VM KAMASHEV'S METHOD FOR PERICARDIUM FORMATION FOLLOWING LEFT LUNG REMOVAL Russian patent published in 2010 - IPC A61B17/00 

FIELD: medicine.

SUBSTANCE: invention concerns medicine, namely oncology and phthisiology and can be used in pericardium formation following left lung removal. The method involves lateral incision of chest from the left, subperiostal separation of soft tissues from ribs, release, transection, ligation of pulmonary root elements, hemostasia, application of iodine tincture onto bronchial tube stump, removal of resected lung, control and maintenance of tightness of bronchial tube stump, covering of lung root stump with mediastinal or parietal pleura by suturing and immersing thereof into mediastinum, transection, displacement and suturing of intercostal muscles and other soft tissues of thorax, installation of pleural drainage, closing of thoracic wall in genera. The lateral incision is made in the 4th intercostal space from midclavicular to paravertebral lines; a wound retractor is installed with intercostal muscles and other soft tissues of thorax being dissected together with parietal pleura from pleural cavity up to subcutaneous fat lengthways along the upper edge of the 8th rib from thorax and across costal arches in the direction from an upper edge of the 8th rib upwards to the incision, with a distance between the place of attachment of the 7, 6 and 5 ribs to thorax that is determined by sequential application thereto of one end of the measuring strip. The opposite end thereof is placed to a projection of apex of heart at its physiological placing on the posterior surface of the pleural cavity along the paravertebral lines; then to points on 1 and 2 ribs thereover with the strip arranged along the line which benda around the left lateral surface of heart. Then muscular layer is separated from subcutaneous fat and parietal pleura with periosteum from ribs towards thorax, while removing uncovered ribs to form a pedicle flap. The free end of the flap is displaced towards the spine, unfolded with the flap covered with the pleural surface on the left lateral surface of heart. The surgeon fixes apex of heart in physiological position. Thereafter the flap is tensed with its face side aligned with the estimated area of the paravertebral line. It is sutured to pleura, with suturing started from the lower angle of the flap to the upper one with controlling a bed formation of the flap. This bed fixes heart in physiological position. Then it is wiped with tampons with washing the whole surface of mediastinum and pleural cavity with 0.9% sodium chloride at 37°C up to removal of last clot of blood and purification of solution to light pink colour, and installation of drainages and closing of thoracic wall are performed after control of motionless position of heart in the formed pericardium with changing the space arrangement of body.

EFFECT: application of given invention allows improving safety of lung resection in the absence of pericardium due to creation of the bed that prevents heart disposition.

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