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Objective: To evaluate the safety and advisability of repeated liver resection (RLR) for recurrent intrahepatic cholangiocarcinoma (ICC)., Material and Methods: The results of RLR for ICC recurrence ( n =10) were retrospectively analyzed between 1999 and 2023. The control group consisted of patients undergoing primary liver resection for ICC ( n =195)., Results: Surgery time ( p =0.001) and blood loss ( p =0.038) were lower in the RLR group. There were no blood transfusions (0 vs. 31.8%, p =0.034) and 90-day mortality (0 vs. 3.2%, p =1.0) in the same group. The risk of complications (30.0% vs.45.6%, p =0.517) and adverse events grade ≥ III (20.0% vs. 17.9%, p =1.0) was similar in both groups. Multifocal intrahepatic nodes were more common in the RLR group (60% vs. 37.9%, p =0.193), while there were no negative factors such as lymph nodes involvement (0 vs. 34.4%, p =0.032) and invasion of surrounding structures (0 vs. 38.5%, p =0.015). Dimensions of the largest node were smaller in repeated resection (2 vs. 8 cm, p <0.0001). Incidence of R0 resections (80.0% vs. 82.1%, p =1.0) was comparable. Long-term results were similar: five-year overall survival 17.2% and 34.7% ( p =0.912), three-year disease-free survival 20.0% and 26.5% ( p =0.421)., Conclusion: Similar results of repeated and primary liver resections confirm advisability of RLR for intrahepatic recurrence of ICC.

Objective: To analyze learning curves and appropriate experience on the features of mini-bypass surgery in 341 obese patients., Material and Methods: A total of 341 laparoscopic mini-gastric bypass surgeries performed by one surgeon were studied. The median age of patients was 40.5 [34; 48.3] years. There were 284 (83.2%) women and 57 (16.8%) men. The median BMI was 45 [40;52] kg/m 2 ., Results: The period of MGB development consisted of 138 interventions. Surgery time was 120 [100; 130] min and 90 [82.5; 100] mins after development of this technique ( p =0.001). Complications occurred in 5 (1.5%) patients (1 patient with Clavien Dindo grade IIIA and 4 ones with grade IIIB). Of these, there were 3 patients with stapler suture defects. There were no complications only in the 4th quartile of surgeries. Surgical experience significantly affects postoperative outcomes. Surgery time was more influenced by surgical skill rather technique of anastomosis imposing., Conclusion: Polynomial regression objectively characterizes development of surgical skills lasting 138 interventions. MGB is safe for morbid obesity with a complication rate of 1.5% and no mortality.

Objective: To study the safety and efficacy of laparoscopic fundoplication and hiatal hernia repair for gastroesophageal reflux disease following hiatal hernia., Material and Methods: We retrospectively analyzed 56 patients with gastroesophageal reflux disease and hiatal hernia .They underwent laparoscopic fundoplication and hiatal hernia repair between January 2020 and January 2023., Results: All surgeries were successful without conversion to open surgery. Surgery time was 56-180 min (mean 68.4±3.6), blood loss 30-200 ml (mean 40.3±5.6). No mortality and severe complications occurred. All patients were followed-up for 6-24 months. The GERD-Q and De Meester scores were significantly lower after 6 months compared to baseline values ( p <0.05), and resting pressure was lower. Tone of lower esophageal sphincter was significantly higher compared to preoperative level ( p <0.05). In 1-2 years after surgery, symptoms completely disappeared in 48 patients and significantly improved in 6 patients. Two patients had no improvement. Contrast-enhanced examination found no recurrent hiatal hernia and digestive tract obstruction., Conclusion. L: Aparoscopic fundoplication and hiatal hernia repair is safe and effective for gastroesophageal reflux disease with hiatal hernia.

Objective: To present the experience of laparoscopic nephrectomies and kidney resections in children., Material and Methods: There were 28 minimally invasive surgeries for renal tumors between July 2015 and March 2023 (92 months). There were 16 (57%) boys and 12 (43%) girls who underwent 22 nephrectomies and 6 kidney resections. The median age of patients was 54 (38; 76.5) months., Results: In the laparoscopic nephrectomy group, the median surgery time was 135 (108-188) min, blood loss - 10 (3.75-15) ml. Total resection was confirmed in all patients. In the group of minimally invasive kidney resections, these values were 182.5 (157.5; 265) min and 50 (42.5; 117.5) ml, respectively. Histological examination confirmed total resection in all patients. In both groups, none patient developed postoperative complications. Event-free survival was 86.72% with a median follow-up of 82 months, and local recurrence-free survival was 95.8% with a median follow-up of 89.8 months., Conclusion: Minimally invasive nephrectomies and resections are safe in children in case of careful patient selection.

Objective: To improve the immediate postoperative results in patients with perforated ulcers., Material and Methods: The study enrolled 25 patients with perforated peptic ulcer (diameter of perforation <8 mm). Mean age of patients was 39 years (range 24-56), perforation size - 5.92 mm (range 3-8)., Results: Mean surgery time was 59.8 min (range 50-85). There were no intraoperative and postoperative complications. All patients were discharged., Conclusion: The proposed method of repair for perforated gastric ulcers is simple, effective, safe and may be recommended for clinical practice.

Objective: To compare short-term results of intracorporeal (IA) and extracorporeal anastomosis (EA) in laparoscopic right-sided hemicolectomy., Material and Methods: A retrospective and prospective analysis included 105 patients who underwent laparoscopic right-sided hemicolectomy with intracorporeal and extracorporeal anastomosis between 2016 and February 2021., Results: We analyzed 105 patients including 64 women and 41 men. Mean age of patients was 62.8±1.5 years in the EA group and 64.7±3.9 years in the IA group. Mean BMI was 24.8±0.5 kg/m 2 in the EA group (range 19 - 34.5) and 24.3±1.0 kg/m 2 in the IA group (range 21 - 30.4). Intracorporeal anastomosis was performed in 33 patients, extracorporeal anastomosis - in 72 ones. Surgery time was 180.0±7.3 min in the EA group and 214.2±17.7 min in the IA group. There were 8 complications in the EA group ( p =0.046). No mortality was observed. Redo surgery rate was 4.16% in the EA group, while there were no redo procedures in the IA group. Postoperative hospital-stay was 12.2±0.5 days in the EA group and 8.8±1.0 days in the IA group., Conslusion: Intracorporeal anastomosis is a safe approach for laparoscopic right-sided hemicolectomy.

