The ligature under the pulmonary artery is possible before and after the intersection of the arterial ligament, as well as distal and proximal to it. If the lower surface of the pulmonary artery has been allocated sufficiently well, the provisional ligature can be held proximal to the ligament after dissecting the back sheet of the pericardium above the instrument held under the pulmonary artery at its upper edge. In such cases, the arterial ligament prevents the superimposed provisional ligature from displacing in the proximal direction and gives greater confidence when anatomical “aortic window” dissections are performed. When conducting a ligature distal to the arterial ligament and a high spread of the tumor along the left pulmonary artery, there is a real threat of dissection of the vessel during its ligation. Shortthe wide left pulmonary artery is fixed in distal parts by conglomerates of lymph nodes, in proximal – by an arterial ligament. Therefore, in such a situation, it is better to proceed to the isolation and intersection of the arterial ligament, and in the area of ​​the lung root, the preparation of the left pulmonary artery within the lymph nodes affected by metastases.

In any case, when bandaging the pulmonary artery or flashing it with the help of mechanical stitching devices directly along the wall of the pulmonary artery, it is necessary first to press the vessel in the level planned for bandaging and make sure that there are no serious circulatory disorders due to narrowing of the pulmonary trunk .

Intrapericardial discharge of the pulmonary veins on the left is technically easier than with right-sided operations. The length of the intrapericardial part of the pulmonary veins on the left is somewhat longer than on the right, and moreover, they are located intrapericardially almost throughout its entire circumference, and the lower pulmonary vein has a long mesentery formed by the posterior pericardial leaflet. The left atrium is more accessible from the left-sided access and can be mobilized much easier if necessary to perform its resection. With a massive tumor lesion of the left atrial wall in seven cases, an intracardiac revision of the left atrium walls through his ear was performed in the clinic, according to the method described for revision of the right atrium and hollow veins. 
 The defeat of the aortic wall tumor significantly increases the risk of surgery and complicates it. As the experience of surgical interventions has shown, it is possible to understand the true size and nature of the germination of the aortic wall by a tumor only in the course of operative diagnostics, through careful preparation. Often, the massive, seemingly immobile tumor conglomerate surrounding the aorta, after its mobilization from healthy tissues, without any technical difficulties, is separated from the vessel wall. Often, even in the case of a tumor in the aorta wall, it is much smaller in size than was assumed at the beginning of the audit. In addition, the germination of the aortic wall by a tumor can be limited only to its adventitia, which can be resected for a very considerable distance.

The aortic dissection is performed according to the same rules as the superior vena cava, from the side of its unchanged departments. After separation of the aortic wall from paracancic changes, the true dimensions of the tumor lesion are clarified. When the germination of the tumor only in the adventitia, it is possible to determine some mobility of the tumor conglomerate with respect to the vessel. The unvented area opens the adventitia and gradually separates it from the middle layer. During germination of all layers of the aorta wall as an indication for resection of its area, we consider the presence of a limited lesion of the descending part, if possible, perform marginal resection without significant narrowing of the vessel lumen after applying aortic clamp.

In peripheral tumors located in the apex of the lung, the so-called “impacted”, the selection of the lung and the assessment of the ability to perform the operation are particularly difficult. Rough manipulations can rupture the subclavian artery and brachiocephalic vein. Therefore, in the allocation of the apex of the lung, it is always necessary to dissect the mediastinum along the vessels. Highlighting the superior vena cava, continue the selection along the right brachiocephalic vein, until the hemithorax dome clearly shows the pulsation of the subclavian artery. Shifting the artery up, carefully dissect it. After isolating the vessels, the posterior parts of the apex of the right lung are allocated more safely. On the left, you first need to isolate the aortic arch and the left subclavian artery extending from it and, continuing to dissect the vessel, isolate the lung.After isolating the left subclavian artery to the hemithorax dome, further extraction of the apex of the lung can be performed more vigorously.

During the execution of surgeries during manipulations at a great depth, which occurs when the apex of the lung and its basal parts are highlighted, it is often difficult to illuminate the surgical field. To solve this problem, a universal tool was designed and applied (Fig. 23), which combines the qualities of a clamp, illuminator and tip of electrodiatermia. A clamp (2) is attached to the Fedorov direct clamp (1) with a single pin connecting the branches, which fixes a flexible optical fiber cable (3) made of fiberglass, 1800 mm long, 3.5 mm in diameter. The light guide cable, in turn, is connected to the light device 489.10 (4) with an input voltage of 6 V (0.8 A).The light guide cable and the light device are used from the Friedel type 441 bronchoscope manufactured by the GDR (the use of a light guide and a light device does not exclude their use in bronchoscopy).

Two versions of latches have been developed: 1 — spring-loaded (Fig. 23 A), consists of a body (K), a clamp (F) and a spring (P); 2 — screw , consists of a body (K) and a fixing screw (B). The “head” of the light guide cable (5) is inserted into the retainer. Clamp with retainer sterilized usually in

dry heat closet. The light guide cable can be sterilized in a steam room for 24 hours or in a 6% hydrogen peroxide solution.

Universal clamping is used by us as a working tool for isolating the lung from adhesions, adhesions, and removal of the diseased mediastinal lymph nodes in a narrow surgical field with poor illumination of the main light source. When performing operations on the lungs using a universal clamp, the overview of the surgical field is significantly improved, the time of the operation is reduced, and its safety is increased.