Minimally invasive assisted surgeries in surgical treatment of patients with chemoresistent tuberculosis

Abstract

Objective — to analyze in our own experience the possibility of using minimally invasive video-assisted resection surgery in the surgical treatment of patients with chemoresistant tuberculosis.
 Materials and methods. An analysis of the results was conducted application of 79 VATS resections in patients with HRTB for the period from 2008 to 2022. When selecting candidates for VATS resection, preference was given to patients with limited peripheral processes.
 Results and discussion. Among the operated patients in almost half of the cases a typical VATS-lobectomy was performed — 40 (50.6 %). The most common typical upper lobectomy on the right was 14 (16.8 %) observations. In second place in terms of frequency are segmental resections: typical segmentec­tomy — 16 (19.2 %); atypical segmentectomy — 11 (13.2 %) observations. Other types of VATS resections were performed less frequently: pulmonectomy — 5 (6 %), lower whitebectomy — 3 (3.6 %), combined resection of the lower lobe and S6 — 4 (4.8 %) observations.The most frequently studied patients were operated on for tuberculosis 36 (43.2 %), on the second stage of the operation were performed for pulmonary FCT — 33 (39.6 %) observations. There were 4 (4.8 %) patients operated on for cerotic tuberculosis. Pulmonary FCT — 33 (39.6 %). Operations for pneumothorax, hemoptysis and HRT complicated by aspergilloma were performed 2 (2.4 %) in each of the nosologies. The results show that the indications for VATS operations were limited forms of HRTB.
 Conclusions. VATS-resections of the lung lobe are minimally invasive and promising treatments that provide anatomical preparation of the elements of the root of the lung. They can be considered as an alternative to open lobectomy. Extensive use of this method is hampered by severe pulmonary fibrosis and the connective tissue process, due to the long inflammatory process and long-term medical treatment, and the cost of endoscopic instruments.