[Improving surgical technique for tracheal resection with anastomosis]. / Usovershenstvovanie khirurgicheskoi tekhniki pri rezektsii lineinoi chasti trakhei s posleduyushchim anastomozom.

OBJECTIVE: To present modern aspects of improving surgical techniques in tracheal resection developed in recent years. MATERIAL AND METHODS: The authors have the most extensive experience in tracheal surgery (>2.000 patients over the past 50 years). Diagnostic capabilities, perioperative management and surgical techniques have changed over such a long period. This concerns the proposed classification of cicatricial tracheal stenosis, features of endoscopic and X-ray diagnostics, indications for various surgeries, choice of surgical approach, technique of tracheal tube mobilization and anastomosis after tracheal excision. Preventive measures for severe postoperative complications are described. CONCLUSION: Such an extensive experience allowed the authors to develop an algorithm for the treatment of patients with tracheal stenosis. This significantly reduced the incidence of postoperative complications and mortality. Replication of such equipment is associated with technical support of hospitals and professional level of specialists consisting of endoscopist, anesthesiologist, intensive care specialist and thoracic surgeon.

[Early predictor of bronchial suture failure after pneumonectomy]. / Rannii prediktor nesostoyatel'nosti bronkhial'nogo shva posle pnevmonektomii.

OBJECTIVE: To identify the relationship between serum CRP/albumin and bronchial suture failure after pneumonectomy. MATERIAL AND METHODS: A retrospective analysis included 100 patients who underwent pneumonectomy with extended lymph node dissection for lung cancer. Patients were divided into 2 groups depending on postoperative complications: group 1 - bronchial stump failure, group 2 - no similar complications. In all patients, we analyzed markers of inflammation (C-reactive protein and albumin) in preoperative period and after 24 postoperative hours. Bronchial stump failure was found in 20 patients (10 patients (14.7%) after left-sided pneumonectomy and 10 (31%) patients after right-sided pneumonectomy). We found a significant relationship between serum CRP/albumin and bronchial stump failure after pneumonectomy (p<0.05). A prognostic formula was based on the ratio of serum C-reactive protein and albumin: PC = CRP/Alb, where PC - prognostic coefficient, CRP - serum C-reactive protein (mg/l) 24 hours after surgery, Alb - serum albumin (g/l) 24 hours after surgery. PC >2.6 determines high risk of bronchial stump failure after pneumonectomy, PC <2.6 - low risk. Sensitivity of this method is 90%, specificity - 97.5%.

[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.

COMPARATIVE ASPECTS OF RESPIRATORY SUPPORT VIA LARINGEAL AIR DUCTS AND ENDOTRACHEAL TUBE FOR VIDEO-ASSISTED ONKOTHORACIC OPERATIONS.

GOAL: To improve patient 's recovery after video-assisted thoracoscopic lobectomies (VATSL) by laryngeal mask using. METHODS: This is a comparative analysis of 74 patients underwent VATSL. In 37 patients anaesthesia consisted of sevoflurane and fentanyl, myorelaxant, respiratory support via independent ventilation of either lung. In another 37patient 's anaesthesia protocol included respiratory support performed via laryngeal mask, propofol infusion and epidural analgesia with ropivacaine 0,2% and fentanyl. During the operation in both groups we evaluated hemodynamic, arterial blood gases, leukocytes, glucose and cortisol blood level, time to consciousness restoration (Aldrete-score) and time to discharge from ICU and duration of hospital stay, frequency of complications. RESULTS: Patients with ventilation through laryngeal mask showed a statistically lower stress-reaction, avoided bronchoscopy with BAL and frequency of complications. Duration of inhospital stay in patients with laryngeal mask was 7±1,3 days; in intubated patients was 11±3,2 days. CONCLUSION: In case of ventilation through the laryngeal mask hyper dynamic state of circulation, glycemia, leukocytes, cortisol blood level and arterial blood pH were lower, whereas Pa CO2 increase. The number of bronchoscopy with BAL and time to discharge from ICU and from hospital not having risk of postoperative complications --lower.

[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.