Background: Endoscopic submucosal dissection (ESD) is a perspective method of organ-sparing treatment of benign colon tumors., Material and Methods: The study included 1.000 patients with colon neoplasms who underwent ESD between October 2016 and October 2021. All surgeries were performed under intravenous sedation., Results: Mean dimension of tumors was 3.4 cm, median of surgery time - 51 (31; 101) minutes. Conversion of endoscopic approach occurred in 7.6% of cases. The main cause of conversion was unsatisfactory lifting in submucosal injection process. Incidence of en bloc and R0 resections was 84.1% and 68.3%, respectively. Postoperative morbidity was 2.9% that correlates with the world literature data., Conclusion: Endoscopic submucosal dissection is an effective and safe method for benign colon neoplasms. Considering high incidence of en bloc resection and low rate of local recurrence in benign neoplasms, further research of efficacy and safety of ESD in early colon cancer is needed.

Objective: Comparative assessment of immediate and long-term results of robot-assisted and conventional endoscopic technologies in the Russian Federation., Material and Methods: Searching for primary trials devoted to robot-assisted (RAE) and traditional video endoscopic (TVE) surgeries in the Russian Federation was carried out in the e-library and CENTRAL Cochrane databases. We used the recommendations of the Center for Expertise and Quality Control of Medical Care (2017, 2019) and the current version of the Cochrane Community Guidelines (2021). These guidelines define the features of meta-analysis of non-randomized comparative studies. Review Manager 5.4 software was used for statistical analysis., Results: We enrolled 26 Russian-language primary sources (3111 patients) including 1174 (38%) ones in the RAE group and 1937 (62%) patients in the TVE group. There were no randomized controlled trials in the Russian Federation, and all primary studies were non-randomized. We found no significant between-group differences in surgery time, incidence of intraoperative complications, intraoperative blood loss in thoracic surgery, urology and gynecology, conversion rate, postoperative hospital-stay, postoperative morbidity (in abdominal surgery, urology and gynecology), postoperative mortality. We observed slightly lower intraoperative blood loss for RAE in abdominal surgery and lower incidence of postoperative complications in robot-assisted thoracic surgery. These results can be compromised by methodological quality of comparative studies, significant heterogeneity and systematic errors., Conclusion: Currently, we cannot confirm the benefits of robot-assisted technologies, since this approach does not worsen or improve treatment outcomes. Further high-quality studies are needed.

Objective: To evaluate an effectiveness of minilaparotomy in the treatment of choledochal malformation (CM) in children., Material and Methods: The study included children with CM who underwent surgery from January 2010 to May 2020. All patients were divided into 3 groups depending on surgical approach: minilaparotomy (ML), laparoscopy (LS) and laparotomy (LT). We analyzed surgery time, early postoperative outcomes and cosmetic results., Results: There were 99 patients with CM for 10 years. ML was performed in 39 patients, LS - in 51 patients, and LT - in 9 patients. Significantly ( p -value <0.001, Kruskal-Wallis test with Dunn paired comparison test, p <0.05) less surgery time was observed in ML group. According to Clavien-Dindo classification of surgical complications, we found a significant prevalence of complications in the LS group ( p - 0.018, Kruskal-Wallis test). Moreover, LS was characterized by insignificant ( p >0.05) predominance of the most severe complications requiring multiple redo surgeries., Conclusion: Currently, open surgery is a "gold standard" in the treatment of children with CM. LS is not preferred in children with CM. ML ensures favorable early outcomes in children with CM.

Objective: To improve the results of surgical treatment of cervico-mediastinal tumors by using of partial upper cervicosternotomy., Material and Methods: A retrospective analysis included 24 patients who underwent resection of cervico-mediastinal tumors via partial upper cervicosternotomy for the period from January 2002 to December 2019. Immediate and intermediate postoperative outcomes were analyzed., Results: Mean surgery time was 282.7 min, intraoperative blood loss - 325.0 ml. Duration of pleural cavity (mediastinum) drainage was 3 days, hospital-stay - 14 days. Major postoperative complications developed in 3 (12.5%) patients. No 90-day mortality was observed. No local relapses were detected throughout the follow-up period (median 36.1 months)., Conclusion: Partial cervicosternotomy is a safe and effective approach ensuring adequate visualization and reliable control of great vessels of the upper mediastinum and neck. This access is valuable for en-bloc resection of cervico-mediastinal tumors located in anterior and posterior parts of the thoracic inlet.

Objective: To identify the criteria of smooth postoperative period after cholecystectomy and risk factors of local surgical infection., Material and Methods: A prospective analysis included 680 patients after laparoscopic cholecystectomy. We assessed incidence and risk factors of infectious complications. Major markers of acute inflammation, ultrasonic features of surgical site in early postoperative period were analyzed., Results: Postoperative infectious complications developed in 35 patients (5.1%). All studied risk factors except an age (obesity, cardiorespiratory diseases, surgery time over 150 min, violation of the principles of antibiotic therapy, intraoperative blood loss over 50 ml, drainage time over 5 days) significantly affected the development of infectious complications. Surgery time over 150 min and violation of the principles of antibiotic therapy were the most significant factors. Serum procalcitonin, erythrocyte sedimentation rate and C-reactive protein were characterized by the highest prognostic value on the 3 rd postoperative day. Threshold values were defined., Conclusion: Surgery time and violation of the rules of antibiotic prophylaxis were the most significant risk factors of postoperative infectious complications. We determined the criteria of smooth postoperative period: procalcitonin <1.5 mg/l, C-reactive protein <50 mg/l, erythrocyte sedimentation rate <39 mm/h, ultrasonic pattern of hypoechoic accumulation within the bed of the bladder (dimension <10 mm) without signs of intestinal insufficiency, abdominal or subhepatic effusion on the 3 rd day after surgery.

