Thoracocaustosis is the operation of burning out pleural fusions. It is shown in pleural adhesions between the lungs and the chest wall, keeping the caverns in a stretched state and preventing the effective collapse of the affected lung.
The thoracoacautic is performed through a thoracoscope after thoracoscopy (see), at which the place of insertion of the instrument is determined.
Tools for thoracocaustics: thoracoscopes with direct and lateral optics, thermo-scooter - a curved wire ending in a platinum loop, a thin conductor tube for the cautery; trocars with cannulas, intrapleural anesthesia needle, electric cords and spare bulbs. Sterilization of the thoracoscope, cautery and cords is done in formalin vapors.
For thoracocaustics, it is necessary to have a gas bubble in the pleural cavity sufficient to move the instruments without the risk of damaging the lung, for which a pneumothorax is imposed and after 3-6 weeks they produce thoracocaustics.
The patient is placed in the position adopted for the imposition of pneumothorax (see. Pneumothorax artificial ); after anesthesia, a trocar is introduced into the pleural cavity, then a thermocauter is inserted into the trocar cannula. Burning out of the adhesions is done in a loop with a slightly red glow.
In the postoperative period, bed rest is necessary for 2–5 days. Within 1-2 days after the thoracocaustic period, the temperature rises moderately. With the appearance of shortness of breath should be pumped 500-1000 ml of air from the pleural cavity. With the appearance of signs of intrathoracic bleeding from the damaged vessels of the chest wall, an urgent thoracotomy is indicated (see). The subcutaneous emphysema often observed (see) resolves, as a rule, independently within 5 - 7 days.
Fig. 1 and 2. Multiple cord-shaped and conical spikes. Fig. 3 and 4. Ribbon and membranous adhesions. Fig. 5 and 6. The location of the loop of the thermal caster on the commissure at the time of burning. Fig. 7 and 8. Anesthesia of fusion during hydraulic preparation (Fig. 7 — the needle is inserted at the base of the fusion, Fig. 8 — the base of the fusion is infiltrated with novocaine; the dotted line shows the pleural incision). Fig. 9. The incremental portion of the lung exfoliates from the chest wall with a Kaufer case.