodesis aplicadas entre los cirujanos de nuestro país. Abstract: Introduction: In February 2022, the Emerging Thoracic Surgery Group of the Spanish Society of Pneumology and Thoracic Surgery initiated a multicenter study on the surgical management of primary spontaneous pneumothorax (PSP). As a preliminary step, this survey was developed with the aim of finding out the current situation in our country to specify and direct this project. Method: A descriptive study was carried out based on the results of this survey launched through the Google Docs® platform. The survey was sent to all active national thoracic surgeons, a total of 319. It consisted of 20 questions including demographic, surgical and follow-up data. Results: We obtained 124 responses (39% of all specialists and doctors in training in the national territory). The most consistent indications were: homolateral recurrence for 124 (100%), lack of resolution of the episode for 120 (96.7%), risk professions for 104 (84%) and bilateral pneumothorax for 93 (75%). The approach of choice for 100% of respondents was videothoracoscopy. Of these, 96 contemplated pulmonary resection of obvious lesions (77%). Regarding the pleurodesis technique, pleural abrasion was the technique most used by 70 respondents (56.7%) while 49 (40%) performed chemical pleurodesis with talc either alone or in combination with mechanical pleurodesis. Conclusions: While there is some consistency in some aspects of surgical management of PSP, this survey makes evident the variability in pleurodesis techniques applied among surgeons in our country.

The article presents the results of diagnostic videothoracoscopy during three years that were performed in an anti-tuberculosis institution. Patients were radiographically discovered to have chest pathology. No bacteria discharge was detected. To verify the diagnosis, 136 patients underwent videothoracoscopy with biopsy. Evaluation of the obtained biopsy results showed that, only 48 patients (35,3%) had specific tuberculous lesions verified. In other cases, a different pathology was noted: sarcoidosis, oncopathology, nonspecific inflammation, and idiopathic pulmonary fibrosis. Thus, the results of this study confirmed the high efficiency of the videothoracoscopy method for verifying the diagnosis in patients without bacterial discharge.

Diagnostic and surgical difficulties were presented in case of a giant mass, found incidentally, in a 65-year-old healthy and asymptomatic man. The patient underwent different diagnostic procedures. Surgery was the treatment of choice. A combination of both open technique and videothoracoscopy to reduce the risk of seeding, pending a certain diagnosis, was resolutive. The postoperative period and recovery time were uneventful. The patient was discharged on the 5th postoperative day. The histological diagnosis was benign schwannoma. There are different aspects to think about, based also on the experience of each center. According to our experience, this is a rare situation; the combined surgical techniques to control the vascular risk and tissue infiltration of the mass seemed to us the approach of choice.

Introduction: The formation of malignant pleural effusion (MPE) is a clinical manifestation of an advanced malignancy or its dissemination. The focus of treatment is primarily palliative and aimed at relieving symptoms, especially dyspnoea.

Aim: Our aim is to evaluate a cohort of patients who had undergone preoperative localisation of lung nodules with the lung marking system Somatex. Methods: From March 2019 to February 2022 we positioned localisation spirals Somatex in 17 consecutive patients by means of CT navigation. We retrospectively evaluated the technical succes, the spiral marker stability and complications of CT navigation. We recorded time between the end of the procedure and the operation, and we evaluated the clinical success expressed with the number of conversion of the operation procedure. Results: In time of the study the lung localisation marker Somatex was introduced in 17 patients. The technical success was 100%. In 16 (94%) patients was the localisation stable. There was the one case of perioperative dislodgement of the marker. There weren't any serious complications of the procedure. At control CT we detected asymptomatic pneumothorax without the need for drainage of the pleural space at 13 patients (76%), in three cases (18%) insignificant parenchymal bleeding occured. Clinically insignificant hemothorax was found in one patient (6%). The procedure duration in the CT room was 8-20 minutes with the mean time interval 13 minutes. The time between marking and the operation procedure was 44-380 minutes with the mean interval of 172 minute. There was no conversion of the videoasisted thoracotomy to the open thoracosurgicall operation. Conclusion: CT navigated localisation of lung nodules with spiral marker Somatex is reliable, quick and safe method for navigaion of the thoracoscopic resection of small lung nodules. [ABSTRACT FROM AUTHOR]

Videothoracoscopic (Video-assisted thoracoscopic) surgery is a minimally invasive technique for performing procedures in the chest. All previously open procedures can be done in this manner. Its advantages include smaller incisions, less pain, faster rehabilitation, shorter hospitalisation, and long-term improved functional and aesthetic results. We aimed to review videothoracoscopic procedures, compare them with their open counterparts, review anaesthetic and technical requirements and report on our experience. VATS procedures for intrapleural infections are the most common, and they have completely supplanted open procedures. Further important VATS procedures include lung resections and biopsies for congenital anomalies, pneumothoraces, inter-stitial and malignant lung diseases. VATS biopsies or resections can be required for mediastinal cysts or tumours. Congenital diaphragmatic hernias and eventerations can also be oper-ated on videothoracoscopically. Oesophageal procedures are demanding and rare but can be performed thoracoscopically. Paediatric VATS procedures have been performed in the Department of Thoracic Surgery, UMC Ljubljana since 2009. Sixty procedures have been performed in patients aged from one day to 16 years. Eight patients were operated in their first year of life and 36 children under the age of six years. VATS has become the approach of choice for most procedures (pathologies). It offers obvious benefits to children and has been, therefore, well received. Further advances are expected with increased knowledge and experience and improved instrumentation.

