In the case of the presence in the root of a lung tumor or a conglomerate of enlarged dense lymph nodes intimately connected with the mediastinal pleura, the latter is widely dissected outside the affected area. Moreover, if the phrenic nerve is not involved in the process, the incision is made posteriorly from it, if the phrenic nerve is affected by the tumor, then —in front, within the unchanged tissues. The back piece of the dissected mediastinal pleura with cellulose and lymph nodes is dissected to the lung root, after which from this access the condition of the pulmonary vessels, the pericardium, the superior vena cava, the main bronchus is examined. When the tumor spreads in the immediate vicinity of the pericardium, its involvement in the tumor process or the presence of a conglomerate of enlarged lymph nodes,deep into the mediastinum and not allowing to assess the state of the posterior walls of the pulmonary vessels, produce a wide pericardotomy. The incision of the pericardium on the right reaches the top of the superior vena cava, at the bottom — the diaphragm, on the left — at the top — the aorta, at the bottom — the diaphragm. Intrapericardial revision allows you to most accurately determine the defeat of the pulmonary vessels, pericardium, heart wall, intrapericardial areas

upper and lower vena cava, to establish the possibility of performing their resection. When performing advanced combined resections for advanced stages of lung cancer, intrapericardial revision is used quite often. So, when performing advanced operations for lung cancer in our clinic, it was used in 46.5% of all cases, and when performing advanced combined ones — in 77.4%.

With right-sided thoracotomy, the greatest difficulties in determining the operability of a patient are related to the diagnosis of a lesion of the pulmonary veins, the wall of the left atrium, hollow veins, the posterior wall of the pulmonary artery, and the esophagus. The spread of the tumor through the pulmonary veins, especially with the defeat of their mouths and the walls of the left atrium create a difficult and dangerous situation not only when performing resection, but also in the process of diagnosing such a lesion. It is caused by topographic-anatomical features of the structure and location of the pulmonary veins. The intrapericardial part of the right pulmonary veins on the right is significantly shorter than on the left, their mouths are located deep on the back surface of the heart, covered in front by the right atrium, from above and below limited to the upper and lower hollow veins,directly to the anterior surface of their mouths, the interatrial sulcus is adjacent, corresponding to the location of the interatrial septum. In addition, they have little mobility, especially the inferior pulmonary vein, due to the existence of the mesentery, which fixes it to the inferior vena cava .