Objective: To analyze assistants` influence on duration of surgery and learning period in minimally invasive video-assisted hemithyroidectomy., Material and Methods: The same surgeon performed 67 minimally invasive video-assisted hemithyroidectomies. Duration of surgery was analyzed in assistants with various number of interventions. Learning curves were designed using logarithmic function., Results: Eight specialists with the same professional skill assisted to surgeon. Each of these specialists performed certain number of operations. Learning period made up 19, 26 and 44 procedures for mean numbers of assistances 21, 8 and 3, respectively. Duration of surgery in the group with 21 assistances was 63.96±2.94 min, for 3 assistances - 80.53±7.07 min in each of 6 assistants (z= -2.38; p <0.017)., Conclusion: Constant surgeon`s assistants is a factor reducing surgery time. Higher number of operations with the same assistant has a reliable inverse correlation with surgery time and duration of learning period.

Objective: To analyze surgical (including minimally invasive) treatment of advanced age patients with colon cancer and severe comorbidities., Material and Methods: Advanced age patients with colon cancer (≥60 years) were compared with younger ones. Concomitant diseases were detected in 94,4% of older patients and in 45,9% of patients in the control group (χ 2 =51,747; p <0,001)., Results: Surgery time, intraoperative blood loss, length of hospital-stay, postoperative morbidity and mortality were similar., Conclusion: Severe comorbidities did not significantly affect surgical outcomes in these patients and did not increase postoperative morbidity and mortality.

Aim: To compare short-term outcomes after transanal total mesorectumectomy (Ta-TME) and laparoscopic (Lap-TME) procedure in 'difficult' patients., Material and Methods: Prospective nonrandomized trial included patients with confirmed middle-/low rectum adenocarcinoma T1-4aN0-2M0 for the period November 2013 - September 2016. We identified 20 out of 55 in TA-TME and 14 out of 54 patients in Lap-TME group as those of 'difficult' subgroup: male, BMI ≥25 кг/м 2 , previous chemoradiotherapy (CRT)., Results: Time of surgery, blood loss, conversions rate, postoperative morbidity and length of hospital-stay were similar in both groups. Hardware anastomoses were more frequent in TA-TME compared with LAP-TME group (78.9% vs. 50%, p=0.086). Specimen quality was more favorable in TA-TME group: Grade I 10% in Ta-TME group vs. 28.6% in Lap-TME group; 'positive' CRM 5% vs. 14.3%, р=0.365. Within-group analysis did not reveal any differences between 'difficult' and 'typical' patients by surgical and pathomorphological characteristics in TA-TME group in contrast to Lap-TME group. Median of follow-up was 24.6 (IR 10.6-40.2) and 23.8 (IR 12.1-39.9) months for TA-TME and Lap-TME groups, respectively. Local recurrence occurred in 1 (1.8%) 'difficult' patient after Ta-TME. Distant metastases were observed in 1 (1.8%) patient of Ta-TME and 2 (3.7%) patients of Lap-TME group. Actuarial 3-years reccurence-free survival was 95.7% for Ta-TME and 93.9% for Lap-TME group, respectively (p=0.923)., Conclusion: TA-TME is advisable for 'difficult' patients. Further multicenter randomized trials are necessary to specify the effectiveness of TA-TME in these patients.

Aim: To estimate efficacy of laparoscopic-assisted procedures for chronic complications of diverticular disease (DD)., Material and Methods: It was made a prospective comparative study within 2007-2015. Inclusion criteria were verified chronic DD (>6 weeks after the first attack) and bowel resection followed by primary anastomosis., Exclusion Criteria: contraindications for pneumoperitoneum, BMI ≥35 kg/m 2 , infiltrate dimension >10 cm, preoperatively non-excluded neoplasm., Results: 233 patients with chronic DD underwent elective surgery, 136 (58.4%) of them were included in the study. There were 80 (58.8%) females aged 57.2±6.2 (24-83) years. Main group consisted of 75 patients after laparoscopic-assisted procedures, 61 were in control group (open ones). Both groups were homogeneous in age, gender, BMI, type of chronic complications, extent of inflammation, extent of bowel resection, surgery time (211.1 vs 206.3 min; p=0.16), incidence of preventive stoma (12.9 vs 19.7%; p=0.32) and complications rate (10.7 vs 14.7%; p=0.47). Maximal time of surgery was noted in case of chronic abdominal mass with statistically significance for main group (240.0±12.2 min vs 207.6±13.7 min; р=0.01). Conversion rate was 12.0% in main group. Main group showed significant higher rate of stapler anastomoses (66.7 vs 22.9%; р<0.0001), less intraoperative blood loss (100 ml vs 350 ml; р=0.001). Early postoperative period was significantly shorter in main group (9.5±0.4 days vs 12.9±1.2 days, р=0.02)., Conclusion: Laparoscopic-assisted procedures for diverticular disease are associated with more favorable early postoperative period with the same complication rate. Technical complexity and operative time depend on the extent of pelvic inflammatory changes.

Aim: To analyze learning curve by using of immediate results of pancreatoduodenectomy at multi-field oncology institute., Material and Methods: For the period 2010-2016 at Abdominal Oncology Department of Herzen Moscow Oncology Research Institute 120 pancreatoduodenal resections were consistently performed. All patients were divided into two groups: the first 60 procedures (group A) and subsequent 60 operations (group B). Herewith, first 60 operations were performed within the first 4.5 years of study period, the next 60 operations - within remaining 2.5 years., Results: Learning curves showed significantly variable intraoperative blood loss (1100 ml and 725 ml), surgery time (589 min and 513 min) and postoperative hospital-stay (15 days and 13 days) in group A followed by gradual improvement of these values in group B. Incidence of negative resection margin (R0) was also significantly improved in the last 60 operations (70 and 92%, respectively)., Conclusion: Despite pancreatoduodenectomy is one of the most difficult surgical interventions in abdominal surgery learning curve will differ from one surgeon to another.

A ruptured thoracoabdominal aortic aneurysm is an urgent situation requiring emergency surgery during which it is necessary to decrease the scope of the intervention in a patient at an extremely high surgical risk. A combination of surgical and endovascular techniques makes it possible to minimize surgical injury, blood loss, to shorten the duration of internal organs ischaemia, to reduce the risk of paraplegia. Presented herein are the results of emergency hybrid intervention for a ruptured thoracoabdominal aortic aneurysm, accompanied and followed by description of the technical aspects of performing the surgical and endovascular stages. The early postoperative period was complicated by thrombosis of the left superficial femoral artery on the background of atherosclerotic lesions, which was successfully eliminated by means of endovascular intervention with endovascular prosthetic repair. After 10 months, the patient underwent a cardiosurgical intervention. Combining surgical and endovascular techniques made it possible in an emergency situation to save the patient's life and to provide its good quality in the remote period of follow up (4 years after the hybrid operation).