Continuous ambulatory peritoneal dialysis (PD)-related hydrothorax (PDRH) is uncommon; however, it is associated with a high discontinuation rate and morbidity. We report clinical characteristics, pleural fluid chemistry patterns, diagnostic modality, management options, and outcomes in 12 patients who have confirmed pleuroperitoneal communication after the inception of the PD program at our institute. The incidence of PDRH in our study was 0.64%. The interval between initiation of PD and hydrothorax ranged from 7 weeks to 40 weeks (average 20.6 weeks). Ten (83.3%) had right-sided, one (8.3%) left-sided, and one (8.3%) bilateral hydrothorax. Most patients (83.3%) had dyspnea with chest symptoms, but two (16.6%) patients were asymptomatic. All patients had confirmed communication either by peritoneal scintigraphy or computed topography peritoneography. PD had to be stopped in two patients and patients were shifted back to hemodialysis. Pleurodesis, through thoracostomy with tetracycline or betadine, was used for four patients. Three patients underwent video-assisted thoracoscopy (VATS) with surgical repair of the diaphragmatic defect, and one underwent VATS assisted talc pleurodesis. All four patients who underwent VATS repair of the defect had successful outcomes. With availability and experience with VATS, most patients had successfully returned to PD with no recurrence and with minimal morbidity. [ABSTRACT FROM AUTHOR]

The declared COVID-19 pandemic has come to affect the entire world. Ever since the first cases were detected, pneumothorax has been considered a rare but possible complication, and may develop in patients under mechanical ventilation due to high pressure. We present here a case of simultaneous bilateral spontaneous pneumothorax with COVID-19 pneumonia with no history of chronic lung disease and no mechanical ventilation. [ABSTRACT FROM AUTHOR]

Results of treatment of 71 victims with combined blunt thoracic and brain trauma were analysed. In the main group (n=35) there was used algorithm, envisaging videothoracoscopic interventions and widening indications for chest stabilization. Mentioned above technique enabled to increase efficiency of diagnostic and treatment in patients with mild and moderately severe brain trauma; this was reflected both in acceleration of restoration of respiratory index by 5,8 days, consciousness – by 4,3-4,9 days depending on trauma severity and decrease of postoperative complications and lethality number.

The OBJECTIVE of the study was to evaluate the effectiveness of the use of «early» (up to 3 days) valve bronchial blocking in the complication of postoperative period in patients with bullous emphysema. MATERIAL AND METHODS. For the period from 2009 to 2017, 32 patients with bullous pulmonary emphysema had a long (more than 3 days) air leakage from the pleural cavity. Depending on the time of the valve bronchial blocker installation, the patients were divided into 2 groups: 1 group («late» blocking): the valve bronchial blocker was placed later than 3 days after the operation (11 patients); 2 group («early» blocking): the valve bronchial blocker was placed for 2–3 days from the operation (21 patients). RESULTS. During the first two days, air discharge through the pleural drainage was discontinued in 16 patients of the «early» blocking group and in 2 patients of the «late» blocking group (р=0.0022). The duration of air leakage in the «early» blocking group was 1.59 days less (44.91 %) than in patients of the «late» blocking group (р=0.0024). The positive blocking effect was fixed in 85.71 % (18) of the patients of the group with «early» blocking, which was 3.6 times higher than in the patients of the «late» blocking group (р= 0.04). The frequency of repeated intervention in the «early» blocking group was 3.81 times less than in the «late» blocking group (54.54 % vs. 14.28 %) (р=0.08). CONCLUSION. «Early» valve bronchoblocation (performed on the 2–3rd day of the postoperative period) had an indisputable advantage in comparison with bronchial blocking performed at the time of more than 3 days postoperative period, allowing reliably faster lung dilatation and eliminating air discharge through drainage from the pleural cavity, without resorting to repeated interventions, which was important, both for the surgeon and for the patient.

The complexity of the differential diagnosis of firearms in the diaphragm is emphasized by many authors. Standard approaches to diagnostic and therapeutic measures are highly traumatic. The desire of surgeons to reduce the traumatic nature of surgical interventions has led to widespread thoracoabdominal surgery of minimally invasive technologies. The purpose of the research: to improve the results of diagnostics of gunshot wounds in the affected patients delivered from the zone of ATO by introducing new videoendoscopic technologies at the stage of provision of specialized surgical care. The object and methods of research. The study was carried out at the surgical clinic of the Military Medical Clinical Center of the Northern Region of the Ministry of Defense of Ukraine. The clinic was delivered to 64 wounded with the simultaneous penetration of the wounded projectile into the chest and abdominal cavity, that is, wounds were damaged by the diaphragm. Research results and their discussion. Diagnostic and therapeutic videothoracoscopy was performed on 64 (100%) wounded. In order to evaluate the diaphragm wounds, namely their number, localization and topography, the presence of foreign bodies of the gunspot, the detection of hematoma, sulfur and associated damage to the organs of the cavity and parenchymal organs of the chest and mediastinum in the clinic, a method for laser imaging of the gunshot wounds of the diaphragm was developed and implemented (sent application for a patent of Ukraine). The proposed method is carried out as follows: during thoracoscopic surgical intervention in the victims with fire-fighting wounds of the diaphragm after performing a visual audit with the help of video endoscopic camera to increase the image to 8-10 times, an overview of difficult-to-reach areas for examination of the chest cavity with the use of an additional source of illumination. Laser irradiation is carried out with the help of the apparatus of laser therapeutic «Lika Therapist M» (the manufacturer of Primer Photonics Plus, Cherkassy), which connects to the proposed endoscopic laser nozzle, which provides uniform diffuse scattering radiation. A review is carried out in red (660 nm), green (525 nm) and blue (405 nm) laser irradiation spectra in its various combinations, with a laser power density of 50 mW, which improves the visibility of wound defects and allows to identify additional non-visual impairments with normal lighting. With the additional use of laser imaging during diagnostic thoracoscopy in the developed way, with the help of the apparatus of laser therapeutic «Lika Therapist M», 8 (13%) patients were diagnosed with additional wound diaphragms that had a tangent (in 6 (9%) patients) and through (in 2 (3%) patients) character. The largest number of diaphragmatic wounds 5 (8%) was detected in a red (660 nm) laser radiation spectrum survey. In our opinion, laser imaging in the red spectrum is most effective. Complications during the application of the developed method of laser imaging of the gunshot wounds of the diaphragm were not observed. The offered videoendoscopic methods of diaphragmatic gunshot wound diagnostics at the specialized level of provision of surgical care allow to effectively visualize defects of the diaphragm, even in hard-to-reach places. Obtaining positive test results is the basis for recommending videothoracoscopic laser imaging of diaphragm wounds for use in surgical practice. Conclusions. In our study, the use of videothoracoscopy allowed to detect a gunshot wound diaphragm, which shows the high sensitivity of the method. The use of the laser imaging technique for the firearms of the diaphragm allowed the additional detection of 8 injured (12.5%) wounds of the tangent (in 6 (9.3%) patients) and transversal (in 2 (3.1%) patients). The use of endoscopic techniques for diagnosing gunshot wounds of the diaphragm is a modern and less traumatic direction of the development of the surgery of damage.

