Minimally-invasive segmentectomy for pulmonary tuberculosis: Single center experience

Abstract

Thoracoscopic pulmonary resections are widely used by thoracic surgeons in the world. Nevertheless, infectious diseases of the lung are associated with a lot of difficulties for implementing of minimally invasive approaches. Four years single-center experience in robot- and video-assisted thoracoscopic segmentectomies for pulmonary tuberculosis was studied in this paper to evaluate the main features of these surgical procedures for infectious disease. From 2016 to 2019 years we were performed 262 anatomical segmentectomy due to localized TB lesions, including 144 patients underwent uniportal video-assisted thoracoscopic surgery, 108 underwent muscle sparing lateral thoracotomy, and 10 cases of robot-assisted thoracoscopic surgery. Conversion rate from uVATS to open surgery was 8%. The advantages of the uVATS approach compared to thoracotomy approach are less blood loss during surgery (56.74 vs. 74.26 mL, P=0.0001); lower consumption of narcotic analgesics (4.35 injections vs. 5.50 injections, P=0.0001) and a lower incidence of complications after surgery (21.5% vs. 36.1%, P=0.015). There were no significant differences in duration of operation (P=0.102), air leak (P=0.981), chest tube drainage (P=0.417), hospital stay (P=0.134) between the uVATS and thoracotomy groups. There was no perioperative mortality. In addition, after bacteriological examination, 13% of patients (n=35) showed amplification of MTB drug resistance. Minimally invasive segmentectomy is effective and safe procedure in the complex treatment of localized forms of pulmonary tuberculosis.