METHOD OF VIDEO ASSISTED EXTRAPLEURAL THORACOPLASTY Russian patent published in 2011 - IPC A61B17/00 

FIELD: medicine.

SUBSTANCE: invention refers to medicine, particularly thoracic surgery. Substance of the method involves the fact that under mixed anaesthesia with separate endobronchial intubation in a prone patient, an incision 10 cm long is executed paravertebrally, parallel to a medial edge of a scapula from a level of a spinous process of a III thoracic vertebra. Skin, subcutaneous fat, a portion of a trapezius muscle, a broadest muscle of back and a greater rhomboid muscle are dissected. The partially dissected muscles and scapula are stripped from an external surface of ribs in a projection of following decostation, and taken aside and entoectad with wide hooks thereby creating a cavity between the greater skeletal muscles and rib cage for big skeletal muscles and a costal skeleton for surgical manipulations. A Thoracoport is fixed in this cavity through a separate puncture 2 cm above an upper angle of a wound; a video thracoscope to inspect the manipulations to be executed is introduced. Thereafter, erector muscular fibres are splitted thereby making free of back segments of the ribs. Decostation of five to six ribs starting with a III rib is enabled by dissecting a periosteum along its external surface with an electric cutting probe, cleaning the rib from the periosteum and intercostal muscles with a raspatory. Without exposing a pleural cavity, tendons and ligaments attached to a transverse process of the third thoracic vertebra are dissected. Forceps are used to cut through a neck of the III rib together with the transverse process of the third thoracic vertebra. Thereafter, the rib is cut through up to a costal cartilage and removed. Similarly, the II and I ribs are removed anteriad up to the costal cartilage, the IV rib - up to an anterior axillary line, the V rib - to a middle axillary line and the VI rib - to a posterior axillary line. Then, an apex of lung is separated in an extrapleural layer for ensuring greater mobility. Closed cavity plasty follows: a wall of the greater cavities in the lung are invaginated with gathers suturing by intercastal tissues without puncturing a pulmonary tissue. At the last stage, a filling material is introduced in the extrapleural cavity; a micro irrigator is inserted in the extrapleural cavity through a single puncture above an operative approach; the wound is closed. Within postoperative 2-2.5 months, until cartilaginous reclaims are formed, an antibiotic or jelly-like collagen solution is introduced daily through the micro irrigator to generate an extra collapse.

EFFECT: invention allows generating sufficient collapse of the pulmonary tissue with minimum injures and decostation extent, providing a high cosmetic effect, reducing postoperative complications as few as possible.

1 ex, 6 dwg