What does a thoracic surgeon treat? Department of Thoracic Surgery (3rd surgical department)

Department of Thoracic Surgery in Children's City Clinical Hospital No. 13 named after. N.F. Filatov, Moscow was organized in 1959 >>>history of the department

The surgical thoracic department of the Filatov Hospital has accumulated extensive experience in treating children with diseases and malformations of the neck, chest and chest cavity, lungs, mediastinum, esophagus, stomach and liver. Good results have been achieved in the treatment of these diseases.

Esophageal surgery: a large group of our patients are children with burns and scar narrowing of the esophagus. More than 600 esophagoplasty operations have been performed. This is the greatest experience in the world. Only in our department we perform plastic surgeries for oropharyngeal stenosis and cervical spine esophagus using a free segment of the small intestine.

Our department carries out a comprehensive examination of children with functional disorders of the esophagus, including daily pH monitoring and radioisotope research evacuation from the stomach. More than 500 gastrofundoplication operations have been performed, effectively relieving children of gastroesophageal reflux, reflux esophagitis and peptic stenosis of the esophagus. Since 2001, all operations for gastroesophageal reflux have been performed laparoscopically, i.e. using special equipment without large incisions.

Chest Wall Surgery: We have the most experience in the country treating children with pectus excavatum, pectus carinatum and other chest wall deformities.

Trachea and lung surgery: a large group of our patients are children with congenital lung defects, bronchiectasis and other lung diseases. Plastic surgeries for tracheal and laryngeal stenoses are unique.

Surgery of the liver and portal hypertension: in our department, more than 300 children with portal hypertension and biliary tract malformations have been operated on.

We also operate on children with renovascular hypertension, coarctation of the aorta and patent ductus arteriosus.

You can refer children with any diseases of the chest and chest cavity, diseases of the neck, liver and stomach to us for treatment.

Our department has introduced lung operations using endoscopic equipment. These operations avoid thoracotomy incisions. We have developed a video-assisted technique for lung resection without the use of expensive staplers. In this case, a classic, standard lung resection is performed. The postoperative period after such operations is much easier compared to standard operations. Hospitalization times are also reduced.

Radical treatment of portal hypertension.

The Department of Thoracic Surgery performed mesenterioportal anastomosis operations for extrahepatic portal hypertension for the first time. These operations are aimed at restoring physiological blood flow through the portal vein. The uniqueness of these operations lies in full recovery physiological and anatomical relationships in gate system with complete elimination of the threat of bleeding from varicose veins of the esophagus. Thus, seriously ill children turn into practically healthy children.

A fundamentally new method of treating pectus excavatum.

Our department has introduced a new method of thoracoplasty - according to Nass. This operation is performed using two small incisions on the sides of the chest and does not require resection or intersection of the sternum or ribs. The postoperative period is much easier. An almost ideal cosmetic result is achieved. With this operation, unlike standard thoracoplasty, the volume of the chest increases to physiological levels.

The department is well equipped to care for the most severe group of children, has the most modern operating room, equipped with a laminar flow system that eliminates infectious complications during surgery, and endoscopic equipment for bronchoscopy, thoracoscopy, and laparoscopy. Doctors have a variety of highly informative diagnostic methods at their disposal, including endoscopic, ultrasound, radioisotope, and radiation (radiography, computed tomography, angiography). On the territory of the hospital there is one of the largest Moscow laboratories for biochemical and microbiological research.

In childhood they occur as congenital diseases- defects and anomalies of development of various organs, as well as acquired - inflammatory diseases, consequences of injuries and burns, as well as tumors. A wide variety of diseases require the doctor to have knowledge and skills in many areas of medicine, including vascular and plastic surgery, oncology, endocrinology, pulmonology and others. The goal of treatment is to return the child to normal full life- can be achieved subject to a complete and comprehensive examination, treatment and postoperative observation of the child in a specialized department by highly qualified doctors.

The surgical thoracic department of the Filatov Hospital in Moscow is the first and largest department of this profile organized in our country. Here, operations are performed for malformations and diseases of the esophagus and stomach, malformations and diseases of the larynx, trachea, and lungs, malformations and diseases of the chest wall (funnel-shaped and keeled breasts), tumors and cysts of the thoracic cavity, operations on the diaphragm, thoracic lymphatic duct , operations on the aorta, operations with open ductus arteriosus, coarctation of the aorta, liver surgery, biliary tract and pancreas, operations for portal hypertension, operations for cysts and fistulas of the neck, operations for benign formations thyroid and parathyroid glands and many others.

We have accumulated extensive experience in performing endoscopic diagnostic and therapeutic procedures for foreign bodies ah trachea, bronchi and esophagus, and other pathological conditions and malformations of the esophagus, stomach and respiratory tract. Laser treatment, cryosurgery and the most modern electrosurgical instruments and devices are used.

All rooms have oxygen and the ability to connect aspirators, as well as devices for respiratory therapy. The intensive care unit provides 24/7 monitoring of vital signs.

Thanks to the widespread introduction of low-traumatic and endoscopic technologies in surgery children with various diseases of the thoracic and abdominal organs, mediastinum and chest, most of them do not need to be transferred to the intensive care unit after surgery, but have the opportunity to stay with their parents in the intensive care ward, equipped with everything necessary for a comfortable stay in the postoperative period.

The department has a modern endoscopy room where it is performed wide range diagnostic esophagoscopy, laryngoscopy, bronchoscopy and therapeutic endoluminal manipulation: removal of foreign bodies of the esophagus and stomach, removal of foreign bodies of the trachea and bronchi, bougienage of the esophagus and trachea, etc. If necessary, we actively use laser and CRYO therapy (liquid nitrogen) in the treatment of diseases and malformations of the larynx, trachea and esophagus. All diagnostic and therapeutic procedures are archived on digital media.

The department has its own ultrasound room with an expert-level device. This expands the possibilities of non-invasive high-precision diagnostics. In addition, many manipulations are performed in our department under ultrasound control: puncture of cysts of the kidneys, spleen, liver, etc.

Thoracic surgeon - medical specialist, engaged in the prevention, diagnosis and surgical treatment of diseases of the chest organs. Make an appointment with this doctor for chest injuries, inflammatory processes of the ribs, diaphragm, esophagus, thyroid gland and lungs.

This specialist works in private and public medical institutions, dispensaries, surgical departments hospitals and clinics, rehabilitation centers, as well as research institutes.

Origin of the profession

Thoracic surgery originated from general surgery. In the beginning, it was a field that dealt with the treatment of the esophagus, lungs, mammary glands and heart. In the twentieth century, this direction became an independent discipline, from which such medical branches as cardiac and vascular surgery and pulmonology were separated. Today, these areas closely interact.

Thanks to the above specialty, there are many opportunities for surgical treatment of diseases of the mediastinum, heart and lungs. In addition, diagnostics have expanded significantly and new methods have emerged. histological examination. As for operations, they are no longer hours-long and very complex.

