Local anesthetic wound infiltration (WI) provides anesthesia for minor surgical procedures and improves postoperative analgesia as part of multimodal analgesia after general or regional anesthesia. Although pre-incisional block is preferable, in practice WI is usually done at the end of surgery. WI performed as a continuous modality reduces analgesics, prolongs the duration of analgesia, and enhances the patient’s mobilization in some cases. WI benefits are documented in open abdominal surgeries (Caesarean section, colorectal surgery, abdominal hysterectomy, herniorrhaphy), laparoscopic cholecystectomy, oncological breast surgeries, laminectomy, hallux valgus surgery, and radical prostatectomy. Surgical site infiltration requires knowledge of anatomy and the pain origin for a procedure, systematic extensive infiltration of local anesthetic in various tissue planes under direct visualization before wound closure or subcutaneously along the incision. Because the incidence of local anesthetic systemic toxicity is 11% after subcutaneous WI, appropriate local anesthetic dosing is crucial. The risk of wound infection is related to the infection incidence after each particular surgery. For WI to fully meet patient and physician expectations, mastery of the technique, patient education, appropriate local anesthetic dosing and management of the surgical wound with “aseptic, non-touch” technique are needed.

Introduction: Surgical site infections (SSI) continue to be a major problem for thoracic surgery patients. We aimed to determine incidence rate (IR) and risk factors for SSI in patients with thoracic surgical procedures. Methodology: During 12 years of hospital surveillance of patients with thoracic surgical procedures, we prospectively identified SSI. Patients with SSI were compared with patients without SSI. Results: We operated 3,370 patients and 205 (6.1%) developed SSI postoperatively. We detected 190 SSI among open thoracic surgical procedures (IR 7.1%) and 15 SSI after video-assisted thoracic surgery (IR 2.1%). Five independent risk factors for SSI were identified: wound contamination (p = 0.013; relative risk (RR) 2.496; 95%, confidence interval (CI): 1.208-5.156), American Society of Anesthesiologist (ASA) score (p = 0.012; RR: 1.795; 95% CI: 1.136-2.834), duration of drainage (p < 0.001; RR: 1.117; 95% CI: 1.085-1.150), age (p = 0.036; RR: 1.018; 95% CI: 1.001-1.035) and duration of operation (p < 0.001; RR:1.005; 95% CI:1.002-1.008). Conclusion: The results are valuable in documenting risk factors for SSI in patients undergoing thoracic surgery. The knowledge and prevention of controllable risk factors is necessary in order to reduce the incidence of SSI.

Introduction/Objective The aim of the study is to analyze the treatment of spontaneous pneumothorax (PSP) through our 10-year experience. Methods The study included 67 patients with PSP treated with video-assisted thoracoscopic surgery (VATS) or with thoracic drainage (TD) in the Clinic for Chest Surgery at the Military Medical Academy in Belgrade, Serbia in the 2008-2017 period. Results PSP patients with VATS were younger (33.2 ± 16.4 vs. 45.5 ± 21.5 years, p = 0.010), and both groups consisted mainly of males (69.2% vs. 78%). VATS-treated patients were hospitalized shorter and wore drains (p < 0.001, p < 0.002). Recurrence after treatment was more common after TD (61% vs. 3.8%) and in most cases it was treated with VATS (92%). The incidence of intraoperative complications is similar between groups (p = 0.599, p = 0.636, p = 0.311, p = 0.388, p = 0.388, respectively). Pain was more common in TD (p < 0.001). The early complications in the group of patients treated with TD occurred more often (p < 0.001, p < 0.001), without significant difference in the incidence of pleura infections and intercostal blockade between groups (p = 0.388, p = 0.388, respectively). Patients treated for PSP with the VATS method came to the control follow-up later, compared to patients treated with TD (p < 0.001). Conclusion VATS proved to be efficient, which was reflected in the optimal duration of surgery, length of hospitalization, tolerable postoperative pain and satisfactory cosmetic effect, and postsurgical relapse in only one case.