Aim: To analyze the possibility of thoracoscopic pulmonary resection for metastatic lesion without pleural drainage., Material and Methods: There were 10 patients aged 53.8 years. Most of patients had solitary lung injury within 3 cm from the visceral pleura on the average. Surgical treatment was performed in standard fashion: hardware atypical pulmonary resection within healthy tissues. Pleural cavity was drained with 24 Fr tube. After that lung was inflated under visual control. Since wounds were closured residual air was evacuated by active aspiration and drainage tube was removed. Control chest X-ray was performed in 2 hours and 1 day after surgery., Results: The technique was successful in all patients. Mean surgery time was 52 minutes. There was no blood loss in all patients. Pneumo- and/or hydrothorax were absent according to control chest X-ray in postoperative period. Mean length of postoperative hospital-stay was 3 days (median 2 days). There were no cases of repeated hospitalization.

Aim: To assess an experience of robot-assisted liver resection using CUSUM-test., Material and Methods: The results of 46 robot-assisted liver resections were retrospectively analyzed by using of CUSUM-test., Results: There were 3 periods in development of the technology. The 1 st period - procedures with the lowest index of difficulty (n=16), the 2 nd period - expansion of the indications for difficult resections (n=18) and the 3 rd period - stabilization of the results (n=12). The dynamics of difficulty index, intraoperative blood loss, duration of procedure and morbidity (Clavien-Dindo Grade II-V) were evaluated. Five liver resections were needed to decrease blood loss and duration of the procedure. Expansion of indications was feasible after 16 procedures. Stable results were obtained after 34 liver resections.

Aim: To analyze the results of radical surgery for upper GI cancer in patients ≥80 years old., Material and Methods: For the period November 2010 - June 2015 there were 14 radical operations in elderly (≥80 years) patients with gastric, liver and pancreatic tumors. There were 4 Whipple procedures, 4 total and 2 distal gastrectomies, 1 total pancreatectomy as well as a central liver resection, one laparoscopic 5 segment resection and one 2, 3, 7 segment resection. We analyzed blood loss, duration of surgery, 90-day mortality, morbidity (Dindo-Clavien scoring), length of hospital-stay., Results: Blood loss ranged from 0 to 1500 ml, mean duration of surgery - from 150 to 560 min. There was one case of in-hospital mortality: one patient after a Whipple procedure died in 17 days after surgery due to massive arrosive bleeding. Complications developed in 8 patients, 3 of them required reoperation. Mean hospital-stay was 15±6 (8-29) days., Conclusion: Advanced upper GI surgery for cancer is feasible in octagenarians and does not lead to inappropriate mortality and morbidity. Comprehensive preoperative examination alongside with enhanced recovery protocol are prerequisites for this type of surgery.

Aim: To improve surgical treatment of patients with cholelithiasis and obesity by using of different technologies of laparoscopic cholecystectomy., Material and Methods: There were 88 (16.4%) patients with overweight and obesity among 538 patients who underwent laparoscopic cholecystectomy. Conventional laparoscopic cholecystectomy was performed in 33 (6.1%) cases, cholecystectomy through single laparoscopic access - in 12 (2.3%), cholecystectomy via single laparoscopic access with trocar support - in 43 (8.0%) patients with body mass index 25-52.3 kg/m2. The article describes the technical features of laparoscopic cholecystectomy., Results: Complications were absent in 83 (94.3%) of 88 cases after laparoscopic cholecystectomy. The lowest pain severity in early postoperative period was noted in case of single laparoscopic access (p<0.05)., Conclusion: Conventional and single-port laparoscopic cholecystectomy is advisable in patients with calculous cholecystitis, overweight and obesity.

Aim: To assess safety of rectum removal with distal sacral resection., Material and Methods: The short-term results of surgical treatment of primary and recurrent locally advanced rectal and anal cancer with sacral fixation have been analyzed. 32 patients underwent combined operations with sacral resection at the level of S2-S5. In 12 patients only one point of tumor fixation (F1) was revealed, 10 patients had two points of fixation (F2), three patients had three fixation points (F3) and in 7 cases the tumor was fixed to four points (F4) of fixation to different pelvic structures., Results and Discussion: Mean intraoperative blood loss and surgery time was 551±81 ml and 320±20 min in cases of sacral fixation only that was significantly lower compared with F2 cases - 1278±551 ml and 433±45 min, F3 cases - 2200±600 ml and 620±88 min, F4 cases - 2157±512.5 ml and 519±52,3 min, respectively (р<0.05). Complications requiring surgical intervention occurred in 9% patients (n=3). Among 23 patients with intact bladder and ureters urinary disorders occurred in 42% (n=10). Resection margin was negative along posterior surface of the specimen in all cases., Conclusion: Advanced surgery with distal sacral resection is advisable for radical removal of locally advanced and recurrent rectal and anal canal cancer fixed to the sacrum with negative resection margin. These operations are feasible in specialized centers and should be performed by specially trained oncological or colorectal surgeon.

The Hypothesis of the Study: The use of bidirectional knotless barbed sutures for closure of capsule and subcutaneous fat tissue in primary total knee arthroplasty (TKA) is safe and time-saving., Material and Methods: 302 patients with end-stage osteoarthritis scheduled for primary non-complex TKA were randomly divided into two prospective groups: in group I (N=102) the capsule of the knee joint and subcutaneous fat tissues were closed by continuous braided suture while in group II (N=200) by bidirectional knotless barbed sutures. The skin in both groups was closed by non-absorbable monofilament polycaproamide uninterrupted suture., Results: The time of the surgery was significantly shorter in group II (65,25±11,9 min) than in group I (72,5±14,7 min) (p<0.05). The volume of hidden blood loss was similar in both groups. The number of patients with superficial infection during the first two week after surgery did not differ significantly (1,9% (I) and 1% (II)): they all healed successfully after skin debridement and additional closure. There were no cases of deep periprosthetic infection (PPI). At 3-month follow-up no difference found regarding pain level and knee function (Knee Society Score)., Conclusion: The use of bidirectional knotless barbed sutures in TKA reduces the time of surgery, does not affect the volume of hidden blood loss or PPI occurrence.