The objective is to analyze own clinical observations with the purpose of optimization of diagnostics and application of the adequate medical grant to patients with wounds of heart.Material and methods. The results of treatment of 268 patients with heart wounds operated in the clinic for the last 27 years were analyzed. The majority of patients 202 (75.4 %) had penetrating and through wounds to the heart, 66 (24.6 %) had non-penetrating injuries. The diagnosis was based on clinical symptoms, the results of electrocardiographic, echocardiographic and x-ray studies. The clinical picture depended on the nature of the wound – penetrating or non-penetrating. Videothoracoscopy helped to clarify the nature of the damage of the heart in vague diagnostic cases. In most patients, heart damage was recognized in a timely manner, a diagnostic error was committed in 18 (6.7 %) patients. In 59 (22.0 %) cases, myocardial wounds were stitched with P-shaped sutures, and in 209 (78.0 %) – with nodular sutures.Results. 240 (89.6 %) patients were discharged in satisfactory condition, 11 (4.1%) patients were transferred to the cardiology department for the follow-up treatment, 17 patients died with penetrating or through cardiac injury. The mortality rate was 6.4 %.Conclusion. Emergency surgery is the only effective method of treating heart injury. Long-term results of treatment were traced in 38 patients in terms of 1 year to 10 years. All patients had a clinical recovery.

Bilateral catamenial pneumothorax coexisted with catamenial hemoptysis is a rare entity. It is usually caused by thoracic endometriosis syndrome. We report a case 24 year healthy female with no comorbid status presenting with bilateral catamenial pneumothorax with catamenial hemoptysis. This lady presented with breathlessness, bilateral chest pain and streaky hemoptysis for four months associated with her menstrual cycle. Chest x ray and CT chest done showed bilateral pneumothorax. Serum CA 125 levels was elevated.USG pelvis done was normal. Bronchoscopy was done in view of hemoptysis showed bilateral inflamed mucosa no active bleeding. Videothoracoscopy was done showed multiple nodules over the diaphragm, biopsy taken from that nodules following biopsy, diaphragmatic meshplasty and talc pleurodesis was done. To prevent the recurrence patient was started on hormonal therapy. Patient improved clinically and radiologically and no recurrence till one year of followup.

The objective of the study is еo evaluate the possibilities of videothoracoscopy in the cases of pleurisy of inflammatory nature of specific and non-specific etiology.Material and methods. We carried out the retrospective analysis of medical histories of 135 patients.. Parapneumonic pleurisy was diagnosed in 68 (54.4 %) patients, tuberculous pleurisy – in 57 (45.6 %) patients.Results. Videothoracoscopy was diagnostic procedure in 61.6 % of patients and was performed for the defragmentation of pleurisy in 38.4 % of patients. Videothoracoscopy allows exactly diagnosing the tuberculous pleurisy by means of biopsy in the absence of lesions on the pleura. Resistant parapneumonic pleurisy was diagnosed in 34.9 % of patients. In cases of parapneumonic resistant pleurisy, the pleurodesis reduces the time of the drainage by means of injection through the drainage of mixtures of betadine and concentrated solution of glucose.

Objective: Comparative analysis of the results of surgical treatment of patients with tumors of the thymus gland via sternotomy and thoracotomy (ST), videothoracoscopic (VTS) and the robotic-assisted (RA) interventions. Materials and methods: Th e results of surgical treatment of 138 patients with tumors of the thymus gland (TG) were analyzed TS was performed in 78 patients, VTS – 47, RA – 13. Th ere were 65 men, 73 women. Th e average age of patients was 50,5±12,7 years (from 19 to 81 years). Results: Intervention time of thymomthymectomy (TTE) by ST amounted to 91.2±33,4 min, VTS of 93.6±25,5 min, RA – 142,7±26,9 min. Aft er ST 6 (7.7%) patients had complications in the postoperative period, 2 (2.6%) fatal outcome. Aft er VTS in one patient complicated post-operative course. Th e duration of stay of the patient in hospital aft er ST TTE was 10.1±3.6 days, VTS – 6.6±1.9 days, RA – 6.3±1.4 days. Loco-regional recurrence and progression of the disease in the remote period were not revealed. Good eff ects (A and b) aft er the VTS TTE achieved at 20.0% of cases in RA at 27.3%, while ST TTE 8.4% of cases. Conclusion: Demonstrated safety and effi cacy of minimally invasive techniques (MIT) in the surgical treatment of patients with thymoma. As were the advantages of the VTS and RA when performing TTE in comparison with ST.

