Introduction: Intrathoracic negative pressure therapy is an adjunct to standard methods of complex empyema management in debilitated patients. Nevertheless, the use of endoscopic one-way endobronchial valves to successfully close large bronchopleural fistulas in patients with advanced pleural empyema has been described in only a few case reports. Aim: To present our experience in managing complex pleural empyema using thoracostomy with intrathoracic negative pressure therapy and/or endobronchial valve implantation. Material and methods: We retrospectively analyzed data from 13 consecutive patients (11 men, mean age: 56 years, range: 38-80 years) who were treated for pleural empyema using thoracostomy with intrathoracic negative pressure therapy and/or endobronchial valve implantation between October 2015 and November 2017. Results: The control of empyema was satisfactory in 12 patients; however, one patient died from sepsis-related multiorgan failure despite complete cessation of air leak on day 9 after endobronchial valve implantation. The overall success rate for the final closure of the chest wall was 9/12 patients (75%): in 5 patients, the wall closed spontaneously, and in 4, the wall was closed using thoracomyoplasty. Conclusions: Thoracostomy with intrathoracic negative pressure therapy, endobronchial valve implantation with tube drainage, and a combination of the two could adequately manage patients with pleural empyema with or without a persistent air leakage fistula.

Introduction: Lung cancer has been the most common cancer in the world and in Belarus. Aim of the research: To evaluate the epidemiology of non-small cell lung cancer and improvements in diagnostics and treatment for the past 11 years in the Brest Region of Belarus. Material and methods: We conducted a retrospective analysis of statistical data (incidence rate, mortality) in the regional cancer registry of the Brest oncological clinic since 2000 and assessed survival for 652 adult patients with different stages of non-small-cell lung cancer (NSCLC) who underwent surgery in the Thoracic Surgery Department of Brest Regional Hospital in 2002-2010. Results: Lung cancer continues to have the highest incidence rate among malignant neoplasms and because of its high fatality rate is a leading cause of cancer-related mortality in the Brest Region and Belarus. The chest radiography screening programme of lung cancer since 2000 and the implementation of computed tomography (CT)-and ultrasonography (USG)guided needle biopsy and VATS LigaSure pulmonary wedge resection for the evaluation of solitary pulmonary nodules has allowed an increase of diagnostic rates and improved the histological confirmation rate of lung cancer in the Brest Region. Multivariate analysis indicates that male sex, age older than seventy and incomplete surgical resection are independent predictors of poor prognosis for postoperative long-term overall survival. Conclusions: Today it is necessary to carry out low-dose spiral computerized diagnostics in the Brest Region, which would detect a greater proportion of asymptomatic lung cancers. Surgical resection remains the only consistent and successful option of a cure for patients with lung cancer.

Introduction: Iatrogenic injuries to the trachea and main bronchi present one of the most dramatic complications traditionally treated by thoracotomy and transcervical-transtracheal approaches but almost never by video-assisted thoracic surgery.Aim: To evaluate our experience in a video-assisted thoracic surgery repair of iatrogenic tracheal lacerations. Material and methods: The group under analysis consisted of 5 consecutive patients (1 male, mean age: 52 years, range: 32-56 years) who were treated for postintubation and intraoperative damage to the tracheobronchial tree using video-assisted thoracic surgery within the period 2015-2018. Thoracic computed tomography and fibreoptic tracheobronchoscopy were used to confirm iatrogenic tracheal ruptures before surgery. The membranous rupture of the trachea was closed with interrupted absorbable sutures, which were additionally sutured through the oesophageal wall or the wall of the gastric conduit to strengthen the suture line. Postoperative treatment included broad-spectrum antibiotic therapy and control tracheobronchoscopy. Results: The average duration of thoracoscopic tracheal rupture repair with suture line reinforcement was 103 min (range: 60-180 min). All patients were treated thoracoscopically without resorting to open surgery and were discharged without any postoperative complications within 16 days (range: 8-22 days). Conclusions: The minimally invasive thoracoscopic approach may be the method of choice for the treatment of intraoperative and post-intubation injuries of the tracheobronchial tree.

Introduction: Esophageal perforation has been considered a catastrophic and often life-threatening event.Aim of the research: To show the results and difficulties in the management of esophageal perforation based on the experience of our department of thoracic surgery as well as data obtained from other hospitals. Material and methods: We performed a retrospective analysis of the management of 103 patients (mean age: 49.4 ±3.1) treated during the period of 1997-2011. Open surgery historical control group (94 patients) was compared with patients (9 cases) who had undergone video-assisted thoracoscopic surgery nonresection procedure in our hospital. Results: Data analysis has revealed that 32 (31%) of all patients were not recognized as a "thoracic esophageal injury" at the first examination. Despite the fact that more than 80% of patients were hospitalized on the first day, in 42 cases (40.8%), surgical treatment was applied after 24 h (52.1 ±7.8). Sixty-percent patients of control group were complicated by postoperative morbidity resulted in higher (p < 0.05) mortality rate (35.1%) and hospital stay time (41.2 ±6.1 days), then VATS management of patients who had 11.1% postoperative mortality and 26.5 ±5.6 days of hospital stay. Conclusions: Esophageal perforations are rare pathology and due to the rarity of this condition and its often nonspecific presentation, the surgical treatment of it is delayed in more than 40% of patients, which leads to death of every third patient. Video-assisted thoracoscopic surgery with adequate drain perforation has had advantages in comparison with standard open surgical techniques in treatment of patients with delayed perforation and severe inflammatory reaction.

Introduction: Thoracoscopic plication is an effective treatment for diaphragmatic eventration, but the procedure has some disadvantages such as inadvertent abdominal organ injuries or superficial sutures that are not strong enough. Aim of the research: In this study, we devised and tested the method of diaphragm plication through simultaneous laparoscopic-and thoracoscopic-assisted left mini-thoracotomy. Material and methods: During the period between October 2012 and March 2014 there were four patients operated on for left-sided diaphragmatic paralysis. The average age was 52.3 ±17.8 years. The preoperative examination included a routine laboratory study, spirometry, plain chest radiograph, and computed tomographic scan of the chest. The initial part of the surgery was a two-port laparoscopy to remove the adhesions between the abdominal viscera and the abdominal segment of the diaphragm using bipolar electrocautery. After that, video-assisted thoracoscopic surgery plication of the diaphragm was performed via anterior mini thoracotomy. Results: The mean operation time was 58 ±11 min, and the mean hospital stay was 9.0 ±2.1 days. All of the patients demonstrated good postoperative recovery. The descending distance of the diaphragm after the surgery ranged from two to four intercostal spaces, which was confirmed with plain chest X-ray. The follow-up ranged from 20 to 38 months and showed no recurrence of diaphragm elevation symptoms. Conclusions: Simultaneous thoraco-and laparoscopic assisted mini-thoracotomy surgery for diaphragm plication is a safe procedure with strong positive clinical effect, and it can serve as an alternative to conventional thoracoscopic approaches especially in patients with high risk of inadvertent abdominal organ injuries.