Area of ​​expertise

A thoracic surgeon is a doctor who treats various diseases of the chest organs (injuries, tumors and inflammation of the diaphragm, thyroid gland, ribs, lungs and esophagus).

The most common diseases for which patients turn to a thoracic surgeon are:

• Pleurisy.
• Emphysema.
• Atherosclerosis.
• Mediastinal tumors.
• Benign and malignant tumors of the esophagus, trachea, lungs and diaphragm.
• Injuries to the lungs and chest.

Features of the profession

One of the most difficult medical directions is considered pediatric thoracic surgery, which specializes in the surgical treatment of diseases of the chest organs in infants, children, and adolescents up to sixteen years of age. During surgical interventions, special instruments are used (for example, a thoracic endoscope with an illuminated optical system that makes it possible to make small incisions). A pediatric thoracic surgeon, as a rule, performs diagnostics on a special monitor. This doctor can remove inflammation and tumors through small incisions (three to five centimeters).

Modern technologies allow the above surgeon to operate on the chest organs using the most gentle method possible. At the beginning of the twenty-first century, methods of endoscopic surgical intervention began to be actively introduced into practice. These methods of surgical treatment are low traumatic. They can be used for both children and elderly people.

The main methods of thoracic diagnosis are:

• Bronchography.
• Bronchoscopy.
• Thoracoscopy.
• Radiography.
• Ultrasonography.
• Echocardiography.
• Spirography.
• Isotopic study.
• MRI and computed tomography.

Professional qualities and skills

A thoracic surgeon must have a high level of knowledge in the field of fundamental medicine, as well as thoracic surgery. This specialist must have:

• self-organization;
• responsibility;
• confidence;
• high intelligence;
• good hand motor skills;
• concentration;
• finger mobility;
• sequence.

In addition, the thoracic surgeon is required to treat patients with special care, attention and understanding.

After the end of the Second World War, thoracic and, in particular, pulmonary surgery was one of the most rapidly developing sections of the surgical specialty. Since the second half of the 20th century, it has given way to cardiovascular surgery.

At the end of the 70s, it seemed that there was stagnation in the further development of thoracic surgery as a science and a surgical subspecialty. Surgical treatment of tuberculosis, cancer, purulent diseases lungs and pleura, tumors and cysts of the mediastinum, diseases of the chest wall and diaphragm was well mastered and became widespread. Then, restorative and reconstructive operations on the trachea and bronchi were developed, which gradually became part of everyday practice.

However, very soon - already from the beginning of the 80s - the impetus for the further development of thoracic surgery was created by new diagnostic methods, progress in transplantology, and since the early 90s - the development of so-called minimally invasive surgery. At the same time, against the backdrop of successes in fundamental and related applied sciences, the technology of performing operations was improved.

Visualization.

Improved imaging methods for various intrathoracic pathologies make it possible to obtain a three-dimensional image and more accurately assess the anatomical situation, including the presence, localization and extent of pathological changes.

Recognized methods for improving visualization in the study of the lungs became high-resolution, then spiral and last years— multiplanar computed tomography. High-resolution computed tomography is a standard method for examining patients with localized and diffuse lung lesions.

Spiral tomography has opened up ways to reconstruct and create three-dimensional, so-called 30-images. It has become possible to obtain images similar to bronchoscopic (“computer bronchoscopy”), bronchographic (“computer bronchography”), and with intravenous contrast, angiographic (“computer angiography”).

Computed angiography is becoming the most acceptable way to diagnose thromboembolism in the system pulmonary artery. Multiplanar tomography, which uses 4 to 8 detectors instead of just one, improves resolution by reducing scan time, reducing artifacts, improving spatial resolution, and enhancing image processing capabilities.

Magnetic resonance imaging in thoracic surgery acquires everything higher value. In patients with mediastinal tumors, magnetic resonance imaging is often more informative than computed tomography to identify their relationship to surrounding structures. For tumors posterior mediastinum it makes it possible to determine their distribution into the intervertebral foramina and the spinal canal. New perspectives are opening up in research pulmonary vessels, pulmonary circulation and ventilation.

Stronger magnets and contrast enhancement allow you to obtain a fairly clear image of contrasted pulmonary vessels with one breath-hold. The quality of the resulting 30-image differs little from that of conventional angiography or spiral computed tomography with contrast.

Currently, magnetic resonance imaging is beginning to be used to assess the ventilation of various parts of the lungs after preliminary inhalation of hyperpolarized helium.

IN differential diagnosis intrathoracic malignant tumors and for detecting metastases is becoming increasingly common positron emission tomography(PAT).

This method is based on the assessment of cellular metabolism. The radiopharmacological drug FDG (U,F - fluorodeoxyglucose) is administered intravenously, which is sensitive to increased glucose metabolism in cancer cells and forms bright spots on scans.

Cancer cells can be recognized in lymph nodes with a diameter of less than 1 cm. The information content of PET increases when it is combined with computed tomography and the creation of combined images. The sensitivity and specificity of the method when studying lung tumors exceeds 90%.

To detect fluid in the pleural cavity and control during puncture and drainage, you can use ultrasound scanning, in which a hypoechoic zone is noted between the parietal pleura and the lung. After pneumonectomy, dynamic ultrasound guidance often replaces the more cumbersome x-ray examination.

In the early endoscopic diagnosis of lung cancer, spectroscopic methods are useful - autofluorescence and fluorescent bronchoscopy. Autofluorescence bronchoscopy is performed without special preparation of the patient after a routine examination of the bronchi. A special light system of a bronchoscope created for this purpose induces a glow in the submucosal layer of the bronchus. This glow penetrates the mucous membrane and is normally green in color.

In the area of ​​thickened and pathologically altered epithelium of the mucous membrane, light is absorbed more intensely and, along with the normal green field, a dark zone is determined. For the detection of “intraepithelial” tumors, autofluorescence bronchoscopy is almost six times more sensitive than conventional bronchoscopy (Weigel T. et al., 2001).

For fluorescence bronchoscopy or photodynamic diagnosis, the patient is pre-injected with 5-aminolevulinic acid (ALA), which is converted into protoporphyrin IX in the tumor tissue. Illumination of the bronchoscope with a special light system reveals its fluorescence. The tumor zone is recognized by its red color. Fluorescence bronchoscopy is useful not only in early diagnosis, but also in the process of postoperative monitoring of patients with lung cancer.

A completely new method for obtaining intraoperative tissue pictures is optical coherence tomography. This method is borrowed from ophthalmology and significantly modified. Optical tomography is similar to the use of ultrasound, but is based on the use of light, so it has a spatial resolution 1-2 orders of magnitude greater than ultrasound.

The black-and-white two-dimensional images obtained in real time represent sections of living tissue with microscopic resolution, which until recently seemed completely impossible in the surgical field. It becomes possible to perform intraoperative optical biopsy without tissue removal with a resolution that approaches histological resolution (Boppart S. et al., 2000).

