Novosti
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Year 2012 Vol. 20 No 2
GENERAL AND SPECIAL SURGERY
B.N. KOTIV, A.P. CHUPRINA, D.YA. YASYUCHENYA, D.M. MELNIK, D.S. SHELEGETOV, V.I. IONTSEV
PHYSICAL METHODS OF TISSUES DISSECTION AND COAGULATION IN THORACOSCOPIC SURGERY
FSBMEE HPE “Military Medical Academy named after S.M.Kirov” Ministry of defence of the Russian Federation,
The Russian Federation
Objectives. To investigate the possibility of practical use of different physical methods of tissue dissection and coagulation in thoracoscopic surgery, to determine the indications for their application.
Methods. The efficiency of ultrasound, argon enhanced and cold plasma coagulation to achieve a safe aerohaemostasis for resection of the lung tissue was demonstrated in the series of experiments on 25 mongrel dogs. The possibility of using these physical methods of tissue dissection and coagulation in video-assisted thoracic surgery was shown in 209 patients with the non-verified disseminated processes, lymphadenopathy and mediastinum neoplasms during the clinical part of this study.
Results. Ultrasonic lung tissue dissection and coagulation permit to achieve a safe aerohaemostasis and the lung wound hermeticity. Cold plasma coagulation is the most superficial mode of electrosurgical exposure. 140 patients had diagnostic surgery and 69 operations performed with curative intent during the study. Thoracoscopic lung resection, biopsy of mediastinal lymph nodes and neoplasms were informative in all cases. Postoperative complications occurred in 15 (7%) patients. There were no lethal outcomes. The average duration of hospitalization made up 6,3±0,4 days.
Conclusions. Thoracoscopic ultrasonic atypical lung resection can be performed in patient with peripheral lung nodules and disseminated processes. Dissection of mediastinal anatomic structures and elements of the lung root should be performed with ultrasonic dissector; cold plasma coagulation for hemostasis near the large vessels of mediastinum and lung root is the most superficial and safest mode of electrosurgical exposure.
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94044, Rossiiskaia Federatsiia g. Sankt-Peterburg, ul. Akademika Lebedeva, d. 6, FGBVOU VPO “Voenno-meditsinskaia akademiia im. S.M. Kirova”, kafedra i klinika gospital'noi khirurgii,
e-mail: fsurgeonf@mail.ru,
Iasiuchenia Denis Aleksandrovich
Kotiv B.N., doctor of medical sciences, professor, colonel of medical service, a head of the chair and clinic of hospital surgery of FSBMEE HPE "Military Medical Academy named after S.M. Kirov’, Ministry of defense of the Russian Federation.
Chuprina A.P., candidate of medical sciences, associate professor, colonel of medical service, professor of the chair of hospital surgery of FSBMEE HPE "Military Medical Academy named after S.M. Kirov, Ministry of defense of the Russian Federation.
Yasyuchenya D.A., captain of medical service, graduate student of the chair of hospital surgery of FSBMEE HPE "Military Medical Academy named after S.M. Kirov, Ministry of defense of the Russian Federation.
Melnik D.M., a surgeon of the thoracic department of the clinic of hospital surgery of FSBMEE HPE "Military Medical Academy named after S.M. Kirov, Ministry of defense of the Russian Federation.
Shelegetov D.S., captain of medical service, clinical resident of the thoracic department of the clinic of hospital surgery of FSBMEE HPE Military Medical Academy named after S.M. Kirov, Ministry of defense of the Russian Federation.
Iontsev V.I., captain of medical service, senior clinical resident of the surgical department of the hospital surgery clinic of FSBMEE HPE "Military Medical Academy named after S.M. Kirov”, Ministry of defense of the Russian Federation.
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