METHOD OF MINIMALLY INVASIVE SURGICAL TREATMENT OF DIAPHRAGM RELAXATION USING CARBON DIOXIDE INSUFFLY INTO THE PLEURAL CAVITY AND CREATING A GOFFERING SUTURE Russian patent published in 2023 - IPC A61B17/34 A61M11/00 A61B6/02 

FIELD: medicine; thoracic surgery.

SUBSTANCE: before performing surgical treatment, spatial visualization of the diaphragm affected by relaxation is determined by the method of multilayer spiral computed tomography with the identification of topographic and anatomical features. After performing anesthesia, with the patient side-lying with the upper limb retracted to the side and with separate ventilation of the lungs, the first 10 mm thoracoport is placed at the level of the posterior angle of the scapula. Medical carbon dioxide is insufflated into the pleural cavity at a pressure of 6–8 mm Hg. A second 10 mm thoracoport is installed in the 5th–6th intercostal space along the posterior axillary line. A third 10 mm thoracoport is installed in the 4th intercostal space along the posterior axillary line. After bringing down the diaphragm in the form of a thinned layer of muscle tissue to the correct anatomical position and collapsing the lung, the first semi-purse-string suture is formed using a non-absorbable self-tightening thread 2/0 V-lock, starting from the anterior medial edge at the level of the transition of the tendon center to the muscular part of the diaphragm with the direction of the formed suture from the tendon center of the diaphragm to the costal part along the anterior semicircle and back from the central part of the costal edge of the diaphragm to the tendon center along the posterior semicircle. After the formation of a semi-purse-string suture, the muscular part of the diaphragm is contracted, creating mechanical compression with a decrease in the free surface of the diaphragm. In this case, the tightened thread is fixed using a metal or polymer clipper. After creating the first row of sutures, insufflation of medical carbon dioxide is turned off. Then a 1.5–2 cm minithoracotomy is carried out through the second or third thoracoport to form the second main row of fixation sutures. Using an endoscopic needle holder, single extracorporeal interrupted sutures are formed with a 1/0 non-absorbable braided suture on a 40 mm stabbing needle with capture of the muscular part of the diaphragm and immersion of the first semi-purse-string row of sutures. Moreover, the direction of the seams is performed from the costal part of the diaphragm to the tendon center from top to bottom. From 5 to 7 interrupted sutures are formed to immerse the entire length of the first row of the semi-purse-string suture. Hemostasis is performed. Pleural drainage is placed in the third thoracoport along the posterior axillary line to the apex of the lung along the posterior pleural sinus. The lung is straightened under the control of a thoracoscope. Wounds are sutured in layers and aseptic stickers are applied.

EFFECT: method makes it possible to reduce traumatic treatment of patients with diaphragm relaxation, eliminate the occurrence of difficulty in diaphragm excursion with impaired biomechanics of external respiration and the development of diaphragmatic hernia, eliminate the manifestations of exudative pleurisy, reduce intra-abdominal pressure in the early postoperative period, reduce the risk of adhesions in the pleural cavity, provide early social rehabilitation of the patient, and improve the quality of life.

1 cl, 3 ex