St Petersburg University surgeons perform live surgeries at the 30th Congress of the World Society of Cardiovascular and Thoracic Surgeons
Scientists from St Petersburg University have taken part in the World Society of Cardiovascular and Thoracic Surgeons (WSCTS) congress. It was held in St Petersburg for the first time. St Petersburg University experts performed live surgeries for the congress participants and talked about their special features and what complications might occur during such operations. They also answered their colleagues’ questions.
Piotr Yablonsky is WSCTS Congress President, Vice-Rector for Medical Activities at St Petersburg University, Chief External Expert in Thoracic Surgery of the Russian Ministry of Health, Surgeon-in-Chief of the Health Committee of the Government of St Petersburg, and Honoured Physician of the Russian Federation. He performed the repeated and complex surgery for pulmonary tuberculosis and lung cancer.
The operation was performed on a patient whose one lung was collapsed due to improper treatment of tuberculosis, and the infection had spread due to pus filling. During the live surgery, the patient had a festering part of her lung removed. Three weeks earlier, surgeons at the Research Institute of Phthisiopulmonology had crossed her bronchus with a special machine without opening her chest. This two-stage approach made it possible to avoid complications from the bronchial stump and safely remove the purulent element.
Vadim Pischik, Professor in the Department of Hospital Surgeryat at St Petersburg University, showed a recording of a thoracoscopic segmental resection through a small incision, which he had performed on the eve of the congress. Such operations are globally regarded as rather complicated and infrequent. They are also performed by scientists from Japan and China. Vadim Pischik is the first surgeon to perform such a segmental resection through a small incision with navigation using a special substance. The operation was performed on a patient with bilateral lung cancer. In this situation, specialists usually carry out two operations a few weeks apart. During the first stage, surgeons ’switch off’ the lung that is being operated on from breathing. The other lung continues to do its job.
The 30th Annual Meeting of the World Society of Cardiovascular and Thoracic Surgeons was supported by: the Ministry of Health of the Russian Federation; the Government of St Petersburg; St Petersburg University; St Petersburg Research Institute of Phthisiopulmonology; the Association of Thoracic Surgeons of Russia; Russian Nurses Association; and the Hannover Medical School (Germany). Among the participants are delegates from: the USA; Great Britain; Israel; Canada; Austria; Germany; Switzerland; France; Belgium; Italy; Spain; Greece; Bulgaria; Serbia; Bosnia and Herzegovina; Türkiye; Belarus; Armenia; Uzbekistan; Kazakhstan; Moldova; China; India; Vietnam; Thailand; Malaysia; Brazil; and Japan.
Within the framework of WSCTS 2022, St Petersburg University organises a satellite symposium "Fundamental Science − Cardiothoracic Medicine". St Petersburg University experts will discuss the pathogenesis of atherosclerosis, tissue engineering and other fundamental issues of cardiothoracic pathology.
If during the first stage the affected lobe of the lung has been removed, in the second operation it will be very difficult to provide this one-lung ventilation. The patient may not survive the operation at all. Vadim Pischik, Professor of St Petersburg University, showed the congress participants how lung segments can be removed more effectively with less risk to the patient.
‘To remove the segment with the tumour, I injected indocyanine green dye (ICG) into the patient’s vessel during the surgery. The substance is invisible in white light, but when exposed to near-infrared light, it gives a clear glow. This makes it possible to see the boundaries of the lung segments and safely remove the necessary areas,’ explained Vadim Pischik.
There are clearly visible boundaries between lobes in humans. However, between segments these boundaries are almost invisible. This is one of the main difficulties of lung segment resection. Thanks to the technique used by Vadim Pischik, Professor of St Petersburg University, the surgeon can clearly see the boundaries between what needs to be removed and what needs to be left.
Another complicated operation was performed by Dmitrii Shmatov, Professor in the Department of Hospital Surgery at St Petersburg University and a cardiovascular surgeon at the Pirogov Clinic of High Medical Technology at St Petersburg University. During the congress, the surgeon showed footage from an aortic valve replacement and supracoronary aortic replacement via ministernotomy for a patient with an ascending aortic aneurysm. An aortic aneurysm is a persistent limited dilatation of the aorta by 50% or more relative to the age norm in that section.
The operation was carried out unconventionally, through a mini-access, i.e. through a small (about five centimetres) incision. The main part of the operation consisted of two stages. Firstly, a part of the aorta with the aneurysm was excised. Then, the surgeon resected the affected aortic valve and implanted a special prosthesis − a synthetic tube.
It is challenging to perform a fairly complex operation from a small access. It is not often that surgeons do this, even through a normal access, because working on the aorta is always difficult. You could say it is the pinnacle of surgery.
Dmitrii Shmatov, Professor in the Department of Hospital Surgery at St Petersburg University and a cardiovascular surgeon at the Pirogov Clinic of High Medical Technology at St Petersburg University
This type of surgery can be performed on patients with aortic valve disorders and disorders with the ascending and aortic arch. Not only does mini-access surgery have aesthetic benefits. It also speeds up the patient’s recovery after the surgery, reduces blood loss during the surgery and shortens the recovery period.