Optical biopsy of a lymph node during surgery allows, for example, to judge the presence of cancer metastases without removing it. The ability to more accurately determine the boundaries of tumor growth during surgery is very important. Work is underway to create contrast agents, miniature tips and compact devices for optical coherence tomography.

Radionuclide methods help identify hidden foci of infection. Thus, antibodies labeled with Tc-99m radionuclide are administered intravenously. They bind to the CD-15 antigen, which is expressed by neutrophils. After 2-90 minutes, the localization of labeled antibodies and, consequently, the source of infection is detected by scanning.

Lung transplantation.

The first allotransplantations of one lung in clinical practice were successfully performed by J. Cooper in Toronto (Canada) in 1983. Since then, separate simultaneous allotransplantation of both lungs, allotransplantation of both lungs in one block, allotransplantation of the heart with lungs, and repeated allotransplantation of the lungs have been developed.

The main diseases for which lung transplantation is performed are diffuse emphysema, fibrosing alveolitis, and primary pulmonary hypertension. One year after transplantation, the survival rate of patients is 65-78%, the percentage of 5-year survival is 43 (McKellar S., 2001).

In January 1993, at the University of Southern California clinic, V. Starnes and R. Cohen initiated lung transplantation from living donors. A transplant of lung lobes from parents was performed to replace both removed lungs in a 22-year-old woman with cystic fibrosis. Subsequently, transplantation of lung lobes from living related donors gained some popularity, mainly in the USA.

In Russia in 1993 Yu.N. Levashev, together with us, performed one such operation on an 11-year-old boy with histiocytosis X; he died 43 days later as a result of rejection of the transplanted lobe and adenoviral infection.

We know of only 4 lung allotransplantations in Russia, of which 2 are described in detail in the literature. The maximum life expectancy after these operations was 35 days. In 1990 Yu.N. Levashev in St. Petersburg was the first to successfully perform tracheal allotransplantation in a patient with fibrosing mediastinitis and severe extended tracheal stenosis.

The significance of the development of lung transplantation lies not only in expanding the possibilities of treating patients with respiratory failure, but also in stimulating the development of new aspects of thoracic surgery.

Difficulties in obtaining donor organs will force us to look for opportunities to use animal organs. Experimental work on lung xenotransplantation is being carried out in a number of countries.

Minimally invasive surgery.

The size and traumatic nature of the surgical approach in thoracic surgery are of significant importance. In many cases, it is the access, and not the intrathoracic intervention, that determines the overall tolerability of the operation, the rate of recovery, and the period of restoration of working capacity.

The fundamental requirement for the size of operational access was classically formulated by Th. Kocher at the end of the last century: access should be as large as necessary and as small as possible.

From a modern perspective, we re-evaluate those aspirations and approaches that already took place more than 50 years ago and laid the foundations for minimally invasive thoracic surgery. So, L.K. In 1950, Bogush developed a method and technique for extrapleural pneumolysis for pulmonary tuberculosis through a small incision in the axillary region.

He performed lung detachment by illuminating the cavity with a thoracoscope light bulb. Apparently, this was the first or one of the first mini-invasive thoracic interventions, which became widespread in institutes, hospitals, dispensaries and anti-tuberculosis sanatoriums in the country.

In the late fifties and early sixties, during lung operations, we also began to use the axillary approach, and then - lateral thoracotomy with the patient positioned on the healthy side. A feature of lateral thoracotomy is a very economical muscle dissection: only the serratus anterior muscle is dissected in a small area, the latissimus dorsi muscle is pulled back, and then the muscles of the intercostal space are widely separated.

A good surgical field is achieved by spreading the edges of the wound with two mutually perpendicular dilators. Gradually, this method of thoracotomy became quite widespread, especially after publication in the French Medical-Surgical Encyclopedia in 1980.

Thoracoscopic surgery, which was founded by N. Jacobeus in 1910-1913, has always had the smallest access for lung surgery. The main operation was the destruction of pleural adhesions in patients with pulmonary tuberculosis with artificial pneumothorax. Many other operations were also performed thoracoscopically, including, for example, thoracic sympathectomy.

In Moscow, the first thoracoscopic operation was performed in 1929 by K.D. Esipov at the Regional Tuberculosis Institute (now it is the Research Institute of Phthisiopulmonology of the I.M. Sechenov Moscow Medical Academy). The well-known monograph by A.N. came out of the same institute. Rozanov “Thoracoscopy and thoracocaustics for pulmonary tuberculosis” (1949).

Before the Second World War and after its end, thoracoscopic surgery became very widespread, and up to 50 thousand such operations were performed in the USSR per year. N.G. Steadily and especially L.K. Bogush introduced a lot of new things into the methodology and technique of the previous thoracocaustics and showed miracles of surgical skill. In the 1960s, as the use of artificial pneumothorax became rare, thoracoscopic surgery almost lost its role.

The rebirth of thoracoscopic surgery began in the 80s. It is associated with the progress of video technology and the ability to transmit color images High Quality on large monitors. Initially, videothoracoscopy was performed using instruments and stapling devices used for laparoscopic surgery. Then special thoracic sets and staplers were created.

The terms “videothoracoscopic” and “minimally invasive” surgery are widely used in the literature. However, endoscopic surgery is more correctly understood as operations performed using endoscopes through natural anatomical openings - in thoracic surgery this is the mouth and nose.

Operations through punctures of the chest wall are endo surgical operations. Minimally invasive surgery is a broader concept. It combines endosurgical operations, on the one hand, and open operations through small surgical approaches, on the other. In fact, we are talking about our usual surgical interventions from small, economical operational access. Therefore, we prefer to talk about minimally invasive approaches in thoracic surgery.

The first videothoracoscopy with endosurgical operation - cervicothoracic sympathectomy - was apparently performed by R. Wittmoser in Düsseldorf in 1968. His television camera was very cumbersome and was connected by an accordion-type device to a primitive telescope. However, modern video thoracoscopy and thoracic endosurgery arose later, in the early nineties.

Joint intensive work of many medical teams and a number of industrial companies producing necessary equipment, led to the rapid spread of endosurgical interventions. Perhaps no other branch of thoracic surgery has developed so quickly. In Europe, America, and Japan, using videothoracoscopy, a wide variety of intrathoracic operations began to be performed, including lobectomy and pneumonectomy, resection of the esophagus, removal of mediastinal tumors, resection of the intervertebral disc, and correction of kyphoscoliosis.

In Moscow, this issue was given attention in our program report at the plenum of the Scientific Council on Surgery under the Presidium of the Russian Academy of Medical Sciences (December 1993). Then, various aspects of thoracic endosurgery were discussed at a meeting of the Presidium of the Russian Academy of Medical Sciences, at the All-Russian Symposium “New Technologies in Medicine” and many other subsequent medical forums.

The anesthetic support of thoracic endosurgical operations and their technical equipment, indications and contraindications for various operations were examined in detail, and they were compared with conventional open thoracic operations.

The first intrathoracic operations under videothoracoscopy in Russia were performed by endoscopic surgery specialists A.A. Ovchinnikov, Yu.I. Gallinger - these were lung biopsies.

