[Videothoracoscopy for diagnosis and treatment of respiratory tract diseases]

Low invasive thoracoscopic and telecontrolled surgery is a new direction of modern thoracic surgery, by expanding its capacities. In patients with spontaneous pneumothorax, thoracoscopy and telecontrolled thoracoscopic surgery allow surgeons to make the same surgical interventions, as at open thoracotomy, such as laser thoracotomy and electrocoagulation of bullas, resection of bullous portions of the lung, pleurectomy and different types of pleurodesis, the postoperative period being much smoother. After thoracic and telecontrolled operations, the incidence of recurrences in patients with spontaneous pneumothorax is similar to that after open surgery. However, the less invasiveness and easier tolerance of endothoracic operations make them the method of choice in the treatment of spontaneous pneumothorax. In patients with the first episode of pneumothorax, thoracoscopic and telecontrolled interventions show a nearly 5-fold reduction in the incidence of recurrences as compared to medical treatment. In recurrent pleural exudates of unknown etiology, thoracoscopy may be considered to be the method of choice, providing 87-94% efficiency and a minimal risk, the efficiency of therapeutical pleurodesis being 85-100%. The contraindication for therapeutical pleurodesis are impediments to lung expanding and failure to eliminate them at thoracoscopy. In patients with pleural empyema, thoracoscopic surgery is indicated when a fortnight medical treatment fails and X-ray signs of extensive lung decay are absent. In diffuse lung diseases, thoracoscopic resection biopsy may substitute for open lung biopsy and indicated in inefficient transbronchial biopsy of the lung when a morphological diagnosis should be established. Its contraindications may be only in patients with severe respiratory failure when it is impossible to make anesthesia with exclusion of one lung. A correct definition of indications and contraindications for endothoracic interventions and their accurate performance are essential in preventing the complications following thoracoscopic and telecontrolled operations and in increasing their effectiveness. Timely open surgery in all technically and tactically difficult situations is a pledge of good outcomes and lower incidence rates of complications.