FEATURES OF SURGICAL ACCESS DURING VIDEOTHORACOSCOPY OPERATIONS IN THE WOUNDED WITH CHEST TRAUMA

Abstract

The aim. To improve the treatment of wounded with combat chest injury by optimizing low-traumatic surgical access using video thoracoscopy. Materials and methods. In the period from 2014 to 2019, 103 injured were treated with video-assisted thoracoscopic surgical interventions in case of chest trauma. According to the objectives of the study, two clinical groups of victims were formed. The comparison group included 54 (52.4 %) victims, the main group – 49 (47.6 %). The wounded accounted for 72 persons (69.9 %), injured – 31 (30.1 %). In case of wounds to the chest, the selection of victims for VTS surgical interventions and the timing of their implementation was carried out taking into account the location, type of injury and trauma, the severity of the condition of the patients, the presence of a combined wound, the possibility of two or one-lung ventilation during the intervention, the timing of admission to a medical institution with the moment of injury, the technical capabilities of military-technical operations. In staging trocars during combat chest injury, we adhere to the general rules for video-assisted thoracoscopic interventions on the chest – the rules of the “triangle”. When a chest injury is involved, the port setting has its variability, which is based on the type of injury and the purpose of the surgical intervention. You can use both standard points of installation of thoracoports, and non-standard individual ones that will correspond to the set clinical goals. Research results and discussion. High efficiency in visualization of the operating area and the technical convenience of surgical techniques have been established. This allows a rational and consistent audit of the anatomical zone of the wound. With a chest injury, the most rational sequence for conducting a pleural cavity audit is on the principle of paramount importance. Conclusions. Features of online access – port setting for injuries to the chest depends on the area of the inlet of the gunshot. When setting ports, it is not necessary to adhere to standard points, the introduction of a thoracoport is possible at any point on the chest wall, but with the obligatory observance of the triangulation rule. The number of input ports for combat trauma to the chest depends on the technical need for a full operation. In the vast majority of military-technical operations, 3 thoracoports are enough.