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Relevance. Modern surgery is characterized by the use of various technical means to perform classical surgical techniques - separation and connection of tissues, hemostasis. The study of the applicability of new surgical devices and the search for technological techniques are an important task.The aim of the study: to evaluate the capabilities of the developed device based on microwave energy for hemostatic coagula­tion of resection surfaces of parenchymal organs.Materials and methods. The method is based on the principle of converting microwave energy into heat when it is absorbed in biological tissue. The choice of the microwave range is due to the higher efficiency of power supply to the heat­ing area. Based on the prototype of a medical microwave complex developed in 2011 for thermal effects on biological tissues (RF Patent 2481080. 2011), a prototype of a microwave coagulator for working with parenchymal organs was created. The device was tested on the paren­chymal organs of large laboratory animals under conditions of preserved and switched off blood flow in various energy supply modes. Tissue samples from coagulated lesions were studied histologically.Results. At the site of exposure of the applicator-coagulator to the parenchymal organ, a zone of coagulation changes appears. A clear dependence of the size of coagulation necrosis on the time and power of exposure was noted. When the blood flow is turned off, the necessary stable hemostasis is achieved by shorter exposure time of the coagulator antenna on the surface of the organ.Conclusions. The most effective and reliable hemostasis is achieved on the liver parenchyma. The use of temporary vascular isolation, especially on the kidneys and spleen, involves a single use of microwave energy to stop bleeding. By changing the power and duration of exposure, it is possible to dose the thermal load on biological tissue with great precision. This adjustment allows you to select the operating mode for each specific case. The obtained results of the experiment of the described system during surgery for the purpose of hemostasis in parenchymal bleeding.

Background: Aggressive course of liver alveococcosis makes it possible to designate it as a “parasitic liver cancer”. The main treatment method for the disease is surgery. The parasitic mass is resected according to R0 principles, with concomitant plastic surgery of the major vessels and bile ducts to increase resectability.Aim: To assess the potential of surgical treatment in patients with advanced liver alveococcosis using transplantation techniques.Materials and methods: We retrospectively analyzed in- and outpatient medical files of 62 subjects with confirmed liver alveococcosis, who had been treated in the Volga District Medical Centre (Nizhny Novgorod, Russia) from 2008 to 2018. Thirty two (32) patients had advanced liver alveococcosis with involvement of afferent and efferent vasculature and biliary tract. Surgical procedures were used in 50/62 patients (or 4.2% of the total number of liver resections performed during this time interval, n = 1197). Complications occurred in 46% (23 / 50) of the cases. Twenty nine (29, or 58%) patients had been operated before (mostly cytoreductive resections and/or explorative laparotomies). Distant lung metastases were found in 2 (4%) patients.Results: Fifty (50) patients had curative surgical procedures: liver resections in 45, deceased donor orthotopic liver transplantations in 5. Most common were extensive liver resections (more than 4 segments). Resection and reconstruction of the main vessels were necessary in 50% (25 cases) of the patients, including v. cava inferior in 25 cases and the portal vein in 24 cases. In 31 patients, resection and reconstruction of extra-hepatic bile ducts was performed, and in 17 (33%) patients resections of the neighboring organs, such as diaphragm, lung, right adrenal, duodenum, stomach, and colon. In 4 cases, resections were performed ex situ ex vivo, followed by auto-transplantation, including 2 cases with reverse auto-transplantation of the left lateral sector to the right. The incidence of liver failure events grade A and B (by International Study Group of Liver Surgery, ISGLS) did not exceed 10% (4 patients). Complications were seen in 25 cases, including Clavien – Dindo Grade II in 5, Grade IIIb in 13, Grade IVb in 2, and Grade V in 5. The number of bile leakage events (ISGLS) class B was 6 and class C 10. All patients underwent obligatory adjuvant anti-parasitic therapy.Conclusion: At present, surgical treatment of liver alveococcosis remains a method of choice, that requires that the hepato-pancreato-biliary center would have in place a well-developed transplantation program, adequate equipment and well-trained surgical and anesthetic teams.

Splenic artery steal syndrome is one of possible arterial complications after orthotopic liver transplantation. Material includes personal experience in diagnostics and treatment of this syndrome. In each case complication was opportunely suspected basing on laboratory and ultrasound data and proved by angiography. Successful treatment was performed using different variants of splenic artery embolization.