[Simultaneous surgery for concomitant lung cancer and diffuse coronary atherosclerosis]. / Simul'tannye operatsii pri rake legkogo i diffuznom koronarnom ateroskleroze.

OBJECTIVE: To evaluate the early outcomes of simultaneous surgeries in patients with concomitant lung cancer and coronary artery disease. MATERIAL AND METHODS: We retrospectively reviewed 37 consecutive patients who underwent CABG with adjunct endarterectomy (n=21) or long segmental coronary artery reconstruction (n=25) and lung resection between 2003 and 2019. Mean age was 61.4±6.7 (range 58-71) years. Males prevailed (n=32, 86.4%). Median sternotomy was used in all patients. Myocardial revascularization was followed by on-pump lung resection. The most common procedure was lobectomy (94.6%) of the right upper lobe (83.7%). Lymph node dissection was performed in all patients. RESULTS: CPB time was 162±19.3 min, aortic cross-clamping time 71±14.2 min. There was no in-hospital mortality. Incidence of perioperative myocardial infarction was 5.4%. Postoperative complications were atrial fibrillation (n=6, 16.6%), re-exploration for bleeding (n=1, 2.7%), pneumonia (n=2, 5.4%). Mean hospital-stay was 14.4 days (range 11-21). CONCLUSION: Simultaneous lung resections and coronary artery reconstruction is a safe and reliable surgical method in patients with diffuse coronary atherosclerosis and lung cancer. The developed system of choice, evaluation and surgical treatment of patients with concomitant cardiopulmonary pathology is fundamental for successful treatment of these difficult patients. We need larger randomized studies for certainty.

[Transsternal occlusion of main bronchi fistulae after pneumonectomy]. / Transsternal'naya okklyuziya svishcha glavnogo bronkha posle pnevmonektomii.

OBJECTIVE: To summarize our experience in transsternal occlusion of main bronchus fistula. MATERIAL AND METHODS: We have performed 146 transsternal occlusions of the main bronchi for the period from 1979 to 2018. There were 123 (84.2%) men and 23 (15.7%) women. Mean age of patients was 63 years. Lung tuberculosis was diagnosed in 36 (24.7%) patients, lung cancer - 91 (62.3%) patients, non-specific suppurative lung diseases - 14 (9.6%) patients, trauma - 5 (3.4%) patients. All patients underwent transsternal occlusion of the main bronchi fistulae with or without pericardial cavity dissection. Wedge-shaped bronchial resection or tracheal bifurcation resection were carried out for a short stump fistula. RESULTS: Perioperative complications occurred in 28 (19.2%) out of 146 patients. Intraoperative complications developed in 4 (2.6%) patients. Postoperative complications were observed in 25 (17.1%) patients. Intraoperative mortality rate was 1.4% (n=2), postoperative mortality - 6.2% (n=9). Thus, overall mortality rate was 7.6% (n=11 It should be noted that intraoperative complications were absent if dissection of the pericardium and pulmonary artery stump ligation were not performed. CONCLUSION: Transsternal occlusion of the main bronchi fistulae was successful in 80.8% of patients. In these cases, healing of fistulae was not associated with any complications. Thus, we believe that transsternal occlusion of the main bronchial stump fistula should be considered as preferable surgical strategy.

[Surgical treatment of extensive posttracheostomy tracheal stenosis using a new technique]. / Lechenie rasprostranennogo stenoza trakhei s primeneniem novoi metodiki.

We report one-stage radical surgical treatment of a 54-year-old patient with extensive cicatricial posttracheostomy tracheal stenosis complicated by tracheomalacia of anterior tracheal wall and previous numerous unsuccessful endoscopic attempts of tracheal recanalization. A new method of prevention of tracheal anastomosis failure was applied.

[Minimally invasive thoracoscopic and robot-assisted lobectomy]. / Miniinvazivnye videotorakoskopicheskie i robot-assistirovannye lobéktomii.

OBJECTIVE: To compare the early outcomes of video-assisted and robot-assisted lobectomy. MATERIAL AND METHODS: There were 74 robot-assisted lung resections for the period 2017-2018. Sixty-six patients underwent lobectomy and 8 - segmentectomy. Patients were divided into 2 groups to compare thoracoscopic procedures. The main group consisted of 66 patients after robot-assisted lobectomy. The control group included 247 patients after video-assisted lobectomy. Mean age of patients was 60.5 years (range 35-70). There 72% men and 28% women. CONCLUSION: Both thoracoscopic procedures are characterized by high efficiency and safety. However, certain disadvantages are peculiar to both methods.

[Video-assisted thoracoscopic thymectomy in myasthenia gravis. New approach]. / Videoassistirovannaia torakoskopicheskaia timéktomiia pri miastenii. Novyi podkhod.

AIM: To present possibility and technical aspects of anesthetic management during video-assisted thoracoscopic thymectomy in patients with myasthenia gravis. MATERIAL AND METHODS: The article describes the proposed modified anesthetic method that is suitable for video-assisted thoracoscopic thymectomy in patients with myasthenia gravis. Nine patients with myasthenia underwent VATS-thymectomy. Anesthesia was performed with artificial airway and auxiliary ventilation without muscle relaxants administration.