Technical equipment for videothoracoscopy and endosurgical operations is produced, assembled and widely advertised by many companies. Among consumables, the most expensive are staplers. The high cost of disposable devices has prompted a number of companies, mainly European, to develop reusable models.

It is important to note the progress in obtaining three-dimensional images. It has long been known that the image perceived by one eye is slightly different from the image perceived by the other. The perception of volume and depth is based on the difference in images in both eyes, i.e. obtaining a three-dimensional image.

For this purpose, the endoscope is equipped with a special camera, which has two optical systems. They provide separate transmission to a special monitor of two slightly different images - conventionally left and right. Separate perception of the image from the monitor by the surgeon's left and right eyes is carried out through stereoscopic glasses. In this case, the image transmitted by the left optical system is perceived by the surgeon with the left eye, and vice versa (3-dimensional system - 3D).

The resulting three-dimensional image facilitates orientation in the cavity and operation with instruments that are closer to those familiar in open surgery. Separately, it should be mentioned the creation of a special video mediastinoscope, which allows mediastinoscopy also in the usual way under direct visual control. Videomediastinoscopy is indispensable for teaching and consultations during research.

When planning endosurgical operations, computed tomography data of the breast are of utmost importance. Anesthesia can be different: general, local, regional (intercostal, epidural, stellate ganglion block). The most common is general anesthesia, usually with separate bronchial intubation and bronchoscopic control of the tube position after turning the patient on his side. The use of bronchial blockers is more difficult and unsafe.

Ventilation, blood oxygenation and hemodynamics require monitoring.

The advantages of endosurgical operations over open ones are as follows:

Positive attitude of the patient;
. less pain after surgery;
. rapid restoration of hand function on the operated side;
. more short term hospitalization;
. early restoration of working capacity.

The main disadvantages of endosurgery are the impossibility of palpation during the intervention, limited instrumental actions, the difficulty of stopping bleeding, the high cost of equipment and consumables; one must also take into account the need for separate bronchial intubation and bronchial blockade to ensure lung collapse on the operated side.

The most important issue is the indications for endosurgical operations. In many hospitals in Europe, America, and Japan, from our point of view, they are overly expanded. In this case, attention should be paid to the psychological pressure that is often exerted on surgeons by the factor of attracting patients, considerations of prestige, as well as the financial policies of industrial firms. On at this stage the main indications for thoracic endosurgical operations can be formulated as follows (Table 1).

The table below requires some comments. Thus, for disseminated lung diseases in patients with severe respiratory failure, endosurgical biopsy is more dangerous than conventional open biopsy due to the need for separate bronchial intubation, bronchial blockade and lung collapse on the operated side.

We always prefer open biopsy in such cases.
In patients with spontaneous pneumothorax, surgery is usually indicated in recurrent cases. However, for example, it is advisable to operate on pilots, swimmers (divers) at the first episode.

Table 1. Main indications for thoracic endosurgical operations

For primary peripheral lung cancer in stage I, endosurgical wedge resection of the lung or lobectomy with lymph node removal is often possible and reasonably feasible. At the same time, many surgeons note that there is no significant difference between such endosurgical operations and open operations through a small approach.

A group of Japanese surgeons published the results of a comparison of the postoperative course in such patients and came to the conclusion that after endosurgery, pain was less pronounced during the first week. After 2 weeks, everything becomes the same, including the state of external respiration, the strength of the respiratory muscles, and the results of the walking test.

Therefore, there is no reason to defend the benefits of endosurgical operations in such patients. It is noteworthy that one of the authors of this article is the world-famous oncologist surgeon and specialist in endosurgery Tsuguo Naruke.

In recent years, reports have appeared about the removal of metastases from the lungs using endosurgical techniques. However, we have a negative attitude towards the removal of metastases from the lungs under the control of video thoracoscopy. The main reason is the inability to palpate the lungs. After all, it is always important to remove all metastatic nodes from the lung, which are detected not only by computed tomography, but also by such an indispensable method as careful palpation.

At the same time, small metastases, not detected by computed tomography, are found in 16.9% of patients (Loehe F. et al., 2001). Feeling the lung with one finger through a narrow opening in chest wall(Landreneau R. et al., 2000) cannot be considered acceptable. One should also take into account the impossibility of repeated endosurgical operations due to pleural adhesions and the frequent difficulty of mediastinal lymphadenectomy.

For closed and penetrating chest trauma, videothoracoscopy can be of great diagnostic value. If necessary, after the diagnostic stage, it is possible to decide on an endosurgical operation, during which the bleeding is stopped, liquid and clotted blood, and foreign bodies are removed. With unstable hemodynamics or major bleeding open thoracotomy is preferred.

In our clinical practice, the main indications for thoracic endosurgical operations are biopsy of the lungs and pleura, sanitation of the empyema cavity, elimination of spontaneous pneumothorax and its causes. It is natural that All Endosurgical operations should be performed by an experienced thoracic surgeon in conditions that allow, if necessary, to proceed to open thoracotomy.

The main contraindications to endosurgical operations are obliteration or the presence of extensive adhesions in the pleural cavity, the danger of turning off one lung from ventilation, and the presumed possibility of radical surgery for a malignant tumor. This is natural, because the patient should not receive “suboptimal” treatment.

A minimally invasive surgical approach may consist of a combination of video-assisted thoracoscopic intervention with a small additional intercostal incision through which endosurgical or conventional surgical instruments and staplers are introduced, and the drug to be removed is removed.

A number of authors call such an additional incision an “auxiliary” or “auxiliary” thoracotomy. It should be noted, however, that often it is the additional incision during the operation that plays the main, and not a secondary, role. In general, the combination of video thoracoscopic techniques with conventional surgical techniques often seems very convenient and useful.

Endosurgery provides solid lessons in open thoracic surgery and stimulates its development from different angles. So, important points They began to improve the technique of thoracotomy with minimal muscle dissection, close attention to the elimination of pain after surgery, the rapid restoration of arm function on the operated side, a short hospital stay and early restoration of ability to work.

In essence, this is a whole program for improving everyday thoracic surgery.

As a result of working on such a program, the negative aspects of open operations compared to endosurgical ones are largely leveled out. Attention is paid to special instructions for patients before surgery and staff training. To eliminate postoperative pain, morphine is used, as well as epidural analgesia, nonsteroidal anti-inflammatory drugs, and electroanalgesia.

The most justified is the combined use of morphine and non-steroidal anti-inflammatory drugs (ibuprofen, ketorolac), and sometimes epidural anesthesia.

Lung resection as a treatment method for diffuse emphysema.

During last decade In the world, surgical treatment of diffuse pulmonary emphysema has become widespread with “pulmonary volume reduction surgery” - this is a literal translation of the English term Lung Volume Reduction Surgery with the abbreviation LVRS.

In fact, this term represents the purpose of the operation—reducing the volume of the lung, and not the surgical method—resection of the lung, i.e. its partial excision. In this regard, we consider it correct, convenient and customary to use the term “lung resection” and not “reduction of pulmonary volume”.

