The highest estimated prevalence of MDR-TB is in India and China. However, the largest number of patients who have been diagnosed with MDR-TB live in the European Region of the WHO. In Belarus, Kazakhstan, Kyrgyzstan, the Republic of Moldova, the Russian Federation and Ukraine, more than 25% of all new patients who have not received treatment for TB in the past, have MDR-TB. 1 Less than one third of notified TB patients worldwide are evaluated with drug susceptibility testing (DST) for RMP; only half of patients with RMP resistance or MDR-TB undergo DST for FQs and second-line injectable drugs. 1 Only 20% of MDR-TB cases have access to adequate treatment. 3,4 It is predicted that the number of patients with MDR-TB and XDR-TB in highburden countries will continue to rise in the coming decades. 5 Treatment for MDR-TB is challenging for patients, relatives, healthcare providers and health systems. 6 The level of drug resistance of the causative strain of M. tuberculosis can be highly variable. 7 Depending on the DST results, current WHO treatment recommendations range from 9 to 20 months of daily combination antibiotic treatment. 8 The treatment is characterised by a high frequency of adverse drug events, often leading to changes in the regimen. 9 Due to high costs, some of the second-line drugs are not available in countries where they are needed most. 10 Despite all of our efforts, according to the latest WHO report, only 55% of patients with MDR-TB and 34% of patients with XDR-TB achieve a successful treatment outcome. 1 Treatment outcomes in MDR-TB and XDR-TB are highly dependent upon available resources. It was recently shown that relapse-free cure-rates in patients with M/XDR-TB can be similar to patients with drug-susceptible TB (DS-TB) when sufficient resources are provided, 11 and treatment can be personalised. 12 The aim of the present article is to update previous TBNET (Tuberculosis Network European Trials) recommendations on the optimal management of patients with M/XDR-TB. 6

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Surgery of pulmonary tuberculosis associated with open thoracotomy due to dense pleural and vascular adhesions. These reasons limited the use of video-assisted thoracoscopic surgery (VATS) in these cases. Robotic surgical system aimed to performing successfully minimally invasive operations for pulmonary tuberculosis. This paper showed 3-year experience of one chest center in this area. The results of this work are recommendations that facilitate the implementation of robot-assisted lung resection in complex treatment of pulmonary tuberculosis.

Thoracic surgery may significantly improve patients' outcomes and even result in a cure in a good portion of patients with bilateral cavitary MDR and XDR TB and should be considered as the essential element of multimodality treatment for MDR and XDR TB, even in patients with bilateral cavitary disease and borderline respiratory reserves.

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