Aim: To study feasibility, effectiveness and safety of minimally invasive video-assisted parathyroidectomy in patients with primary hyperparathyroidism; to define the advantages and disadvantages of this technique compared with conventional open surgery., Material and Methods: The study includes the results of 33 minimally invasive video-assisted parathyroidectomies performed in patients with primary hyperparathyroidism. The control group included 36 patients who underwent conventional open surgery., Results: There were significantly increased time of surgery in the main group (41.2±12.7 min vs. 28.4±10.9 min, p<0.05), decreased need for postoperative analgesia (1,2±0.3 vs. 1.9±0.5 days, p<0.05) and significantly longer postoperative scar (1.8±0.2 vs. 6.2±0.5 cm, p<0.01). Incidence of complications was similar in both groups (6.1% vs. 8.3%, p>0.05)., Conclusion: Minimally invasive video-assisted parathyroidectomy for primary hyperparathyroidism is feasible, safe and effective intervention that improves early postoperative course and cosmetic outcomes.

Aim: To analyze the reduction of pain severity, time of surgery, intraoperative blood loss, incidence of unintentional lesion of dura mater, infectious complications and hospital-stay after lumbar microdiscectomy., Material and Methods: The study included 104 patients aged 24-58 years (37 men and 67 women, mean age 45 years) who underwent lumbar microdiscectomy within January 2015 - June 2016. The main and control groups consisted of 48 and 56 patients with and without obesity respectively. In all cases lumbar microdiscectomy was made. Pain syndrome was assessed by visual analogue scale and Oswestry questionnaire., Results: In 6 weeks, 6 and 12 months after surgery significant improvement of both lumbar and leg pain was observed. Significantly reduced pain was stable and similar in both groups within follow-up although there was a tendency to increased pain in long-term period in group 1. Blood loss and infections were slightly higher in obese group while surgery time and hospital-stay were significantly higher in these patients., Conclusion: Features of patients with excessive body weight should be considered prior to elective surgery. Probably, implants are advisable to stabilize spinal motion segment and improve the outcomes among patients with excessive body weight.

Aim: To assess efficacy and safety of laparoscopic cholecystectomy in patients with liver cirrhosis., Material and Methods: 46 patients with liver cirrhosis Child-Pugh class A and B underwent laparoscopic cholecystectomy for the period from August 2001 to December 2015. Indications for surgery were acute calculous cholecystitis in 21 (45.6%) patients and chronic calculous cholecystitis in 25 (54.4%) patients., Results: Mean surgery time was 75 minutes. Conversion to open surgery was required in 2 patients. Postoperative complications including bleeding, liver dysfunction, ascites, wound complications were observed in 11 (23.9%) patients. There were no deaths. Mean hospital-stay time was 2.5 days., Conclusion: Laparoscopic cholecystectomy may be successfully performed in carefully selected patients with compensated cirrhosis. The advantages of minimally invasive technique are less blood loss, surgery time and hospital-stay.

Aim: To assess laparoscopic surgery in treatment of colon cancer patients., Material and Methods: The results of laparoscopic treatment of patients with colorectal cancer are presented in the article. It was estimated the influence of various clinical parameters including age, gender, comorbidities, tumor localization and stage and complications on laparoscopic management of these patients., Conclusion: It was revealed that efficiency of laparoscopic surgery in patients with colon cancer is affected by tumor stage and presence of complications.

Aim: To improve the results of treatment of patients with retroperitoneal tumors., Material and Methods: The study included 83 patients with retroperitoneal tumors including 57 cases of benign tumors and 26 patients with malignancies. Laparotomy (Lt), robot-assisted (RA) and laparoscopic (Ls) techniques were used in 35, 34 and 14 patients respectively. Median tumor sizes in the largest dimension were 102 mm, 75 mm and 81.5 mm in Lt, RA and Ls groups respectively., Results: Average time of surgery was 112.5 minutes in Lt-group, 140 min in RA group and 125 minutes in Ls group. Median blood loss was 125 ml, 50 ml and 50 ml in the same groups respectively. Conversion was performed in 1 patient during RA-surgery and in 7 patients during laparoscopy. Postoperative complications occurred in 6 patients after laparotomy and in 5 patients after RA-intervention. There were no deaths., Conclusion: Comprehensive evaluation of different surgical methods is necessary to achieve successful treatment of retroperitoneal tumors. Conventional approach is indicated for tumors over 10 cm while minimally invasive techniques are justified for tumors less than 10 cm. RA-interventions facilitates surgery for tumors located in difficult areas and small anatomical spaces as well as for neoplasms adjacent to great vessels.

Possibilities of laparoscopic technologies application while surgical excision of gas- trointestinal stromal tumors (GIST) were analyzed. In 2000 - 2015 yrs in the clinic 28 patients were operated on for gastric GIST. In 10 of them laparoscopic gastric resec- tion with tumor (in 3 - the tumor excision in borders of nonaffected tissues, in 4 - gas- tric fundus resection or stapler resection of a great curvature together with tumor, in 3 - transgastric excision of the tumor, using staplers) surgery was done. The disease recurrence in 2-5 yrs follow-up was absent. Laparoscopic operations has advantage over open interventions while preserving oncological radicalism.

Objective: To determine the antihypoxic efficacy of mexidol in carotid endarterectomy (CE) procedure in patients with cerebral atherosclerotic stenosis using cerebral oximetry., Material and Methods: Clinical/psycho/neurological monitoring was performed in 109 patients with internal carotid artery stenosis of 69±7.0% and neurological symptoms of cerebral ischemia, 2-3 degree, in pre- and postoperative periods. Cerebral oximetry was carried out perioperatively. Fifty-four patients were treated with mexidol in a dose of 1000 mg/day for 14-15 days and 55 patients did not received mexidol., Results and Conclusion: The difference in initial brain oxygenation (rSO2) between the main and comparison groups was shown (60.8±5.0 and 47.29±5.5%, respectively). During operation, the degree of blood oxygenation in these groups decreased by 57% and 41%, respectively. On day 7, sinificant differences in the Schulte test in two groups of patients with similar neurological status were found considering efficiency of work and mental stability before and after operation. No differences were found in the comparison group. Mexidol used for antihypoxic brain protection in carotid endarterectomy of patients with cerebral atherosclerotic stenosis significantly reduces the degree of cerebral hypoxia, decreases the duration of surgery, improves neurological status of patients and performance of psychological tests in postoperative period.

