VIDEO-ASSISTED EXTRAPLEURAL THORACOPLASTY TECHNIQUE Russian patent published in 2025 - IPC A61B17/24 A61B17/94 

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to thoracic surgery. With the patient lying on his/her stomach, 5 cm long incision is made along a paravertebral line between the VII cervical and I thoracic vertebrae. Skin, subcutaneous fat, trapezius muscle and greater rhomboid muscle are dissected in layers. Then the dissected muscles and the scapula are withdrawn from the external surface of the ribs in the projection of the subsequent decostation and aside, creating a cavity between the muscles and the costal frame for manipulations. Video thoracoscope is introduced into this cavity through the main incision, and further manipulations are performed under its control. Thereafter, fibres of the spinal erector muscle are dissected to allow access to the posterior segments of the ribs. Five ribs are decorated, starting from the III rib, for which an electric coagulator is used to dissect a periosteum along its outer surface. Rib is cleaned from the periosteum and intercostal muscles with a raspatory without opening the pleural cavity. Tendons and ligaments attached to the transverse process of the third thoracic vertebra are dissected. According to Liston, nippers cut through the neck of the III rib together with the transverse process of the III thoracic vertebra. Thereafter, the rib is cut to a cartilaginous portion and removed. Similarly, the II rib is removed anteriorly to the cartilaginous part, the IV rib is removed to the anterior axillary line, the V rib is removed to the mid-axillary line. Under the control of the videothoracoscope, the I rib is bite at the neck behind the level of the assumed location of the stellate ganglion. Then electrocoagulator is used to dissect tissues above tuberculum m. scaleni anterioris, serving as an attachment point of the anterior scalene muscle. Tissue is separated with a raspatory in a projection of subclavian vessels, which are then retracted anteriorly, eliminating the possibility of their injuries. Remaining ligaments fixing the I rib are dissected. Then, having fixed the I rib with a bone holder, rotational movements are performed to separate the bone at the level of the cartilaginous part. Antibiotic and analgesic solutions are introduced into the formed extrapleural cavity. Microirrigator is inserted through separate puncture 2 cm above the surgical approach into the extrapleural cavity. Wound is closed in layers. In the postoperative period for 1.5 months before the formation of cartilaginous regenerates of the ribs through the microirrigator, the solutions of the above preparations are introduced daily.

EFFECT: method enables reducing traumatism of video-assisted extrapleural thoracoplasty, safely isolating and removing the first rib, achieving high therapeutic effect with maximum possible cosmetic effect, accelerating rehabilitation and improving quality of life of patients.

1 cl, 5 dwg, 1 ex