In clinical practice, conservative treatment of patients with diffuse pulmonary emphysema with rehabilitation measures can reduce shortness of breath and, to a certain extent, restore functional status. At the same time, palliative surgery - pulmonary resection - often improves results conservative treatment and rehabilitation of these patients.

From 1995 to 2001 in the USA, Western Europe and Japan, significant positive experience has been accumulated in the use of pulmonary resection for the treatment of diffuse emphysema. Why in Russia with its high level pulmonary surgery, pulmonary resection for emphysema is not popular? Indeed, from a methodological and technical point of view, all options for marginal or wedge-shaped resections using a mechanical suture do not present any difficulties and are widely performed everywhere for tuberculosis, tumors and other diseases, including in patients with concomitant diffuse emphysema.

The key problem is organizational. For successful treatment patients with pulmonary emphysema and the implementation of complex programs of therapy, rehabilitation and monitoring of patients require an integrated approach and the closest interaction of a team of specialists. These are therapists, pulmonologists, physiotherapists, nutritionists, respiratory therapists, anesthesiologists, resuscitators and, finally, surgeons.

Conclusion on the effectiveness of pulmonary resection in complex treatment emphysema will be done in the next 2-3 years after the completion of a large cooperative study currently ongoing in the United States.

Providing and performing thoracic operations.

For all operations vital role plays the principle of maximum possible reduction of blood loss and abstinence from transfusion donated blood. For this purpose, before surgery, use erythropoietin and autologous blood sampling, and then normovolemic hemodilution, precision surgical hemostasis, intraoperative and postoperative autotransfusion.

In terms of creating new surgical instruments, attention is paid to their articulation under the mechanism of the hand. For working in the chest cavity through small accesses, bayonet-shaped tweezers are convenient. Bipolar electric scissors are very useful during lung operations, allowing the incision to be combined with hemostasis by bipolar electrocoagulation. Sufficiently long clip holders can be used to clip vessels deep in the wound.

In the late 1960s - early 1970s, various methods were developed in our country and then became widespread in thoracic surgery application of low frequency ultrasound. In clinical conditions, an ultrasonic scalpel, a saw, and dissectors were tested - they did not justify themselves.

At the same time, treatment of the cavity through a layer of liquid with low-frequency ultrasound turned out to be very effective for the prevention and treatment of pleural empyema. Subsequently, this method was also successfully used to prevent contamination of the pleural cavity during operations for echinococcosis and to prevent implantation of tumor cells during operations for lung cancer.

The ultrasound generators were devices of the URSK series (7N-18) with an oscillation frequency of 24.5-27.7 kHz and then their various modifications (Alveola device - 44 kHz). Currently, low-frequency ultrasound is used less frequently in Russia, but abroad people are showing interest in it and creating new equipment.

Thus, during oncological operations to remove mediastinal tissue, we used an ultrasonic destroyer-irrigator-aspirator (CUSA) with an oscillation frequency of 23 kHz and an amplitude of 355 μm. The fiber is destroyed and the cell suspension is aspirated.

A new ultrasonic “harmonic” scalpel for cutting and coagulation with an oscillating frequency of 55 kHz has been widely advertised. It minimally injures tissue and allows, with less danger and good hemostasis, to separate different tissues in the desired layer. anatomical structures. In this case, the temperature in the area of ​​action of the scalpel does not exceed 80°C.

Very impressive is the report of successful ultrasound coagulation of the thoracic duct and persistent chylothorax transected during resection of an aortic aneurysm (Takeo S. et al., 2002).

During operations on the lungs, trachea and bronchi, precision techniques for removing pathological formations, microsurgical techniques, bipolar electrocoagulation, the use of adhesive, hemostatic and absorbent coatings, laser technology, and argon plasma coagulation are becoming widespread.

Precision techniques for removing various pathological formations from the lungs have received worldwide recognition (Dressier C, 1995). The operation is performed on a ventilated lung. Its main elements are the separation of lung tissue into small portions by mono- or bipolar coagulation using conventional or bipolar scissors, the application of ligatures to relatively large vascular and bronchial branches, and suturing of the lung wound.

For reliable aerostasis when applying a mechanical suture to the lung using any stitching devices, new ones are considered useful biological or synthetic pads (Peri-Strips- from bovine pericardium, Seamguard- made of polytetrafluoroethylene). True, in a special comparative randomized study, surgeons from Atlanta and Pittsburgh (USA) did not reveal a statistically significant difference in the quality of aerostasis in patients using a proprietary pad made of preserved bovine pericardium and without it.

Pharmacological agents for aerostasis from damaged areas lung until recently were ineffective. Fibrin glues have become significantly better ( Tisseel, Tissucol), but they are also often “washed out” not only with blood, but also with air. For the effective use of fibrin glue, a coating is required that, in addition to hemostatic properties, has adhesive ability and can be sufficiently tightly fixed to the surface of the lung.

Such a means of the latest generation has become TachoComb- absorbent wound covering for local application. TachoComb is a collagen plate coated on one side with fibrinogen, thrombin and aprotinin. The adhesive surface is marked yellow due to added riboflavin. Upon contact with the wound surface, clotting factors are released and thrombin converts fibrinogen into fibrin.

Aprotinin prevents premature fibrinolysis by plasmin. The plate is glued to the wound surface for 3-5 minutes. Subsequently, it resolves and is replaced by connective tissue within 3-6 weeks.

What is new is the creation of a polymer synthetic absorbable adhesive FocalSeal. The high-energy neodymium YAG laser is widely used in endoscopic surgery for photocoagulation of tumors in the respiratory tract and, less commonly, for dilating a scar-stenotic section of the trachea or bronchus.

However, recently preference in such situations is given to argon plasma non-contact coagulation, which is not accompanied by charring of tissues, smoke emission and provides better hemostasis. Another application of lasers is the well-known photodynamic therapy of tumors of the trachea, main bronchi and esophagus (usually palliative) after the administration of Photofrin-polyheme-toporphyrin.

Improvement of laser technology in endosurgery and open thoracic surgery is proceeding in two directions. The first of them is creation of multi-purpose combined lasers. They increase cutting efficiency and speed easy way separate and integrated use of the advantages of carbon dioxide and YAG lasers.

According to O.K. Skobelkin and other laser surgery specialists, combined laser ray can be shaped with parameters that ensure bloodless dissection and minimal tissue trauma. To do this, the energy of a neodymium YAG laser must be twice the energy of a carbon dioxide laser.

Complete hemostasis and minimal tissue trauma promote regeneration processes. The second direction is the improvement of the contact method of surgery, which preserves the tactile sensation that is always important for the surgeon. In the contact method, radiation is transmitted through a light guide, the end of which is placed in a conical quartz or sapphire tip.

It is essential to create more advanced tips that are inexpensive and do not require cooling. The light guide and tip form a highly effective surgical instrument—a contact laser scalpel.

