[Intraoperative near-infrared fluorescence imaging of peripheral lung tumors]. / Intraoperatsionnaya flyuorestsentnaya vizualizatsiya perifericheskikh opukholei legkikh v blizhnem infrakrasnom diapazone.

The main objective of surgical intervention in lung cancer is the radical removal of the entire tumor with the maximum possible preservation of healthy tissue. Although the area of the tumor lesion is known by the results of preoperative studies, it can be difficult to use this information to establish the exact boundaries of resection during surgery, especially with small sizes of the lump and when using minimally invasive approaches. There are several techniques to solve this problem. One of the latter is intraoperative fluorescence imaging in the infrared range, which makes it possible to detect a tumor not only with greater contrast than it can be done in white light, but also with its deep location. This review is devoted to the discussion of various aspects of this approach related to molecular imaging methods. The current situation based on the use of green indocyanine green, available for clinical use as a fluorescent agent is considered, the issues of using new targeted drugs are examined, as well as the possibility of increasing the depth of probing and combining with related treatment methods, which should contribute to a more radical operation and reduce the likelihood of local relapses.

[The first experience of fluorescent angiography with indocyanine green in primary esophagoplasty with gastric conduit in patients with malignant tumors of the esophagus]. / Pervyi opyt flyuorestsentnoi angiografii s indotsianinom zelenym pri pervichnoi ezofagoplastike zheludochnym steblem u bol'nykh so zlokachestvennymi opukholyami pishchevoda.

OBJECTIVE: To evaluate the possibilities of intraoperative indocyanine green fluorescein angiography (ICG technology) in primary esophagoplasty by gastric conduit in patients with malignant tumors of the esophagus. MATERIAL AND METHODS: The study included 74 patients. Depending on the localization of the tumor in the esophagus, a Lewis-type or McKeown-type operation was performed. The retrospective group (surgery without the use of ICG technology) included 53 patients who underwent surgery from 2015 to 2020 years.The prospective group (surgery with the use ICG technology) included 21 patients operated on from 2021 to 2023 years. ICG technology was used to assess microcirculation in the gastric conduit during esophagoplasty, as well as to identify the right gastroepiploic artery. RESULTS: The ICG fluorescein angiography technique for assessing microcirculation in the gastric conduit was a simple and easily reproducible procedure. Perfusion of the gastric conduit was regarded as satisfactory in 16 (76%) cases, unsatisfactory in 5 (24%) cases, which required resection of the distal part of the conduit. All cases of poor perfusion were in patients with narrow gastric conduit and neck anastomosis location (McKeown-type operation). Anastomotic leakages occurred in 8 (15%) patients in the retrospective group, 4 (19%) patients in the prospective group (p>0.05). In 4 out of 5 cases of poor gastric conduit perfusion, anastomotic leaks occurred. Immediate postoperative results in the compared groups were also comparable. The use of ICG technology in 5 (45%) cases out of 11, when laparoscopic mobilization of the stomach was performed, helped to visualize the right gastroepiploic artery, which is the main source of blood supply to the formed gastric conduit. The use of ICG technology in 3 patients with a compromised gastrostomy stomach demonstrated the absence of significant microcirculation disorders in the stomach wall. CONCLUSION: The first experience of using fluorescein angiography with ICG in primary esophagoplasty by gastric conduit in patients with malignant tumors of the esophagus demonstrated the safety, simplicity and availability of this technique. An objective assessment of the effectiveness of the application of ICG technology requires the accumulation of experience.

[Surgical management of tracheal anastomosis failure and risk of arterial bleeding]. / O khirurgicheskoi taktike pri nesostoyatel'nosti trakheal'nogo anastomoza i ugroze arrozionnogo krovotecheniya.

OBJECTIVE: To determine the optimal algorithm for tracheal anastomotic insufficiency and prevention of arterial bleeding. MATERIAL AND METHODS: We present 2 patients with defects of tracheal anastomosis after tracheal resection and divergence of tracheal edges. We primarily analyzed appropriate emergency care and prevention of subsequent severe complications such as arterial bleeding and respiratory insufficiency. CONCLUSION: Tracheostomy may be preferable for complete late tracheal anastomotic insufficiency to restore breathing. However, surgery should be accompanied by prevention of arterial bleeding. Isolation of damaged area, particularly tracheostomy tube, from the mediastinum by well-vascularized tissues can prevent bleeding from major vessels (for example, innominate artery). Follow-up is unreasonable due to worsening of clinical situation, risk of hemorrhagic complications and fatal outcomes. General satisfactory clinical status of the patient is not of matter. Repeated tracheal anastomosis is justified only for early insufficiency, i.e. within 2-3 days when postoperative inflammation is mild.