One of the most popular procedures amongst obesity surgery is the sleeve gastrectomy. There is international consensus regarding the usage of bougie for sleeve gastrectomy calibration. Nevertheless, there is a dissociation between the number of oesophageal perforations reported for any other oesophageal/gastric operation that requires bougie (e.g., anti-reflux surgery, incidence 1.2%) and bariatric surgery, where this complication seems to be almost a myth. Interestingly enough, the number of bariatric procedures is much higher than any other oesophageal/gastric surgery. This suggests that oesophageal perforations in obesity surgery are underreported. We report a case of injury of the intrathoracic oesophagus with bougie that occurred during a sleeve gastrectomy. In the infrequent case that the perforation is diagnosed during surgery, primary repair during the same intervention is highly recommended. Videothoracoscopy might be an effective option in case of necessity. We were able to complete the sleeve gastrectomy without increasing morbidity.

Objective: To describe the initial results with uniportal Video-Thoracoscopic Surgery (VATS) performed in two campuses by members of the Section of Thoracic Surgery of the University of Chile ("Clínica Las Condes" and University of Chile Clinical Hospital). Materials and Method: Between January 2016 and January 2019, a total of 105 patients underwent uniportal VATS. Clinical data was collected retrospectively from digital records including demographic (age, sex) and clinical variables (diagnosis, surgery, duration of the chest tube, length of stay, conversion rate and postoperative complications). Results: Uniportal VATS was performed on 105 patients during the study period. Twenty-eight cases (26.6%) corresponded to lobectomy or anatomic segmentectomy. In 4 cases a 2nd port was required, 1 patient had to be converted to mini-thoracotomy and 1 to thoracotomy (5.8% global conversion). Overall, the median length of stay was 3.07 ± 3.1 days and the median duration of chest tube drainage was 2.67 ± 1.61 days. Seven patients (6.6%) presented complications. One patient died due to progression of his disease, there were no deaths related to the procedures. Discussion: Uniportal VATS has similar indications than multiportal VATS. On experienced hands, uniportal VATS has a low morbidity rate. Uniportal VATS appears to produce less post-operative pain, with shorter hospital stay and a faster return to normal life compared to standard VATS. Conclusion: We present the first uniportal VATS series in Chile. Results were similar to published series. Implementation and development of uniportal VATS requires a learning curve similar to any new surgical procedure. [ABSTRACT FROM AUTHOR]

Background and aims: The management of thoracic wounds induced by sharp objects outside an extreme emergency remains controversial. The means vary from exploratory thoracotomy to simple monitoring. Between these two extremes, videothoracoscopy as a means of exploration plays an important role and helps to avoid unnecessary thoracotomies, thus making it possible to make early diagnosis of diaphragmatic lesions. The aim of this study was to report our experience in videothoracoscopic management of thoracic wounds by penetrating objects. Material and methods: From January 2010 to December 2015, 58 patients with an average age 22.5 years with a thoracic stab wound with a stable hemodynamic condition underwent videothoracoscopy. Results: Thoracoscopy revealed a diaphragmatic injury in 17 patients, cardiac or pericardial wounds in four and a haemorrhagic pulmonary injury in 1; all were treated at video-assisted mini-thoracotomy. In the other 36 patients, videothoracoscopic exploration did not demonstrate any intra-thoracic lesion and the procedure consisted of aspiration of a residual hemothorax with the installation of a good view-controlled thoracic drainage. Hospital stay was between 48 and 72 h. Conclusion: Videothoracoscopy is a safe and effective way to explore the thoracic cavity in patients with chest wounds with suspected diaphragmatic lesions. It avoids thoracotomy especially in hemodynamically stable patients. [ABSTRACT FROM AUTHOR]

OBJECTIVE. The authors investigated pulmonary-pleural complications of pancreatitis and evaluated results of CT examination in diagnostics and possibility of low invasive surgery in treatment of pancreaticogenic pleurisy. MATERIAL AND METHODS. A retrospective analysis was made of 156 medical histories of patients with acute pancreatitis and their results. An ultrasound examinations of the chest and CT scan were applied in order to determine lung tissue condition and presence of fluid in pleural cavities. RESULTS. The application of CT in diagnostics of pulmonary-pleural complications allowed doctors to identify an effusion in pleural cavities in 3,5-50 % patients with acute pancreatitis. The number and localization of effusions were defined more precisely. CONCLUSIONS. Mini-invasive procedures (puncture, videothoracoscopy) with examination of exudate on amylase activity and biopsy of pleura determined the causes of pleuritis. This was effective in pleritis elimination against a background of different methods of treatment of pancreatitis.

