Minimally invasive surgical treatment of combat trauma of the chest cavity (first results)

Abstract

Annotation. The article is devoted to the study and comparison of the first results of the treatment of the wounded with combat damage to the chest cavity, which were obtained during the hostilities of 2022-2023. The aim of the study – to improve the results of treatment of the wounded with damage to the organs of the thoracic cavity, by implementing modern diagnostic and surgical methods using minimally invasive technologies and tissue viability imaging systems. All wounded (20 patients) underwent VATS surgical interventions with pleurectomy, lung decortication and resections of areas of damaged lung parenchyma. The wounded of the first group (10 patients) additionally underwent visualization control of the viability of tissues by using ICG technology with the contrast “Verday” 0.1 mg/kg of body weight and subsequent lung resection within the determined limits of viability. In the second group (10 patients), if lung resection was necessary, the selection of the resection margin was based on the surgeon's subjective assessment. In the postoperative period, the following were evaluated: the duration of artificial lung ventilation after surgical procedures, the duration of dependence on oxygen support, the presence of repeated VATS or thoracotomy operations, the presence of acute respiratory distress syndrome in adults (ARDS), pneumonia, pneumothorax, pleural empyema. Statistical analysis of clinical data on postoperative complications was carried out using the statistical analysis package EZR v. 1.35 (Saitama Medical Center, Jichi Medical University, Saitama, Japan). The Mann-Whitney test was used to analyze the differences between groups of quantitative and rank characteristics. According to indicators evaluated after operations, no significant difference between groups of patients was obtained was, however, there was a trend toward better outcomes in the patient group where ICG contrast was used to assess tissue viability and assess the extent of lung resection. The absence of a significant difference between the indicators of the two groups is due to the small sample of patients included in the study. Therefore, it is necessary to continue to investigate the use of indocyanine green (ICG) contrast technology during VATS interventions with a larger sample of patients.