[Randomized trials and progress in surgery]. / Randomizirovannye issledovaniya i progress khirurgii.

It is very difficult to find certain surgical field in which surgeon's decision is absolutely evidence-based. The objective of evidence-based medicine (and surgery) is offering the best treatment for each patient that should encourage conducting the randomized trials (RT) as the highest level of evidence. The results of RTs often contradict the existing clinical experience, and experience per se does not always confirm the significance of the results obtained. One cannot make any conclusions based on RT data. Treatment strategy for a particular patient remains unclear. The authors have analyzed the results of large-scale RTs devoted to laparoscopic cholecystectomy, rectal surgery, lung cancer surgery, postoperative care, treatment of pulmonary emphysema. It was shown that RT data as the highest level of evidence are not always true for surgery. In most clinical situations, the decision is not based on RT results. The desire of surgeons to master a new technique is often more significant than patient care, while clinical experience and the laws of the market are more important than science. There is no doubt that knowledge of RT results are essential in training period, but this means quite a bit for a particular patient. The best decision can be made during discussion and conversation with colleagues, where an experience of each specialist will have the same value as the best evidence.

Photodynamic Theranostics of Central Lung Cancer: Capabilities of Early Diagnosis and Minimally Invasive Therapy (Review).

The aim of the study was to assess the prospects for central lung cancer (CLC) screening using fluorescent diagnostics and its treatment by endobronchial photodynamic therapy (PDT). Bronchoscopic fluorescent diagnostics using chlorin e6 photosensitizers and a developed instrumental system enable to reveal tumor changes in large bronchi mucosa at early stages, and a developed PDT technique performed under fluorescent control helps achieve personalized treatment. Such an approach is considered as a theranostic technique - photodynamic theranostics. central lung cancer screening requires a fluorescent dye characterized by availability and can be used directly within the examination. Indocyanine green can be used as a dye, its peculiarity is the necessity to excite and record fluorescence in the near-infrared (NIR) wavelength band. First experiments using NIR bands to diagnose a bronchoscopic system showed the detectability of tumor areas using on-site bronchoscopic photodynamic theranostics, which consists in NIR imaging of tumor foci when a standard dose of indocyanine green is administered during the examination. Conclusion: Further progress of early diagnostics and minimally invasive CLC therapy will be determined by the development of new photosensitizers, which should be characterized by a high absorption band in NIR area, quick accumulation in a tumor, high yield of single oxygen in NIR illumination, bright fluorescence, high potential in terms of the induction of an anti-tumor immune response.

[Analysis of lymphatic drainage pathways using infrared fluorescence in patients with lung cancer]. / Izuchenie putei regionarnogo limfoottoka pri rake legkogo s pomoshch'iu infrakrasnoi fluorestsentsii.

OBJECTIVE: To develop a method for analysis of lymphatic drainage pathways from the lobe of the lung affected by non-small cell lung cancer (NSCLC) using infrared fluorescence. MATERIAL AND METHODS: A study enrolled patients with NSCLC who underwent anatomic resection of the lung with systematic lymph node dissection and preliminary intraoperative peritumoral injection of indocyanine green conjugate with human albumin. Registration of fluorescence in regional lymph nodes (LN) was carried out immediately after excision of specimen using the FLUM-808 instrumental system. RESULTS: Infrared fluorescence was observed in 117 hilar and mediastinal lymph nodes from 43 patients (2.7 nodes per a patient). Comparison of localization of fluorescent LN with localization of tumor in various lobes established significant variability of lymphatic drainage pathways. CONCLUSION: The developed method of infrared fluorescent evaluation of lymphatic drainage in patients with NSCLC confirms the necessity of systematic lymph node dissection for adequate staging.

Infrared Fluorescent Angiography during Experimental Trachea Transplantation.

Indocyanine green fluorescence was used for evaluation of the degree of trachea revascularization after its autotransplantation in rabbits (transplantation of 1- and 2-cm segment of the trachea). Intravenous administration of indocyanine green was followed by a significant fluorescence of the substance in microvessels of the trachea over 30-40 sec. Immediately after surgery, fluorescence in the implanted segment was absent, but within 7 days it was completely restored in rabbits receiving transplantation of a 1-cm segment. After transplantation of 2-cm segment of the trachea, fluorescence did not recover, which corresponded to the clinical picture and autopsy results. Thus, fluorescent angiography is an informative method for evaluation of trachea revascularization.

[Palliative surgical correction of respiratory insufficiency in diffusive pulmonary emphysema]. / Palliativnaia khirurgicheskaia korrektsiia dykhatel'noi nedostatochnosti pri diffuznoi émfizeme legkikh.

