Kupchak I. Optimization of videothoracoscopy for mediastinal lymphadenopathy

The purpose of the dissertation is to reduce the level of possible intraoperative and postoperative complications during videothoracoscopic biopsy of mediastinal lymph nodes. In the dissertation the main causes of intraoperative and postoperative complications during videotoracoscopic biopsy of mediastinal lymph nodes were studied. The effectiveness of the use of artificial pneumothorax and changing the position of the operating table for creating optimal conditions for mediastinal lymph nodes biopsy during videotoracoscopy has been studied. The use of these methods allowed: to increase the level of achievement of sufficient collapse of the lung from 73,8 % to 94,7 % of cases and the level of satisfactory visualization of the mediastinum from 64,3 % to 92,1 % of cases. Effectiveness of using medical alpha-cyanаcrylic glue and hemostatic sponge with the aim of preventing hemorrhagic complications during video-thoracoscopic biopsy of mediastinal lymphnodes has been investigated. Their use allowed: to reduce the level of postoperative hemorrhagic complications from 4,8 % to 0,0 % of the cases and the frequency of postoperative infections of the pleural cavity from 4,8 % to 2,8 % of cases, to reduce the total number of complications from 21,4 % to 2,8 % of cases. A new method for the prevention of infectious complications during videothoracoscopic biopsy of mediastinal lymphnodes has been developed, which allowed: to reduce the level of infectious complications from 4,8 % to 2,8 %, the incidence of leukocytosis from 14,3 % to 8,3 %, and the frequency of hectic fever from 11,9 % to 5,6 %. An algorithm for the optimal use of videocoroscopy for mediastinal lymphadenopathy has been developed.