The article presents the results of 257 robot-assisted radical prostatectomies, 135 partial nephrectomies and 32 radical nephrectomies at the period from 2010 to 2016. The operations were performed on robotic complex da Vinci S. The mean operative time was 170±50 min, 158,4±72,2 min and 143,3±67,3 min, the mean blood loss was 130±35 ml, 213,0±102,2 ml and 141,4±49,0 ml for robotic radical prostatectomy, partial and radical nephrectomy, respectively. The mean time of warm ischemia consisted of 13,1±2,7 min. Five-year cancer-specific survival rate was 100%, 100% and 98%. The overall survival rate was 97,5%, 87% and 92% for robotic radical prostatectomy, partial and radical nephrectomy, respectively.

Aim: To evaluate prospectively the hemodynamic performance of «BioLAB Mono» stentless bioprosthesis implanted into aortic position., Material and Methods: Twenty seven patients (mean age 71 (67; 73); 17 women) with severe aortic stenosis underwent aortic valve replacement with «BioLAB Mono» stentless bioprosthesis from 2012 to 2014. The valves were implanted into supra-annular position using continuous polypropylene suture., Results: In the early postoperative period 1 patient (3.7%) died for acute heart failure. The mean aortic cross-clamping time was 81 (75; 90) min. Echocardiographic peak pressure gradient were 18 (16; 23) mmHg (postoperative). There were no cases of valve dysfunction in early postoperative period. Level of thrombocytes recovered after 10 days postoperatively., Conclusion: «BioLAB Mono» aortic bioprosthesis implantation is easy and reproducible. The valve has excellent hemodynamic performance in early postoperative period.

Aim: Transanal endoscopic microsurgery (TEM) is a main treatment technique for rectal adenomas, but can also be used for selected malignant tumors. This study presents TEM experience., Methods: The study enrolled patients with rectal adenomas, and selected adenocarcinomas. Preoperative work-up included: digital rectal examination, rectoscopy with biopsy, colonoscopy, EUS, pelvic MRI., Results: Three hundred and thirty patients [mean age of 61,4±10 (33–88)] underwent TEM. The mean size ± SD of tumors was 3.2±1.2 cm (0.6–10.0). Mean distance from anal verge was 6.7±2.6 cm (2.0–14.0). Preoperative biopsy revealed: adenoma ― 263/330 (79,7%), adenocarcinoma ― 67/330 (20,3%). The median operating time was 40 (15–220) min. Tumor-free margins were obtained in all operative specimens. In 5/330 (1.5%) cases tumors were fragmented. The morbidity rate was 19/330 (5.7%). Pathological investigation revealed: adenoma in 192/330 (58.1%) cases, adenocarcinoma stage Tis, T1, T2 and T3 in 138/330 (41.9%). Median follow-up lasted for 24 (1–57) months. Five patients (2.0%) with adenoma and four patients (5.2%) with adenocarcinoma had local recurrence., Conclusion: Transanal endoscopic microsurgery for rectal adenomas and selected malignant tumors is associated with low morbidity and low recurrents rates.

Aim: To analyze the outcomes of single-port laparoscopic cholecystectomy., Material and Methods: Early and long-term postoperative period has been analyzed in 240 patients who underwent laparoscopic cholecystectomy (LCE) including 120 cases of single-port technique and 120 cases of four-port technique. Both groups were compared in surgical time, pain syndrome severity (visual analog scale), need for analgesics, postoperative complications, hospital-stay, daily activity recovery and return to physical work, patients' satisfaction of surgical results and their aesthetic effect., Results: It was revealed that single-port LCE is associated with lower severity of postoperative pain, quick recovery of daily activity and return to physical work, high satisfaction of surgical results and their aesthetic effect compared with four-port LCE. Disadvantages of single-port LCE include longer duration of surgery, high incidence of postoperative umbilical hernia. However hernia was predominantly observed during the period of surgical technique development., Conclusion: Further studies to standardize, evaluate the safety and benefits of single-port LCE are necessary.

Aim: To evaluate and compare intraoperative features, early surgical outcomes, quality of excised specimen after laparoscopic and transanal total mesorectal excision (LA-TME and TA-TME)., Material and Methods: Prospective randomized study included 45 patients with confirmed rectal adenocarcinoma (cT2-4N0-2M0) since October 2013. LA-TME and TA-TME groups consisted of 23 and 22 patients respectively. Inclusion criteria were patients with primary-operable rectal cancer and satisfactory response after neoadjuvant chemo- and radiotherapy. Both groups were comparable in stages of cancer, age and body mass index (BMI). Median length from anal edge was 6.5 cm and 7 cm in TA-TME and LA-TME groups respectively. There was significantly greater number of patients after chemo- and radiotherapy in TA-TME group (86% vs. 48%, p=0.006)., Results: Surgery time was 305 and 320 minutes in LA-TME and TA-TME groups recpectively, median blood loss -- less than 100 ml. Mean hospital-stay was 8.0 days in both groups. Each group had 1 conversion including laparoscopic procedure in TA-TME group. Transanal extraction of specimen was performed in 86% vs. 48% in TA-TME and LA-TME groups respectively (p=0.021). Complications (Clavien-Dindo sclale) were observed in 27% and 26% in TA-TME and LA-TME groups respectively without statistically significance. Complications IIIb, IVb and V degrees were not diagnosed in TA-TME group. Also in this group «good», «satisfactory» and «unsatisfactory» quality of TME was obtained in 68%, 14% and 18% of cases. At the same time in LA-TME group these values were 74%, 9% and 17% respectively (p=0.859). One of operated patients had «positive» lateral edge (TA-TME). Median distal edge of resection was 21 mm and 23 mm in TA-TME and LA-TME groups respectively., Conclusion: Preliminary data show comparable early outcomes after transanal and laparoscopic techniques. Laparotomy and associated compications are avoided in case of transanal extraction of specimen. Further researches are necessary to study functional and long-term results.

