Single-stage bilateral VATS lungs resection from the unilateral access in patients with pulmonary tuberculosis

<b>Purpose of the Study:</b> To compare the effectiveness of single-stage bilateral pulmonary resection (SBPR) from unilateral intercostal-mediastinal access with video-assisted thoracoscopy (VATS) and consecutive bilateral pulmonary resection (CBPR) in treatment of patients with destructive pulmonary tuberculosis (TB). <b>Material and Methods:</b> An open, randomized, controlled, prospective clinical trial of 189 patients with bilateral destructive TB was conducted. In the 1st group (n=91), the SBPR with the VATS was performed from unilateral intercostal-mediastinal access, in the 2ndgroup (n=98), the CBPR was performed. Despite specific adequate chemotherapy, 44.0% of the 1st group and 50.0% of the 2nd group patients (p=0.41 χ2) were smear or/and culture positive. Among them, the MDR-TB was detected in 32.5% of the 1st group and 36.7% of the 2nd group (p=0.68 χ2). <b>Results:</b> The developed method of SBPR showed high efficacy. Intraoperative blood loss of less than 300 ml in the 1st group was observed in 96.7% patients, in the 2nd group - in 68.4% (p&lt;0.001 χ2) (OR = 13.57; 95% CI 3.98-46.29). The mean postoperative blood loss in the 1st group patients was 332.2 ± 23.7 ml and it was 1.8 times lower than the total average blood loss after two consecutive operations in the 2nd group - 610.8 ± 28.8 ml (p = 0.01 U). Postoperative complications were observed in 4.4% patients of the 1st group and in 14.3% of the 2nd group (p=0.03 TTF) (OR = 3.63; 95% CI 1.15–11.46). Bacteriological conversion was detected in 97.5% 1st group and in 83.7% 2nd group patients (p=0.04 TTF). Cavities closure were observed in 98.9% of the 1st group and in 91.8% patients of the 2nd group (p=0.04 TTF).