In recent years, a special neodymium laser MY 40 1.3 with a wavelength of 1316 nm has been created to remove metastases from the lung. It allows you to separate significantly faster, with better aerostasis and hemostasis. lung tissue(Rolle A., Eulerich E., 1999). In our country, V.D. has the first experience of working with such a laser. Fedorov and A.A. Vishnevsky.

For the prevention of restenosis of the trachea and main bronchi in cases of cicatricial narrowing, softening (malacia) of their walls or compression from the outside, the use of intraluminal stents. Kstents have strict requirements: ease of installation and removal, sufficient rigidity, absence of an inflammatory reaction from surrounding tissues and a tendency to displace. Particular difficulties arise with stenosis in the area of ​​the tracheal bifurcation.

Of the various stents, preference is given to silicone models. Recently, their significant disadvantages have been noted due to the relatively small lumen, sputum fixation, and frequent displacement. Many experts consider expanding mesh metal stents, uncoated or with a special coating, to be the best for cicatricial stenosis and tumors ( Ultraftex, Polyflex, Wallstent). They are smaller in size, push the walls apart more, are less likely to move and delay sputum secretion less.

However, one should keep in mind the great difficulties associated with the problem of removing such stents.

Interventional radiology very often makes it possible to avoid major open operations in cases of congenital intrapulmonary arteriovenous aneurysms. For vascular occlusion, detachable latex or silicone balloons with silicone gel or a spiral made of stainless steel or platinum are used most successfully.

Intelligent operating room.

The operating room of the future is an automated surgeon's workplace. It is assumed that ultrasound, but mainly magnetic resonance imaging, will be of some importance in monitoring its actions. In this regard, it is necessary to solve many complex physical and technical problems.

Thus, in ultrasound technologies it is necessary to provide a three-dimensional image. It must work in real time and, through computer processing, be reconstructed into a similar volumetric computed tomographic picture that is close and understandable to surgeons. By the way, significant progress in ultrasound diagnostics may soon become an intermediate stage of the intensive work of American companies on the creation of such systems.

When working with magnetic resonance systems, it is important to reliably protect the patient and personnel from the induced magnetic field electric current, create conditions for the operation of all surgical and anesthesiological equipment, and prevent artifacts in the image. In parallel with complex and expensive work in these areas, the production of surgical instruments and other equipment made of ceramics or stainless steel with a high nickel content has already begun, which can be used conveniently and safely in a strong magnetic field.

“Magnetic resonance operating rooms” should allow for very precise aspiration biopsies, facilitate a number of operations and create conditions for tumor treatment methods such as interstitial laser therapy, radiofrequency, ultrasound, thermal, cold and chemical destruction. Apparently, the use of magnetic resonance imaging will become a serious new direction in interventional radiology.

Intuitive surgery, robots, teleoperation systems.

The newest trends in endosurgery include so-called intuitive surgery, which is based on the use of robots and teleoperation systems. Equipment for intuitive surgery consists of a console for visual control of the surgeon’s actions, computer and mechanical equipment for controlling instruments using a robot.

The surgeon's actions during 3D video control and optical magnification are transmitted to the robot through the console. The result is high precision, firmness and dexterity of action.

The first generation of robots were the so-called assistant robots - they fixed the endoscope and camera according to the verbal orders of the surgeon.

The second generation of robots is a hand with electronic control and control of the surgeon, the ability to lift up to 1.5 kg while holding an endoscope, reacting to the surgeon’s voice and executing key commands. The latest generation of robots represents very complex devices that are given their own names (for example, Mopa robots, Da Vinci, Aesop, Hermes device for voice control of actions).

When using microrobots (“flies”), their movement is recorded on a videotape or laser disk. Pathology is recorded and assessed using a special program artificial intelligence. It is important that the patient does not experience any discomfort.

Separately, it should be noted the absolute importance of robots for intraoperative radiation therapy. The created teleoperation systems with computer assistance and telemanipulator robots for endosurgery should provide the ability to remotely perform a wide variety of operations through minimal operational access.

The requirements for teleoperation systems are as follows:

Visibility surgical field in three-dimensional image;
. the presence of auditory, tactile, proprioceptive sensitivity;
. remote control of tools using robots;
. precision of preparation, tissue separation, suturing.

The operating thoracic surgeon is surrounded by a computer world and feels himself in the chest cavity. Surgery is performed with precision using a teleoperation system and robots (microrobots). The operation can be controlled from great distances.

The capabilities of teleoperation systems and robotics, their prospects and the shape of surgery of the future seemed almost fantastic until recently. However, a number of systems have been created, and many operations have already been successfully performed in the clinic (cardiac surgery, urology, orthopedics). Thus, most of the path has already been passed and in the coming years robotics and teleoperation systems, despite very high cost, will receive some distribution.

Naturally, it is possible and even necessary to look into the more distant future. Apparently, the face of surgery and many surgical operations will completely change and there will be a need to equip operating rooms for tissue engineering, biotechnological, biochemical, genetic interventions.

The role of integration.

For the development of thoracic surgery, continuous integration with other surgical subspecialties is of utmost importance. These are otorhinolaryngology, cardiac surgery, vascular surgery, abdominal surgery, orthopedics and traumatology, neurosurgery, and plastic surgery.

Together with otorhinolaryngologists, reconstructive operations for laryngotracheal stenoses, closure of laryngotracheofissures and stomas, and removal of foreign bodies from the trachea, bronchi, and esophagus are being developed.

Median sternotomy and transverse bipleural access with intersection of the sternum for simultaneous operations on both lungs and mediastinal organs were borrowed from cardiac surgery.

Experience in heart surgery has made it possible to develop transpericardial treatment of the main pulmonary vessels during pneumonectomy, access to the trachea and main bronchi through the pericardial cavity, intrapericardial reamulation of the stumps of the pulmonary artery and superior pulmonary vein, right-sided posterior transpericardial access to the pulmonary artery and such an important section as surgical treatment of thromboembolism pulmonary artery.

Together with cardiac surgeons, a transplant harvesting technique has been created for the simultaneous use of the heart and one or two lungs. During lung transplantation necessary cases extracorporeal circulation is used. An essential stage of lung transplantation is the formation of an atriovenous anastomosis.

The joint work of cardiac surgeons with oncologists and thoracic surgeons makes it possible to successfully perform one-stage operations for cancer and heart diseases - primarily for coronary insufficiency(Davydov M. et al., 2001).

Surgeries on the main arteries are necessary to eliminate compression stenosis of the trachea, bronchi and esophagus in cases of malformations of the aorta and its branches. Knowledge and skills in vascular surgery are constantly needed in mobilization of the descending aorta for access to the left tracheobronchial angle, circular or fenestrated resection and repair of the pulmonary artery, and excision of an arterial or arteriovenous pulmonary aneurysm.

During certain extended operations for lung cancer, there is a need for marginal or circular resection of the superior vena cava or descending aorta. In such cases, vessel replacement is often required. In patients with superior vena cava syndrome, bypass surgery is used as a palliative operation.

