Video-assisted surgery in the treatment of patients with tuberculosis of lungs and pleura

Objective — to analyze and compare the experience of performing VATS-resections of lungs and VATS pleurectomy with decortication (PE with pulmonary DC) in patients with pulmonary tuberculosis in comparison with classical methods of lung resection and pleurectomy.Materials and methods. In the study, patients were divided into two groups. The first — patients who underwent VATS resections and classical resection with extensive thoracotomy for tuberculosis. The second — patients with tuberculosis who underwent VATS PE with pulmonary DC and its classic version.Results and discussion. VATS — lung resections in patients with tuberculosis, compared with classic open resections, reduced the number of intraoperative complications by 3.6 %, the number of postoperative complications by 3.1 %, the average blood loss during surgery by almost 100.0 ml, the average duration of the operation is more than 90 minutes, the average length of stay in the intensive care unit for 2 days, the average length of stay in the hospital in the postoperative period almost twice, the average duration of narcotic analgesics for 3 days, the number of relapses by 1.6 %. Early mobilization of patients (up to 3 days) in whom the VATS method was used was observed 77.3 % more often than in patients operated by the traditional open method. The overall effectiveness of treatment in the main group increased by 3.0 %. VATS PE with DC was performed in 35 patients, and classical pleurectomy with decortication of the lung in 38 patients. Conclusions. The use of VATS surgery as a method of treatment of patients with pulmonary and pleural tuberculosis is an effective, convenient and minimally invasive method. Performing VATS surgery is accompanied by minor blood loss, better cosmetic effect than when performing a thoracotomy. The use of VATS allows for earlier mobilization of the patient and to expand the indications for the use of VATS in elderly patients and patients with limited vital functions; reduction of terms of stay of the patient in a hospital, and accordingly ­ reduction of the estimate for treatment.