AIM: To analyze early postoperative period in patients with diffuse pulmonary emphysema after palliative surgical correction of respiratory failure. MATERIAL AND METHODS: The study included 196 patients who underwent bullectomy (n=111) and surgical reduction of pulmonary volume (n=85). RESULTS AND DISCUSSION: Overall morbidity and mortality were 40.8% and 12.2% respectively. Among patients older than 60 years these values were significantly higher (58.0% and 22.6% respectively). It was shown that age over 60 years is associated with high risk of complications and mortality after excision of large and giant bulls. In patients <60 years morbidity is comparable after bullectomy and surgical reduction of pulmonary volume. CONCLUSION: Selection of patients for palliative surgical correction of respiratory failure is generally corresponded to that for lung transplantation. However, these methods should be considered complementary rather competing.

[Argon-laser ablation is a new method of airways recanalization for tumoral stenosis]. / Novyi metod rekanalizatsii dykhatel'nykh putei pri opukholevykh stenozakh: argonolazernaya ablyatsiya.

AIM: To develop the new method of laser recanalization of airways for tumoral stenosis. MATERIAL AND METHODS: It is proposed to conduct laser effect in the gas environment that does not support combustion (argon). Also the device for these AIM: is suggested. The method is called argon-laser ablation (ALA). A comparison of ALA and conventional high-energy laser exposure (LPD) was performed. RESULTS: ALA and LPD were used in 46 patients and 17 patients with non-small cell lung cancer. The duration of endobronchial operations and incidence of complications were significantly higher in group 2. The incidence of complete remission was significantly higher in group 1. CONCLUSION: Endobronchial argon-laser ablation of tracheal and bronchial tumors removes exophytic tumoral component in more favorable conditions compared with conventional high-energy laser exposure. Also it significantly increases an efficiency and reduces the frequency of complications.

ENDOBRONCHIAL PHOTODYNAMIC THERAPY UNDER FLUORESCENCE CONTROL: PHOTODYNAMIC THERANOSTICS.

One of the disadvantages of photodynamic therapy is impossibility to specify the method according to biological features of malignant tumor such as a degree of blood supply, accumulation of photosensibilizator in tumorous tissue, proliferative activity and etc. The authors aimed to develop a mode of individualization of endobronchial photodynamic therapy of central non-small cell carcinoma of lung and assessment of method efficacy. The suggested method is based on fluorescent diagnostics of degree of accumulation of photosensibilizator in timorous tissue and the rate of its expenditure in process of performing of photodynamic therapy. There was made a comparison of parameters of methods and results of photodynamic therapy in 2 randomized groups. Each group consisted of 45 patients. The research method was applied in the main group and the standard method was used in the comparison group. It was found that the research method allowed significant reduction of duration of irradiation compared with conventional method (at the average from 690±65sec to 470±45sec, p=0,02), though the treatment results were the same. The suggested method allowed separation of group of patients with absence of fluorescence of timorous tissue. Performance of photodynamic therapy is unreasonable for these patients.

SURGICAL SAFETY CHECKLIST: FROM IDEA TO PRACTICAL APPLICATION.

Methods of surgical interventions performing, modifications, instruments used for operation became more developed every year. In spite of this fact, tendency of increase of the rate of iatrogenic errors took place and it was possible to prevent these mistakes by application of Surgical Safety Checklist. The «checklists¼ are easily available, not very expensive in practice and they are simple to use. An application of such questionnaires could improve the team work and understanding between members of the crew, which could influence directly on operation outcome. The article presents the history of creation of safety list, the analysis of efficacy of «checklist¼ application in clinical practice in different countries, information about controversial questions in «checklist¼, perspectives of its application.

[Possibility of the use of the conjugate of indocyanine green with albumin for infrared fluorescent diagnosis of pathological processes in experiment].

An investigation of fluorescent diagnosis possibility in the near infrared range was performed on a rat model of the Pliss lymphosarcoma (30 rats) with the use of indocyanine green (ICG) as a fluorescent marker and photosensitizer. For conju- gates of ICG there were used bovine and human albumins as these proteins in solution strengthened and stabilized fluorescence and in intravenous administration promoted improving diagnosis while the diagnostic contrast after administration during the optimum time was no less than 6. It permitted to easily detect a pathological focus (tumor or inflammation).

CRITERIA OF SURGICAL RISK IN PATIENTS WITH DIFFUSE LUNG EMPHYSEMA WITH LARGE AND GIANT BULLAS.