[Anesthesia during video-assisted thoracoscopic lobectomy using laryngeal ductwork and auxiliary mechanical ventilation]. / Opyt vypolneniya anestezii pri provedenii videoassistirovannykh torakoskopicheskikh lobektomii s ispol'zovaniem laringeal'nogo vozdukhovoda i vspomogatel'noi ventilyatsii legkikh.

The article presents the experience of video-assisted thoracoscopic lobectomies in patients without endotracheal intubation and sparing of spontaneous breathing. The results of intraoperative monitoring and laboratory data of all perioperative period are described. In view of these data it was concluded that such approach can decline the severity of stress-response against surgical aggression in this group of patients.

[Anesthetic management of reconstructive surgery on the respiratory tract]. / Osobennosti anesteziologicheskogo obespecheniya rekonstruktivnykh operatsii na dykhatel'nykh putyakh.

In the article provides an analysis of own of clinical experience peculiarities of carrying out of anesthesia, when performing 466 various tracheo-bronhoplastiс of operations for the period from 1979 to 2014 the year a one team of surgeons. Preoperative preparation, anesthesia and postoperative management of patients are key to improving treatment outcomes. Full arsenal of modern methods of ventilation lets you choose for each stage of surgery is most convenient for the surgeon and patient-safe way to maintain gas exchange. Presented in this paper our anestiology experience allows you to discuss and elect the proposed management of patients through the selection and optimization of the method that best meets modern requirements.

[Videothoracosopy in diagnosis and surgical treatment of tuberculosis]. / Videotorakoskopiia v diagnostike i khirurgicheskom lechenii tuberkuleza.

From 1993 to May 2001, 795 psychiatric patients were treated including 563 with pleural effusion, 98 with multiple or solitary tuberculoma, 69 with tuberculous empyema, 14 with fibrotic-cavitary tuberculosis, 51 with disseminated tuberculosis. Mean age of the patients was 32 years. Survey of pleural cavity with pleural or lung biopsy was performed in 691 patients. In tuberculoma 14 lobectomies were performed, 23 patients underwent atypical lung resection without stapler (including with precise technique). Bilateral on-stage interventions were made in 32 patients. In empyema necrectomy and lung decortication were performed. 14 patients underwent videocavernoscopy with sequestrectomy and cavity drainage. In disseminated tuberculosis lung biopsy without staplers was usually performed. Aerohemostasis was achieved with plasma stream. One patient with empyema and one patient with pleural effusion died (lethality was 0.25%). Rate of postoperative complications was 7.5% in tuberculoma and 1.5% in disseminated tuberculosis. Conversion to thoracotomy was necessary in 3 (3%) patients with tuberculoma and 12 (17%) patients with empyema. Mean hospital stay was 4 days after diagnostic surgery and 7 days after lung resection. In pleural effusion diagnosis was verified in 98% cases, in disseminated tuberculosis--in 100%. Videothoracoscopy is the best diagnostic method for pleural effusion and disseminated forms of lung tuberculosis and operation of choice in tuberculoma and empyema. Videothoracoscopy in tuberculosis is highly effective and associates with low rate of postoperative complications and lethality.

[Surgical treatment of stage IIIA non-small-cell lung cancer]. / Khirurgicheskoe lechenie patsientov s IIIA stadiei nemelkokletochnogo raka lëgkogo.

Data on five-year survival were evaluated for 258 patients with non-small cell lung cancer (stage IIIA) (N2). In 155 patients (60%), N2 tumor was detected during surgery. Total resection was carried out in 179 (69.4%), subtotal--79 (30.6%). Total lymph node dissection was not employed in the latter group. Lateral thoracotomy was used in 213 cases. Transsternal procedure was performed in 45 cases of bulky tumor and extensive invasion of mediastinal fat. A comparison of five-year survival data failed to establish any relationship between survival and postoperative radiochemotherapy in radically-operated patients. It was found that surgery for non-small lung N2 tumors with mediastinal involvement is indicated and may be effective if total lymph node dissection is performed.

[Video-assisted thoracoscopy in treatment of pleural empyema]. / Videotorakoskopiia v lechenii émpiemy plevry.

The experience of treatment for 609 patients with empyema of the pleura with the use of videothoracoscopy technique has been summarized. 436 (71.6%) patients were at stage 1 of the disease, 126 (20.7%)--stage 2 and 47 (7.7%)--stage 3. All complications of intrapleural bleedings arisen in 3 (0.5%) patients, have been controlled through thoracoscope. There were no postoperative complications. Transformation of videothoracoscopic operation into the open one has been required in 11 (1.8%) patients: in 4--due to extensive destruction of the lung tissues, in 4--due to atelectasis of the lung, and in 3--because of the danger of endoscopical injury to the mediastinal organs. Feasibility of videothoracoscopic decortication of the lung and pleurectomy at stage 3 of chronic empyema of the pleura was demonstrated. 37 (78.7%) patients were cured by this method.