Aim: To demonstrate training curves for endosurgical interventions in neonates and infants., Material and Methods: It was analyzed duration of thoracoscopic reconstruction of esophageal atresia (31 patients) and laparoscopic Nissen fundoplication (61 patients) performed for the period from January 2005 to December 2012. Graphs and tables reflecting correlation between duration and number of operations were framed., Results: Figures demonstrate reducing duration of surgery with increase of endosurgical interventions number., Conclusion: Our data revealed that time necessary for minimally invasive procedures in infants and neonates decreases in process of experience accumulation.

The objective of the present study was to elucidate etiology and clinical picture of the tumours of the external ear as well as to evaluate the effectiveness of their radiowave surgery. We sought to optimize the surgical strategy for the treatment of tumour-like masses, benign and malignant neoplasms of the external ear with the use of the Surgitron radiowave scalpel.

Abdominal aortic aneurysms are encountered predominantly in elderly patients suffering from severe concomitant diseases. Therefore, the rate of various complications associated with resection of aortic aneurysm amounts to 30%, with lethality in separate cohorts of patients reaching 43.7%. According the authors' opinion, in the development of intra- and postoperative complications of special importance is the duration of aortic clamping accompanied by severe haemodynamic alterations in coronary, cerebral and renal vessels. These changes are key moments in the development of fatal outcomes. In order to reduce the duration of aortic clamp the authors suggested a non-standard surgical technique of prosthetic repair of the abdominal aorta. Presented herein is a clinical case report illustrating this technique. The patient operated on according to this technique was discharged in a satisfactory condition with no serious postoperative complications. The proposed non-standard surgical technique makes it possible to reduce the duration of aortic cross-clamping in resection of an aneurysm by 10-12 minutes.

Objectives: According to different authors, the percentage of genital prolapse among gynaecological diseases that require surgical correction reaches 28−38,9%. Pelvic muscle wasting is a special kind of pelvic prolapse, often leading to cervical elongation and hypertrophy. Contemporary methods of treatment for this condition have the high rate of relapse― 8,9−22%, thus urging to improve the existing techniques., Purpose: This research was to estimate the effectiveness of novel modification of Manchester operation in comparison with classic Manchester operation in the management of pelvic prolapse with cervical elongation., Methods: We enrolled 83 patients with pelvic prolapse and cervical elongation and divided them into two groups. In GroupI (n=47) we used the novel surgical method, supplementing original Manchester procedure with cervical stump fixation and other improvements. In GroupII we used original Manchester procedure. We compared laboratory measures as well as surgery duration, blood loss, incidence of complications, and duration of post-operational hospital stay. Patients were followed-up for 2years to estimate long-term effectiveness of surgical intervention. Statistical analysis was performed in SPSS 17.0., Results: Surgery duration in GroupII was significantly longer (47,8±26,2 vs 57,5±35,1 minutes, p<0.05). There were no significant differences in lab tests, post-operational hospital stay (5,2±0,9 vs 7,3±1,2) and incidence of post-operational complications (3 vs 4 cases). Over the 2 years of follow-up we registered 1 case of relapse in Group I and 3 cases of relapse in Group II, thus estimating the effectiveness of surgery as 97,9 vs 91,7%, a non-significant difference. We noticed that all relapsed women had signs of systemic dysplasia of connective tissue., Conclusion: Suggested modification of Manchester operation improves duration of surgical intervention itself, while providing a comparable level of effectiveness.

Aim: To improve the results of surgical treatment of lumbar spine stenosis., Material and Methods: Surgical treatment of 84 patients was analyzed. There were 2 groups consisting of 48 and 36 patients respectively. Advanced decompression and fusion were performed in group 1, minimally invasive decompression (flavectomy, marginal arch resection, facetectomy) with implantstion of interspinous dynamic implants DIAM -- in group 2. Patients with isthmic spondylolisthesis were excluded., Results and Discussion: Both methods did not show difference in efficacy of leg pain relief during follow-up (1.7--8.5 years). 16.7% of patients after fusion of more than 2 segments had pain above and below fusion area in long-term postoperative period. Such pain was not observed in group 2. One patient of the 1st group had fixation system destruction that required repeated intervention. Groups have not difference in back pain severity after surgery on 1 segment. Also less intraoperative blood loss and duration of surgery were established in group 2., Conclusion: Minimally invasive decompression with implantstion of interspinous dynamic implants is effective and safe alternative to advanced decompression and fusion in lumbar spine stenosis management.

Today in the clinic all surgical interventions on endocrinal organs are conducted, using welding technology. Comparative analysis of the operative interventions efficacy, performed applying a standard method (control group) and using welding technology (the main group), was conducted. Performance of operations, using electric welding technologies have permitted to reduce the operative intervention duration by 20 - 30%, the blood loss volume--by 30 - 50%, a postoperative pain syndrome severity and the analgetics expense--by 20%, a postoperative stationary treatment duration--by 1-2 days.

Aim: To develop the optimal protocol for balloon dacryoplasty (DCP) through an experiment., Material and Methods: The experiment enrolled 12 Chinchilla rabbits (24 eyes). DCP protocol for group 1 (5 rabbits, 10 eyes) implied two dilations of 90 and 60 sec followed by another two of the same duration, while in group 2 (5 rabbits, 10 eyes) all four dilations were of 90 sec. The balloon was moved proximally before the every third dilation. The remaining 2 rabbits (4 eyes) who did not receive balloon DCP constituted the control group. The animals were killed on days 1, 3, 7, and 14. In all cases nasolacrimal duct morphology was studied., Results: By day 14 after the procedure, inflammatory changes in nasolacrimal ducts either had resolved (protocol 1) or persisted (protocol 2).