Aim: There is air in the pleural space without an external effect in the case of spontaneous pneumothorax, and it is important in terms of treatment, clinic, and underlying diseases in thoracic surgery. In this study, it was aimed to present the approach to the patients with spontaneous pneumothorax in the period of compulsory public service. Material and Methods: The patients who were treated with spontaneous pneumothorax between June 2017 and January 2018 in our clinic were included in this study. Gender, age, smoking status, type of treatment and length of hospital stay were recorded. Result: 18 patients (2 female, 16 male) were included in the study. Eleven of the patients (61.1%) were smoking. Surgical treatment was applied to 7 (38.8%) of the patients. As a surgical approach, videothoracoscopic wedge resection and partial pleural decortication in 5 patients, videothoracoscopic bulla ligation and partial pleural decortication in 1 patient and thoracotomy bulla ligation in 1 patient were applied. Ten patients were treated with tube thoracostomy and one patient was treated with nasal oxygen. Complications did not occur in the patients. Conlusion: Spontaneous pneumothorax is a disease requiring urgent diagnosis and treatment. The purpose of the treatment is to provide the lung totally expanded and to prevent recurrence of pneumothorax. Tube thoracostomy is usually the first approach, but we recommend that the videothoracoscopic surgery can be used in the conditions of the public hospital because of its advantages for the patients who have surgical indications. [ABSTRACT FROM AUTHOR]

Goal of research: to evaluate efficiency of videothoracoscopy in diagnosis and treatment of patients with injuries and emergency diseases ща chest organs.Material and methods: Study wasbased on treatment results analysis of 2111 patients with injuries and chest organs emergency diseases, who were treated at Republican Research Centre of Emergency Medicine in 2001-2014. Chest trauma made up 1396 (66,1%) victims. There were 477 (22,6%) patients with spontaneous pneumothorax. At the stages of initial diagnosis, the radiologic evaluations, CT investigations and videothoracoscopies were performed. In chest trauma patients the videothoracoscopy underwent in 844 cases, in spontaneous pneu#mothorax this method was employed in 290 patients. Complicated forms of lung echinococcosis were observed in 238 (11,3%) patients and complicated forms of lung echinococcosis were evident in 72 patients.Results. Videothoracoscopy and video-assisted interventions allowed to eliminate lungs and pleura pathology in 1206 (57,1%) patients, whereas the traditional methods were effective only in 905 cases (42,9%).Conclusions. Investigation methods such as multiplanar radioscopy, radiography, chest CT and videothora-coscopy must be included into algorithm of diagnosis and surgical treatment of chest injuries and emergency diseases of chest organs. At chest trauma the videothoracoscopy allows to avoid broad thoracotomy from 9,4% to 4,7% of cases, to reduce the frequency of repeated interventions from 17,4% to 0,5% and diminish a number of early postsurgery complications from 25,4% to 10,9%. Videothoracoscopy of chest traumas allows to reduce frequency of repeated interventions from 19,8 to 1,7%.

Results of treatment of 71 victims with combined blunt thoracic and brain trauma were analysed. In the main group (n=35) there was used algorithm, envisaging videothoracoscopic interventions and widening indications for chest stabilization. Mentioned above technique enabled to increase efficiency of diagnostic and treatment in patients with mild and moderately severe brain trauma; this was reflected both in acceleration of restoration of respiratory index by 5,8 days, consciousness – by 4,3-4,9 days depending on trauma severity and decrease of postoperative complications and lethality number.

Results of treatment of 71 victims with combined blunt thoracic and brain trauma were analysed. In the main group (n=35) there was used algorithm, envisaging videothoracoscopic interventions and widening indications for chest stabilization. Mentioned above technique enabled to increase efficiency of diagnostic and treatment in patients with mild and moderately severe brain trauma; this was reflected both in acceleration of restoration of respiratory index by 5,8 days, consciousness – by 4,3-4,9 days depending on trauma severity and decrease of postoperative complications and lethality number.

BACKGROUND. Clotted hemothorax is the most common complication of the chest injury requiring surgical treatment in most patients.MATERIAL AND METHODS. Videothoracoscopy was performed in 51 patients with complications of penetrating chest trauma in 2011–2012. Clotted hemothorax occured in 27 cases (52.9%).RESULTS. It was found that the main cause of this complication was inadequate pleural drainage effect. Clotted hemothorax developed after drainage of the pleural cavity and primary surgical debridement in 12 patients (44.4%), in 8 patients (29.6%) after atypical thoracotomy and in 7 patients (25.9%) after typical thoracotomy. The average interval between operations was 8.1±5.0 days.CONCLUSION. The best results of treatment for clotted hemothorax were achieved under the early detection of clotted hemothorax in case of thoracoscopic evacuation in the range from 3 to 7 days (4.7±2.1). Videothoracoscopy performed more than 7 days after detection may increase the volume of surgery, cause significant complications, and considerably prolong treatment.

RElEVANCE. Hypotension caused by intrapleural bleeding or wound of the heart is an indication for thoracotomy in chest wound. drainage of the pleural space is performed in normotensive patients in the absence of immediate threat to life and other indications for thoracotomy. Thoracoscopy allows diagnosing and fixingintrapleural damage in patientswhen thoracotomy is not indicated. The main condition for the procedure is stable hemodynamics.MATERIAl AND METHODS. Medical histories of 591 patients operated on between 2002 and 2012 with the use of traditional methods and videothoracoscopy have been studied. Four expert groups were formed (drainage of pleural space, atypical thoracotomy, videothoracoscopy and typical thoracotomy), consisting of 375 patients, to determine the value of shock index and the pace of intrapleural bleeding, enough for a safe thoracoscopy. We used binary logistic regression (ROc analysis), studying the findings.THE RESULTS. It was found that the safe performance of thoracoscopic surgery for a chest injury is reasonable when the value of shock index is less than 0.97 and the pace of intrapleural bleeding is less than 250 ml/hour.CONCLUSION. The retrospective study determined the safety parameters to perform thoracoscopyin patients with chest wound.