The article presents an assessment of postoperative period in patients with diffuse lung emphysema with large and giant bullas on the basis of surgical risk criteria, which were developed for the patients with diffuse emphysema without bullas. Retrospective study determined the group of patients who had high rate of surgical complications after bullectomy. The patients (46) were divided into 2 groups and it depended on the initial condition of the patients. There was stated, that the main criterion of surgical risk was a decrease of the level of OFL lower than 20% of the proper level in patients with large and giant bullas.

[INTRAOPERATIVE DETECTION OF SENTINEL LYMPH NODES USING INFRARED IMAGING SYSTEM IN LOCAL NON-SMALL CELL CARCINOMA OF LUNG].

The article presents the results of the first domestic experience of intraoperative fluorescence mapping of sentinel lymph nodes in lung cancer. The research included 10 patients, who underwent surgery over the period of time from September 2013 to May 2014. After performing thoracotomy, the solution of indocyanine green (ICG) was injected using subpleural position above the tumor in 3-4 points. Fluorescence (ICG) image guided surgery was carried out by using infrared radiation (wave length 808 nm) on lung surface, root of lung, mediastinum in real time. Fluorescence lymph nodes were mapped. In case that metastatic lesions weren't revealed in sentinel lymph nodes, they weren't noted in other nodes. Method specificity consisted of 100%. Biopsy and histological study of sentinel lymph nodes mapped during fluorescence (ICG) image guided surgery could be useful for prevention of lymphodissection in patients with non-small cell carcinoma of lung.

[VIDEO-ASSISTED THORACIC SURGERY USING LOCAL ANESTHESIA IN LUNG ABSCESSES AND PYOPNEUMOTHORAX].

The article presents the results of 42 video-abscessoscopies (VAS) in acute and gangrenous lung abscess and 32 video-thoracoscopies (VTS) in pyopneumothorax, which were performed using local anesthesia and sedation. There were several indication to operation: sanation of cavities, removal of necrotic sequestration and fibrin, decollement, biopsy. Perioperative complications developed after 11 surgeries (13%): emphysema of soft tissues of pectoral cells (5), phlegmon of the thorax (3), bronchial hemorrhage (2), pneumothorax (1). One of the patients died, because of progressing of main disease. VAS and VTS were carried out in 5-8 days after cavity drainage of abscess or pleural cavity in 50 patients.. In other 15 cases operations were performed directly before drainage. The bronchial hemorrhage and phlegmons of the thorax were noted in patients of second group. The patients had good tolerance of VAS and VTS operations fulfilled using local anesthesia and sedation. They are safe in case that operation follows drainage of abscess or pleural cavity after decrease of inflammatory processes.

[Intraoperative detection of the sentinel lymph nodes in lung cancer].

An analysis of the scientific data was made. It was used the literature devoted to the intraoperative visualization of the sentinel lymph nodes in patients with lung cancer. Correct detection of such lymph nodes with following pathologic investigation allowed limiting the volume of lympho-dissection in a number of patients. There is the possibility of maximal in-depth study of the sentinel lymph nodes by purposeful application of most sensible pathologic and molecular methods for detection their micrometastatic lesions. At the same time the treatment strategy and prognosis could be determined. The authors present the results of an application of dye techniques, radioactive preparation and fluorescence imaging for sentinel lymph node detection. Advantages and disadvantages of the methods are shown in the article. There are validated the prospects of technical development, study of information value of new applications and the most perspective method of fluorescence indocyanine green visualization by lymph outflow.

[ULTRASONIC ASSESSMENT OF DIAPHRAGM CONDITION OF THE PATIENTS, WHO PASSED THE SELECTION FOR LUNG VOLUME REDUCTION SURGERY].

The article showed the results of ultrasonic assessment of topographic and functional diaphragm indices in patients with severe diffuse emphysema. They passed the selection for lung volume reduction surgery. The comparison of diaphragm indices was presented in patients with diffuse emphysema and control group of healthy volunteers. Dynamics of diaphragm condition was studied after surgical treatment. There wasn't noted any statistical difference of diaphragm topographic indices as compared with the control group. There wasn't shown a correlation between respiratory function indices and functional diaphragm indices, but it was noted a positive tendency in characteristics during quiet breathing.

[Diagnostics and surgical treatment of lung cancer in conditions of special thoracal department for patients with purulent lung diseases].

The authors investigated features of diagnostics and surgical treatment of lung cancer which was complicated by purulent destructive process. The possibilities of radical operative intervention were considered after preliminary adequate treatment of purulent complications in 226 patients. It was noted, that the diagnostic thoracotomy should be used in doubtful cases in order to estimate the resectability of lung cancer.