Transanal endoscopic microsurgery (TEM/TEO) is a standard treatment for rectal adenomas but can also be used for selected malignant tumors. Rectal adenomas, selected adenocarcinomas and carcinoids were chosen for operations. Preoperative work-up included: digital rectal examination, rectoscopy with biopsy, colonoscopy, EUS, pelvic CT (MRI). Two hundred and two patients [mean age of 62.4 ± 10.3 (33-86)] had TEO. The mean size ± SD of tumors was 3.2 ± 1.4 cm (0.6-8.0). Mean distance from anal verge and dental line was 7.1 ± 2.4 cm (2.5-14.0) and 4.6 ± 2.6 cm (0.5-12.0), respectively. Preoperative biopsy revealed: adenoma--156/202 (77.2%), adenocarcinoma--39/202 (19.3%) and carcinoid--7/202 (3.5%). The median operating time was 40 (20-180) min. Tumor-free margins were obtained in 200/202 (99%) operative specimens, 2/202 (1.0%) cases tumors were fragmented. Morbidity was 7/202 (3.5%). Pathological investigation revealed: adenoma in 109/202 (54.0%) cases, adenocarcinoma stage Tis, T1, T2 and T3 in 86/202 (42.5%), carcinoid in 5/202 (2.5%), neurilemoma in 1/202 (0.5%), neurofibroma in 1/202 (0.5%). One hundred and two patients had follow-up (95%). Median follow-up at 20 (1-41) months; 3/192 patients with adenocarcinoma, 1/192 patient with adenoma and 1/192 patient with carcinoid had local recurrence. Thus, transanal endoscopic microsurgery for rectal adenomas and selected malignant tumors is associated with low morbidity and low recurrents rates.

Unlabelled: The necessity of preventing venous thromboembolic complications in patients after endured surgical interventions for varicose disease remains a debatable problem. The study was aimed at assessing the incidence of deep vein thrombosis after phlebectomy and determining its clinical significance., Material and Methods: The authors carried out a prospective cohort study comprising a total of 86 patients (73 women and 13 men, aged from 16 to 64 years, the mean age 39.1±11.8 years) presenting with class C2-C4 varicose disease. All patients under conduction and tumescent anaesthesia were subjected to crossectomy, stripping, and miniphlebectomy. The operations lasted from 60 minutes to 3 hours 30 min (average duration--123±23 min). According to the Caprini score, in 58 patients the risk of thromboembolic complications was assessed as moderate (3-4 points), and in 28 patients as high (5 points and greater). In the postoperative period elastic compression was used in all patients, the activation began 1-2 hours after the operation. Anticoagulants in preventive doses were indicated in 6 patients due to the presence of additional risk factors., Results: Ultrasonographic examination in the postoperative period revealed 3 (3.5%) cases of crural muscle vein thrombosis. Anticoagulation therapy was not indicated in these patients. Detecting thrombosis was followed by dynamic follow up. Ultrasonographic study revealed complete recanalization of thrombosed veins by the end of the second month of follow up. The incidence rate of thrombosis in the group with the moderate baseline risk of thrombosis amounted to 1.7% and in the group with high risk of thrombosis to 9.1% (p>0.1)., Conclusion: Crossectomy, stripping of subcutaneous veins, and miniphlebectomy carried out under conduction and local anaesthesia are not significant risk factors for the development of thromboembolic complications.

Robot-assisted resection of duodenal inferior horizontal part and duodeno-jejunal transition was performed in 5 patients with tumors in this area including gastrointestinal stromal tumor in 4 cases and jejunal adenocarcinoma in 1 case. It is suggested there section method with vertical and inferior horizontal parts and pancreatic head dissection right-to-left. There were no intra- and postoperative complications. Robot-assisted resection of duodenal inferior horizontal part and duodeno-jejunal transition may be successfully used for tumors with diameter less than 5-6 cm.

For the period from 2003 to 2014 at the Oncogynecology Department laparoscopic surgery for ovarian cancer was performed in 49 patients aged 19 to 76 years. During the surgical interventions special attention was paid to the principles of oncological radicalism and ablastics, the volume of surgery depended on the extent of tumor process, morphological characteristics of tumor, a patient's age and the desire to preserve reproductive function. In 42 (85.7%) cases laparoscopic procedures were conducted to restaging (after non-radical operations in gynecological hospitals). In all 49 patients a histological form of ovarian tumor corresponded to adenocarcinoma. Mean operative time was 140 ± 10,5 minutes, the average blood loss--80,2 ± 14,3 ml. Postoperative complications (bleeding from the omentum) were recorded in 1 (2%) patient, the need for conversion was occurred in 4 (8.2%) cases due to the adhesive process or signs of dissemination. As a result of laparoscopic surgery an increase in staging of disease was fixed in 14 cases (28.6%). Follow-up median was 45 months, relapses occurred in 5 (10.2%) patients. Of 49 patients 2 (4.1%) died from disease progression. Disease-free and overall survival rates were 89.8% and 95.9%, respectively. Thus, data of world literature and our own experience indicate the potential equivalent of laparoscopic and laparotomy approaches in treatment for early ovarian cancer.

This article analyzed the immediate treatment results of 210 patients, underwent endovideosurgical operative treatment concerning colorectal cancer (106 laparoscopic and 104 robotic-assisted operations). According to the first results, there was no significant difference between two methods in such medical indices as the volume of intraoperative hemorrhage, terms of hospital stay and peristalsis recovery, the rate of conversion and complications in. early postoperative period, quantity of removed lymph nodes, quality of TME. The application of robotics allowed performance of precision work in conditions of limited space of the small pelvis.

Material and Methods: Robot-assisted operations for non-organ retroperitoneal tumors were performed in 20 patients. The biggest tumor's diameter was 160 mm, the smallest--32 mm, mean value was 79.1±37.8 mm. According to morphological investigation data lymphangioma was diagnosed in 4 (20%) patients, lipoma--in 3 (15%) cases, peritoneal cyst--in 2 (10%) patients. Solitary lymphatic node, teratoma, leiomyosarcoma, accessory stomach, bronchogenic cyst, adenogenous cancer, ureterocele, megaureter, schwannoma, leiomyoma, malignant paraganglioma were observed in 1 (5%) case respectively., Results: Surgery duration was 138±55.9 min. Blood loss was 69±112.7 ml (range 0-500 ml). Intraoperative complications (bleeding) were diagnosed in 3 (15%) patients. There were no conversions. Robot-assisted variant has been demonstrated in case of non-organ retroperitoneal tumors with diameter not more than 100-120 mm.