Introduction. The aim of this manuscript was to report a case series of three patients diagnosed with multiple primary synchronous cancers (MPSC) in the lungs who were treated multidisciplinary at a single-center institution. Outline of cases. Three male patients were referred to the Clinic for Chest Surgery, at the Military Medical Academy in Belgrade, Serbia for planned surgical treatment of previously detected lung cancers. During subsequent diagnostic procedures, second primary synchronous tumors were detected in all presented cases. All patients underwent surgical resection and chemotherapy or a combination of chemo- and radio- therapy. Two of three patients died with an average survival period of 32 months. One patient is still alive, with current disease-free interval of 21 months. Conclusion. MPSC is a rare condition. The final diagnosis should be based on clinical, radiological, histopathological, and genetic analyses. Treatment modalities of MPSC depend on the clinical staging of the disease, patient?s general medical condition, and general assessment of tumor operability and resectability.

lečenje bolesnika, osmišljavanje i pisanje rada Aleksandar Nikolić-lečenje bolesnika, saradnja pri pisanju rada Vlado Cvijanović-lečenje bolesnika, saradnja pri pisanju rada Aleksandar Ristanović-korekcije jezika, saradnja pri pisanju rada Nataša Vešovićkorekcije jezika, pronalaženje literature Dejan Stojković-tehničko ureĎivanje rada, pronalaženje literature Vanja Kostovski-pisanje apstrakta Ljubinko Đenićprevod na engleski jezik Stevan Čičićprevod na engleski jezik 3

Introduction/Objective. Besides sternotomy, video-assisted thoracoscopic surgery (VATS) is used for treatment of thymus tumors. The objective of our study is to compare oncological and perioperative outcomes in patients with I-II stage of thymic tumors treated with video-assisted thoracoscopic surgery or standard sternotomy procedures. Method: The study included only primary I-II thymoma according to the Masaoka classification treated between May 2006 and February 2018. Out of 116 treated patients that had pathohistologically verified stage, 100 (86. 2%) were matched by propensity score for sex, age, body mass index, myasthenia, tumor size, Masaoka classification stage. Oncological (direct post-operative survival, recurrence) and perioperative outcomes (intra and postoperative complications, length of hospitalization) that affect the efficacy and safety of surgical techniques have been analyzed and compared between the two groups. Results: Among 50 patients operated by VATS, 34 patients (68%) were treated by uniportal approach, 13 (26%) by biportal and three (6%) by threeportal approach. The VATS intervention had shorter intervention time (p < 0.001), duration of hospitalization (p < 0.001), and usage of thoracic drainage (p < 0.001). There was a significant difference in terms of late control (p < 0.001). There was no significant difference between the groups regarding visual analog scale score, as well as in terms of the time of recurrence (p = 0.305, p = 0.268). Conclusion: Compared to standard sternotomy, VATS thymectomy is an equally effective and significantly safer method with a minimum rate of intra and postoperative complications.

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Introduction. Penetrating injuries of the neck are potentially life-threatening conditions. They can cause injuries of larynx, trachea, esophagus and major blood vessels in this area. Case report. The patient was a 28-year-old male who was stabbed with broken glass penetrating the front side of the base of his neck. The patient had dyspnea and the wound was inflicted the night before admission to hospital. An otorhinolaryngologist found a stab wound in the region of the left basis of the neck. The wound was 2 cm long with no signs of bleeding and deep injuries of the anatomical structures of the neck. However, since left hemopneumothorax was clinically and radiologically apparent, drainage of the thorax was performed upon admission to the intensive care unit. Initially, 400 mL of hemorrhagic effusion was evacuated. However, 24 hours later the patient became hemodynamically unstable. It was an indication for videoassisted thoracoscopy (VATS). Therefore, VATS was used as a diagnostic method in order to determine the nature of the injury. Intraoperatively, we treated a laceration of pleuropulmonary adhesion which was continuously bleeding from the apex of the thoracic cavity. As a result, adequate surgical hemostasis was achieved. Furthermore, during the three-week postoperative period, thoracic tubes were placed due to the prolonged air leakage. A thoracic tube was placed laterally along with another one which was placed in intercostal space higher. After total reexpansion of the left lung, thoracic tubes were extracted, and the patient was discharged. Conclusion. Nowadays, VATS has become a highly important ultimate treatment of thoracic trauma. This minimally invasive method allows us to verify injury type and localization, to resolve it and further to follow-up evaluation of pathological changes in the lungs, pericardium, mediastinum, pleura and thoracic wall. In the case of stab wounds in the cervical region, any injuries of the lungs and pleura must be taken into consideration.