На сегодняшний день проблема выбора метода лечения, при свернувшемся гемотораксе, остается, несомненно, актуальной. До сих пор нет четких показаний к применению того или иного метода лечения. В настоящее время основным фактором для применения того или иного метода лечения является критерий времени, прошедшего с момента заболевания. Проанализированы истории болезни 368 пациентов. Используя, критерии включения и исключения редуцировали базу данных. Сравнили группы по наличию или отсутствию различий. С помощью применения анализа зависимостей исключили переменные, которые не имеют связи с группировкой пациентов. Описаны параметры оценки состояния пациента, которые, так или иначе, влияют на групповые различия. Среди этих параметров выявлены как физикальные, так и лабораторные. Список переменных превышает общеизвестные критерий времени от начала болезни и данные рентгенологической картины. Данная совокупность сведений о состоянии пациента может быть использована в методах математического моделирования для формирования набора переменных, характерных для каждой группы и в последующем для создания алгоритма выбора метода лечения пациентов.Цель. Оценить возможность создания алгоритма тактики лечения больных со свернувшимся гемотораксом.Методология: сбор архивной информации, формирование базы данных, статистический анализ.Результаты: сформирован набор физикальных и лабораторных данных, по которым группы достоверно отличаются между собой.Область применения результатов: медицина.

One of the most popular procedures amongst obesity surgery is the sleeve gastrectomy. There is international consensus regarding the usage of bougie for sleeve gastrectomy calibration. Nevertheless, there is a dissociation between the number of oesophageal perforations reported for any other oesophageal/gastric operation that requires bougie (e.g., anti-reflux surgery, incidence 1.2%) and bariatric surgery, where this complication seems to be almost a myth. Interestingly enough, the number of bariatric procedures is much higher than any other oesophageal/gastric surgery. This suggests that oesophageal perforations in obesity surgery are underreported. We report a case of injury of the intrathoracic oesophagus with bougie that occurred during a sleeve gastrectomy. In the infrequent case that the perforation is diagnosed during surgery, primary repair during the same intervention is highly recommended. Videothoracoscopy might be an effective option in case of necessity. We were able to complete the sleeve gastrectomy without increasing morbidity. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 66-year old man who was suffering from pleural infiltration and Waldenström macroglobulinemia (WM) and with a history of colon cancer and hypertension. The article discusses the detection of chylothorax in the patient, diagnosis of pleural thickening with the use of computed tomography (CT) scan, and treatment with the application of videothoracoscopy.

The most challenging diagnostic issue in the management of thoracoabdominal wounds concerns the assessment of asymptomatic patients. In almost one-third of such cases, diaphragmatic injuries are present even in the absence of any clear clinical signs. The sensitivity of noninvasive diagnostic tests is very low in this situation, and acceptable methods for diagnosis are limited to videolaparoscopy or videothoracoscopy. However, these procedures are performed under general anesthesia and present real, and potentially unnecessary, risks for the patient. On the other hand, diaphragmatic hernias, which can result from unsutured diaphragmatic lesions, are associated with considerable morbidity and mortality. In this paper, the management of asymptomatic patients sustaining wounds to the lower chest is discussed, with a focus on the diagnosis of diaphragmatic injuries and the necessity of suturing them.

OBJECTIVES: Traditionally, chronic empyema has been treated by thoracotomy and decortication. Some recent reports have claimed similar clinical results for videothoracoscopy, but with less morbidity and mortality than open procedures. Our experience with thoracotomy and decortication is reviewed so that the results of this surgical procedure can be adequately evaluated. MATERIALS AND METHODS: From March 1992 to June 2006, 85 patients diagnosed with empyema were treated at Santo Tomás Hospital by the first author. Diagnosis of chronic empyema was based on the duration of signs and symptoms before definitive treatment and imaging findings, such as constriction of the lungs and the thoracic cage. Thirty-three patients fulfilled the criteria for chronic empyema and underwent open thoracotomy and decortication. RESULTS: Twenty-seven patients (81.8 %) were male and the average age of the study group was 34 years. The etiology was pneumonia in 26 patients (78.8%) and trauma in 7 (21.2%). The duration of symptoms and signs before definitive treatment averaged 37 days. All patients had chronic empyema, as confirmed by imaging studies and operative findings. Surgery lasted an average of 139 min. There were 3 (9%) complications with no mortality. The post-operative length of stay averaged 10 days. There were no recurrences of empyema. CONCLUSIONS: Open thoracotomy and decortication can be achieved with low morbidity and mortality. Long-term functional results are especially promising. We suggest that the validation of other surgical approaches should be based on comparative, prospective and controlled studies.