When transplanting a lung or its lobe, it is always necessary to perform vascular anastomoses, and sometimes to implant a vascular platform into the aorta with the mouth of the bronchial artery. Finally, accidental injury to a large vessel requires the application of a vascular suture.

Microsurgical techniques have been successfully used experimentally for tracheal transplantation on a vascular pedicle (Dadykin S.S., Nikolaev A.V., 2001) and in the clinic for plastic surgery of large tracheal defects (Gudovsky L.M. et al., 1997; Peradze T.Ya. et al., 1998), closing the pleural empyema cavity with a flap of the latissimus dorsi muscle on a vascular pedicle (Hung chi Chen et al., 1998).

The relationship between thoracic and abdominal surgery is multifaceted. First of all, it is necessary to name thoracoabdominal wounds, operations for diseases of the esophagus and all operations for malformations, injuries and diseases of the diaphragm. A complication of injuries and a number of diseases are fistulas that connect the pleural cavity or bronchial lumen with the stomach, colon, bile and pancreatic ducts. Hepatopulmonary echinococcosis occurs.

In a number of thoracic operations, laparotomy is performed to exploit the pedunculated omentum in the chest cavity, on the chest wall, or between fragments of the sternum. Contact with abdominal surgeons is important when performing simultaneous operations on the lungs and abdominal organs.

Orthopedics and traumatology in thoracic surgery are encountered in the process of treating funnel-shaped and keeled breasts, when replacing defects and osteosynthesis of the sternum and ribs.

Elements of neurosurgery are necessary for the removal of mediastinal-intravertebral hourglass-shaped neuromas, as well as for operations for lung cancer with Pancoast syndrome, with Thoracic Outlat Syndrome.

Plastic surgery in the form of complex autoplasty is used to correct cicatricial tracheal stenosis and to close large defects of the chest wall.

The close connection of thoracic surgery with other sections of the surgical specialty justifies the need for an integral, and in a broad sense, a multidisciplinary approach to solving practical and scientific issues.

Scientific research.

To obtain data that meets the requirements of evidence-based medicine, prospective, randomized and multicenter studies with multivariate mathematical analysis are necessary.

The main directions of research work in thoracic surgery will apparently remain experimental studies, development of diagnostic and treatment standards, creation medical equipment(devices, instruments, devices) and a specialized national database, which should be of great importance for improving the quality of surgical care.

It is important to emphasize the relevance of multidisciplinary work, especially taking into account promising research in the field gene therapy. Finally, in all areas of practical and research work, reliance on modern information technologies is necessary. As N. Negroponte (1995) figuratively noted, we live and work in the era of transition “from atom to bit.”

Internet.

The Internet is extremely popular. It took radio 38 years to reach 50 million listeners, and television 13 years. The Internet has acquired such a number of users in only 5 years.

In surgical science and practice, the Internet is becoming increasingly important for information, statistical quality control of surgical work, creating databases for multicenter studies, as well as for training students and doctors. Since 1997, thoracic surgery has been represented on the Internet.

At www.stsnet.org/journals there are 4 main journals on cardiothoracic surgery in English: the American “The Annals of Thoracic Surgery” and “The Journal of Thoracic and Cardiovascular Surgery”, the European “European Journal of Cardio-Thoracic Surgery” and Asian "Asian Cardiovascular& Thoracic Annals".

Instead of a conclusion.

As surgeons, we are conservatives. It is difficult for us to change long-term skills and habits based on the knowledge, experience of our predecessors and our own. However, as soon as we are convinced of the advantages of new technologies, they are quickly perceived and taken worthy place in surgical practice.

Surgery is the largest medical branch that deals with the treatment of any disease using surgical techniques. Specialists in this profile must have in-depth knowledge and extensive experience in carrying out various manipulations. However, our body is a very complex structure, and one person cannot understand the work of absolutely every structure. Therefore, it was decided to divide surgery into several areas. Doctors of each of them must thoroughly know all the details of the structure of a certain group of organs, the etiology of all possible diseases, their manifestations and ways to solve problems that arise.

This article covers the topic of thoracic surgery and its specialists. This area of ​​medicine deals with the diagnosis and surgical treatment of all structures located in the chest area. First of all, these include the respiratory organs, including:

• Lungs;
• Bronchi;
• Pleura;
• Trachea.

Its competence also includes the esophagus, gastric diaphragm and mediastinum. It is the surgeon of this profile who fights for the life of the patient after an acute chest injury, for example due to an accident or injury.

To be able to treat people, a doctor must graduate from a medical institute, complete an internship in his field, and then begin full-time work. However, in surgery everything is much more complicated, because a specialist needs to understand not only how organs work under normal and pathological conditions, but also during the surgical procedure.

In addition, the thoracic surgeon is responsible for vital important systems breathing and digestion, next to which the cardiovascular department is located, which means its responsibility is very serious.

In general, he can be characterized as a specialist trained to work on organs in the sternum area, that is, limited to the chest and spine.

• He knows everything about these structures,
• Can diagnose their condition,
• Recognize the disease
• Give an objective assessment of the severity of the lesion,
• And draw a conclusion regarding the need for surgical treatment.

Then it moves to the selection stage effective operation, which will be completely safe for a particular patient. Let's look at examples of what a thoracic surgeon treats.

Despite the limited list of organs that the chest contains, a specialist will always find something to work with. A huge number of all cases are occupied by patients with chest injuries, as well as with progressive inflammatory diseases and abscesses. A whole branch in thoracic surgery can be called the treatment of benign and malignant tumors. Certain part Patients in this department are occupied by people with tuberculosis.

Diseases respiratory system that fall under the competence of a thoracic surgeon:

• Pleurisy is inflammatory process, affecting the pleural layers;
• Pleural empyema is the result of a progressive infectious lesion, manifested by purulent accumulations in the pleural cavity;
• Lung abscess - purulent damage to lung tissue;
• Pulmonary embolism - blood clots in the artery leading to the lung;
• Chylothorax is a condition in which lymph with fat accumulates in the pleural cavity;
• Bronchiectasis - an increase in the width of the bronchus due to damage to its walls;
• Atelectasis is the collapse of a section of the lung in which gas exchange ceases;
• Bronchial or tracheal stenosis is a pathological narrowing of their cavities;
• Pneumothorax is a disease in which air or gases accumulate in the pleura;

What does a thoracic surgeon do and what does he do?

The lung and the adjacent structures of its system are not the only thing that a thoracic surgeon treats. The disease may affect the mediastinum or esophagus. It's about about pathologies such as:

• Mediastinitis - acute or chronic inflammation in the middle part of the chest, called the mediastinum;
• Osteomyelitis is an infectious lesion of the bone tissue of the ribs, during which pus is formed;
• Chondritis - inflammation of cartilage, as a complication of pneumonia or other infectious disease;
• Esophagitis - inflammation of the mucous membranes of the esophagus;
• Achalasia of the esophagus is a disorder of food passage caused by insufficient functionality of the lower sphincter in the esophagus;
• Esophageal diverticulum is a formation on the mucous membrane of the esophagus in the form of a pouch;
• Burn of the esophagus, any injury or fistula in its walls;
• Tumor of the esophagus.