Background: The aim of this study is to present the new technique of transcervical-subxiphoid-videothoracoscopic "maximal"thymectomy introduced by the authors of this study for myasthenia gravis. Materials and Methods: Two hundred and sixteen patients with Osserman scores ranging from I-III were operated on from 1/9/2000 to 31/12/2006 for this study. The operation was performed through four incisions: a transverse 5-8 cm incision in the neck, a 4-6 cm subxiphoid incision and two 1 cm incisions for videothoracoscopic (VTS) ports. The cervical part of the procedure was performed with an open technique while the intrathoracic part was performed using a video-assisted thoracoscopic surgical (VATS) technique. The whole thymus with the surrounding fatty tissue containing possible ectopic foci of the thymic tissue was removed. Such an operation can be performed by one surgical team (the one team approach) or by two teams working simultaneously (two team approach). The early and late results as well as the incidence and localization of ectopic thymic foci have been presented in this report. Results: There were 216 patients in this study of which 178 were women and 38 were men. The ages of the patients ranged from 11 to 69 years (mean 29.7 years). The duration of myasthenia was 2-180 months (mean 28.3 months). Osserman scores were in the range of I-III. Almost 27% of the patients were taking steroids or immunosuppressive drugs preoperatively. The mean operative time was 201.5 min (120-330 min) for a one-team approach and it was 146 (95-210 min) for a two-team approach (P < 0.05). While there was no postoperative mortality, the postoperative morbidity was 12%. The incidence of ectopic thymic foci was 68.4%. The rates of complete remission after one, two, three, four and five years of follow-up were 26.3, 36.5, 42.9, 46.8 and 50.2%, respectively. Conclusion: Transcervical-subxiphoid-VTS maximal thymectomy is a complete and highly effective treatment modality for myasthenia gravis. The need for sternotomy is avoided while the completeness of the operation is retained.

Sclerosing fluids to achieve pleurodesis could be hardly replaced for bed-side procedures, but other devices may be successfully applied during thoracoscopy. Thulium Cyber Laser was experimented for this purpose and compared to talc poudrage. Twenty pigs underwent operative videothoracoscopy (VATS). Ten models were subjected to double-port VATS and parietal pleura photoevaporation using Thulium Cyber Laser™ (TCL) 150 W 2010 nm on the posterior third of three ribs; the pleural surface was homogeneously treated inside the target perimeter. The remaining ten pigs underwent uniportal thoracoscopy; talc poudrage was performed using the current clinical practice dosage (1 g/18 kg) with accurate talc powder spread over the whole pleural surface. All models were followed up for 60 days. Pleurodesis firmness was graded on a three-tier scale (none-moderate-firm) and site-matching topographical expectancy was evaluated. TCL produced pleurodesis in all models: 7/10 were firm and 3/10 moderate. Talc poudrage pleurodesis was firm in 4/10 and moderate in 6/10. Pleural adhesions were found exclusively in the treated area after laser treatment, while talc created a wide spectrum of effects, most commonly anarchic jagged adhesions obliterating less than 50 % of the pleural cavity (7/10), mostly declivous. The pathologist found more aggressive inflammation (sometimes severe) in the talc group. Expected localized pleurodesis was always registered in laser group (10/10), while talc poudrage was found poorly effective if consistent pleurodesis is expected in an apico-dorsal position (2/10). Laser pleurodesis appears more homogeneous, qualitatively not inferior, and topographically more predictable than talc pleurodesis. Parietal photoevaporation seems effective and the localized pleurodesis is reproducible. [ABSTRACT FROM AUTHOR]

Videothoracoscopy (VTC) has found its place in minimally invasive thoracic surgery, with a wide range of indications: mediastinal conditions (myasthenia gravis, thymoma, neurogenic tumours) and lung diseases (lung cancer, lung metastases). VTC has also enabled the development of robot-assisted thoracic surgery (RAV). VTC and RAV enable closed thoracic surgical procedures to be performed, but with different tools. The post-operative objectives are the same: reduction in morbidity and mortality rates, early rehabilitation, improvement in quality of life and improvements in long-term results. The short- and medium-term results of both of these techniques are also the same. RAV has seen considerable developments in France in terms of its indications, surgical volume and its distribution across numerous academic and private centres. Some exereses would be more simplistic, and likely to be more reproducible from a technical point of view via RAV than with VTC. For example: mediastinal exereses and pulmonary segmentectomies, where RAV appears to be a more appropriate route than VTC. The cost of robotics in thoracic surgery is yet to be determined compared with classic minimally invasive surgery, but any difference is not likely to put a stop to its development. Finally, RAV has teaching implications through simulations and also the integration of modern imaging techniques, which will allow better preparation for the surgical procedure and ensure it is as safe as ultimately possible. [ABSTRACT FROM AUTHOR]

OBJECTIVES: There are no guidelines regarding the surgical approach for spontaneous pneumothorax. It has been reported, however, that the risk of recurrence following video-assisted thoracic surgery is higher than that following open thoracotomy (OT). The objective of this study was to determine whether this higher risk of recurrence following video-assisted thoracic surgery could be attributable to differences in intraoperative parenchymal resection and the pleurodesis technique. METHODS: Data for 7647 patients operated on for primary or secondary spontaneous pneumothorax between 1 January 2005 and 31 December 2012 were extracted from Epithor®, the French national database. The type of pleurodesis and parenchymal resection was collected. Outcomes were (i) bleeding, defined as postoperative pleural bleeding; (ii) pulmonary and pleural complications, defined as atelectasis, pneumonia, empyema, prolonged ventilation, acute respiratory distress syndrome and prolonged air leaks; (iii) in-hospital length of stay and (iv) recurrence, defined as chest drainage or surgery for a second pneumothorax. RESULTS: Of note, 6643 patients underwent videothoracoscopy and 1004 patients underwent OT. When compared with the thoracotomy group, the videothoracoscopy group was associated with more parenchymal resections (62.4 vs 80%, P = 0.01), fewer mechanical pleurodesis procedures (93 vs 77.5%, P < 10-3), fewer postoperative respiratory complications (12 vs 8.2%, P = 0.01), fewer cases of postoperative pleural bleeding (2.3 vs 1.4%, P = 0.04) and shorter hospital lengths of stay (16 vs 9 days, P = 0.01). The recurrence rate was 1.8% (n = 18) in the thoracotomy group versus 3.8% (n = 254) in the videothoracoscopy group (P = 0.01). The median time between surgery and recurrence was 3 months (range: 1-76 months). CONCLUSIONS: In the surgical management of spontaneous pneumothorax, videothoracoscopy is associated with a higher rate of recurrence than OT. This difference might be attributable to differences in the pleurodesis technique rather than differences in the parenchymal resection. [ABSTRACT FROM AUTHOR]