In addition, the doctor can remove a foreign body that has entered the hiatus. Most often, all his operations are urgent, although sometimes they can be planned, but then a referral to the surgical office is issued by the attending gastroenterologist or pulmonologist, or less often by a general practitioner.

Diseases treated by a thoracic surgeon tend to manifest themselves with pronounced symptoms, since they most often have a serious danger due to a progressive condition. These include the fact that the patient experiences severe attacks of pain, concentrated in the chest and in the esophagus. The passage of food also worsens, and blood appears in the saliva. If pus comes out during a cough or is simply present bad smell, there is shortness of breath or suffocation, then this is a reason to make an appointment with a thoracic surgeon.

When visiting a specialist, he needs to understand what kind of disease has affected the patient, and for this he needs to undergo several studies. Blood, stool and urine tests are mandatory, further at the discretion of the doctor. Sometimes it is necessary to examine the sputum, but in most cases x-rays and ultrasound cannot be avoided.

Modern and very informative methods include SCT, PET, interventional ultrasonography, angiography, bronchoscopy, thoracoscopy, arthroscopy, biopsy and puncture.

Pediatric thoracic surgery

The skills of a thoracic surgeon can be compared to fine jewelry work, since everything he does surgical interventions produced near the heart. Moreover, this organ sometimes needs to be slightly shifted.

Lung resection without thoracotomy.

We have introduced lung operations using endoscopic equipment. These operations avoid thoracotomy incisions. We have developed a video-assisted technique for lung resection without the use of expensive staplers. In this case, a classic, standard lung resection is performed. The postoperative period after such operations is much easier compared to standard operations. Hospitalization times are also reduced.

Radical treatment of portal hypertension.

In the Department of Surgery, mesenterioportal anastomosis operations for extrahepatic portal hypertension were performed for the first time. These operations are aimed at restoring physiological blood flow through the portal vein. The uniqueness of these operations lies in the complete restoration of physiological and anatomical relationships in the portal system while completely eliminating the threat of bleeding from varicose veins. Thus, seriously ill children turn into practically healthy children.
A fundamentally new treatment method
chest deformities.

Thoracoplasty according to Nuss. (treatment of children with pectus excavatum)

We have introduced a new method of thoracoplasty - according to Nuss. This operation is performed using two small incisions on the sides of the chest and does not require resection or intersection of the sternum or ribs. The postoperative period is much easier. An almost ideal cosmetic result is achieved. With this operation, unlike standard thoracoplasty, the volume of the chest increases to physiological levels.

The surgery is well equipped to care for the most severe group of children; it has the most modern operating room, equipped with a laminar flow system that eliminates infectious complications during the operation, and endoscopic equipment for bronchoscopy, thoracoscopy, and laparoscopy. Doctors have a variety of highly informative diagnostic methods at their disposal, including endoscopic, ultrasound, radioisotope, and radiation (radiography, computed tomography, angiography). On the territory of the hospital there is one of the largest Moscow laboratories for biochemical and microbiological research.

In childhood, there are both congenital diseases - defects and anomalies in the development of various organs, and acquired ones - inflammatory diseases, consequences of injuries and burns, as well as tumors. A wide variety of diseases require the doctor to have knowledge and skills in many areas of medicine, including vascular and plastic surgery, oncology, endocrinology, pulmonology and others.

The goal of treatment - to return the child to a normal, full life - can be achieved subject to a complete and comprehensive examination, treatment and postoperative observation of the child in a specialized department by highly qualified doctors.

We have accumulated extensive experience in performing endoscopic diagnostic and therapeutic procedures for foreign bodies of the trachea, bronchi and other pathological conditions and malformations of the esophagus, stomach and respiratory tract. Laser treatment, cryosurgery and the most modern electrosurgical instruments and devices are used.

Consultation, hospitalization and treatment in the department for all Russian citizens who have a compulsory health insurance policy, from the moment of birth until the age of 18, regardless of their place of permanent residence, are carried out under a compulsory health insurance policy.

A referral from your local health authority is not required.

Hospitalization of Russians over 18 years of age, as well as citizens of near and far abroad, is possible under the terms of voluntary health insurance.

In recent years, there has been a consistent trend towards an increase in the number of children admitted and operated on.
Most of the children who come to us have previously been operated on in other medical institutions.
Many operations and treatment methods were developed and applied in our country for the first time by the department’s staff.

Children under 3 years old have the opportunity to stay with their parents around the clock in boxed single and double rooms. Older children are accommodated in rooms for 6 people. The department treats children aged from the neonatal period to 18 years on the basis of a compulsory health insurance policy. Hospitalization of Russians over 18 years of age and foreigners is carried out under the terms of voluntary medical insurance. All rooms have oxygen and the ability to connect aspirators, as well as devices for respiratory therapy. The intensive care unit provides 24/7 monitoring of vital signs.


Thanks to the widespread introduction of low-traumatic and endoscopic technologies in the surgical treatment of children with various diseases of the thoracic and abdominal cavity, mediastinum and chest, most of them do not need to be transferred to the intensive care unit after surgery, but have the opportunity to stay with their parents in the intensive care ward, equipped with everything necessary for a comfortable stay in the postoperative period.


The department has a modern endoscopic room, where a wide range of diagnostic esophagoscopies, laryngoscopies, bronchoscopies and therapeutic endoluminal manipulations are performed: removal of foreign bodies of the esophagus and stomach, removal of foreign bodies of the trachea and bronchi, bougienage of the esophagus and trachea, etc. If necessary, we actively use laser and CRYO therapy (liquid nitrogen) in the treatment of diseases and malformations of the larynx, trachea and esophagus. All diagnostic and therapeutic procedures are archived on digital media.


The department has its own ultrasound room with an expert-level device. This expands the possibilities of non-invasive high-precision diagnostics. In addition, many manipulations are performed in our department under ultrasound control: puncture of cysts of the kidneys, spleen, liver, etc.
Every year, more than 500 operations (link to the operation report) of the highest degree of complexity and more than 600 studies and manipulations (link to the endoscopy report) under anesthesia are performed (bronchoscopy, biopsy, ultrasound-guided puncture, endoluminal operations on the respiratory tract and esophagus, etc.

Operating room of the thoracic surgery department

The operating room is equipped according to the most modern standards and is adapted to perform surgical interventions of the highest category of complexity on the organs of the neck, chest, abdominal cavity, large main vessels, etc. Most operations are performed using thoracoscopic or laparoscopic access, i.e. without large cuts. High precision imaging, the availability of neonatal endosurgical instruments and anesthesia machines allow operations to be performed even on the youngest patients. This makes the flow much easier postoperative period and shortens the child's hospital stay.
The department has 3 anesthesiologists who constantly work only with our patients. These are highly qualified specialists who supervise not only the operations, but also the postoperative period.