Results of treatment of 71 victims with combined blunt thoracic and brain trauma were analysed. In the main group (n=35) there was used algorithm, envisaging videothoracoscopic interventions and widening indications for chest stabilization. Mentioned above technique enabled to increase efficiency of diagnostic and treatment in patients with mild and moderately severe brain trauma; this was reflected both in acceleration of restoration of respiratory index by 5,8 days, consciousness - by 4,34,9 days depending on trauma severity and decrease of postoperative complications and lethality number. [ABSTRACT FROM AUTHOR]

Background: The rapid development of minimal invasive surgery in the 1990s coincided with the introduction of videothoracoscopic splanchnicectomy of nerve fibers engaged in the sensation of chronic pain related with advanced cancer. This study was aimed to determine pain intensity in patients with advanced cancer in the epigastric region before and after thoracoscopic splanchnicectomy. Material and methods: The thoracoscopic splanchnicectomy was performed in 33 patients aged 42 to 77 form 2001 to 2005. Patients with chronic epigastric pain due to advanced cancer were qualified for the surgery. The pain intensity was ranked with Prince Henry Hospital Pain Scale (PHHPS). Results: Even though all study patients were on continuous analgesic medications, the mean pain intensity in PHHPS scale was 2.67 points. Two days and thirty days after the surgery, the pain was ranked 1.28 and 1.57, respectively. All patients decreased the doses of their analgesic medication and seven of them entirely discontinued analgesic therapy. Conclusions: The thoracoscopic splanchnicectomy is well suited, although relatively little known, method of the therapy of chronic pain in advanced malignancy. It may be recommended as an option in the current palliative analgesic therapy.

OBJETIVOS: Analisar, em pacientes submetidos a simpaticotomia videotoracoscópica para tratamento da Hiperidrose Primária (HP), as conseqüências hemodinâmicas da desnervação vascular das artérias carótidas e vertebrais após a trans-secção cirúrgica da cadeia simpática torácica (simpaticotomia), através da mensuração de parâmetros ultra-sonográficos. MÉTODO: Vinte e quatro pacientes portadores de HP submetidos a quarenta e oito simpaticotomias torácicas endoscópicas foram avaliados através da mensuração da velocidade de pico sistólico (VPS), velocidade de pico diastólico (VPD), índice de pulsatibilidade (IP) e índice de resistência (IR) nas artérias carótidas comuns, internas e externas, além da artéria vertebral bilateralmente usando o eco-doppler duplex scan. As avaliações foram realizadas antes da intervenção cirúrgica e trinta dias após o procedimento. O teste de Wilcoxon foi usado na análise das diferenças entre as variáveis antes e depois da simpaticotomia. RESULTADOS: A simpaticotomia no nível de T3 foi a trans-secção mais realizada (95,83%), seja isoladamente (25%) ou associada a T4 (62,50%) ou a T2 (8,33%). Houve aumento significativo no IR e no IP da artéria carótida comum bilateralmente (pPURPOSES: Analyze, in patients with primary hyperhidrosis (PH) who was undergone to videothoracoscopic sympathicotomy, the degree of vascular denervation after surgical transection of the thoracic sympathetic chain by measuring ultrasonografic parameters in carotid and vertebral arteries. METHODS: Twenty-four patients with PH underwent forty-eight endoscopic thoracic sympathicotomy and were evaluated by duplex eco-doppler measuring systolic peak velocity (SPV), diastolic peak velocity (DPV), pulsatility index (PI) and resistivity index (RI) in bilateral common, internal and external carotids, besides bilateral vertebral arteries. The exams were performed before operations and a month later. Wilcoxon test was used to analyse the differences between the variables before and after the sympatholisis. RESULTS: T3 sympathicotomy segment was the most frequent transection done (95,83%), as only ablation (25%) or in association with T4 (62,50%) or with T2 (8,33%). It was observed increase in RI and PI of the common carotid artery ( p

The authors present a rare and unusual case of complication, migration of osteosynthetic material for stabilization, titanium rod, which was used for stabilization of comminutive fracture of the first lumbar vertebra. This rod migrated from the retroperitoneal space to the pleural cavity. The removal of this rod was carried out by videothoracoscopy.

Lymphangioleiomyomatosis with tuberous sclerosis complex is a rare disease. One of the most frequent complications of lymphangioleiomyomatosis is pleural effusion (chylothorax) wich can be treated with the use of VATS. Authors report a case of pulmonary lymphangioleiomyomatosis in a 56-year-old female patient with tuberous sclerosis complex with an 8-week history of recurrent chylothorax, dyspnea and debilitating weakness. By CT scan a flat tissue proliferation was seen in the site of the thoracic duct and it was supposed to be the reason for the pleural effusion. A VATS resection of this laesion and ligation of the thoracic duct was performed successfully. Chylothorax is often associated with pulmonary lymphangioleiomyomatosis. Lymphangioleiomyomatosis combined with tuberous sclerosis complex is extremely rare. In case of chylothorax VATS treatment is successful and may be the first choice.