Invasive Surgical Technology Research Articles

Laparoscopic Access in Radical Surgical Treatment of Complicated Gastric Cancer: a Single-Center Experience

Over the past decades, there has been an active introduction of minimally invasive surgical technologies in the treatment of various diseases, including gastric cancer. In Asian countries and Europe, laparoscopic gastrectomy is an alternative to open gastrectomy for early gastric cancer, with a tendency to displace the latter. In the Russian Federation, laparoscopic gastrectomy is performed in a few specialized centers. From 2013 to 2022, the surgeons of our Center treated 141 patients diagnosed with gastric cancer at different stages (64 men, 39 women, mean age of 60.5±10 years). Of these, 52 patients (50.5%) underwent open surgeries (group I), 51 (49.5%) — laparoscopic surgeries (group II). The study included patients diagnosed with gastric cancer complicated by bleeding or gastric outlet/cardioesophageal junction obstruction, over 18 years of age, who signed consent for the processing of personal data and inclusion of their clinical data in the research and underwent surgical treatment. We analyzed such parameters as the duration of surgical intervention and the duration of hospital stay, the rates of hospital/relapse-free 2-year survival, and uncomplicated postoperative period. Laparoscopic-assisted surgeries lasted longer; however, due to more precise technique and better visualization of anatomical structures, there was a smaller volume of intraoperative blood loss. During laparoscopic-assisted radical gastrectomy, it is possible to perform more precise lymph node dissection, increase the number of harvested lymph nodes and, thus, increase the probability of detecting lymph nodes with metastases; which, in turn, has a direct impact on increasing the 2-year relapse-free and 2-year overall survival of patients. There was no significant difference in the incidence or severity of postoperative complications and mortality. These data are an important indicator of the effectiveness of the minimally invasive surgical method of treatment, which indicates greater safety of the laparoscopic method compared to intervention from laparotomy access.

Management and complications of tubo-ovarian abscesses: a brief literature review

Tubo-ovarian abscesses (TOAs) are identified as a severe and complex form of inflammatory disorder, marking an advanced progression of pelvic inflammatory disease (PID), mainly resulting from the escalation of polymicrobial infections within the female genital tract. This literature review is dedicated to elucidating the contemporary management strategies and associated complications of TOAs, amalgamating the current scholarly discourse while spotlighting the emerging therapeutic trends. The inherent complexity of TOAs, manifesting through a broad array of clinical presentations from mild symptoms to acute pelvic discomfort and fever, necessitates a comprehensive, multidisciplinary approach to achieve effective management. Traditional management has predominantly focused on antibiotic therapy, the cornerstone of initial treatment modalities. Nonetheless, this review expands on the increasing acknowledgment of minimally invasive surgical interventions, like ultrasound-guided drainage, especially in scenarios where medical therapy falters or in the presence of sizable abscesses, underscoring scenarios where antibiotic treatment may be insufficient. The discourse further explores the pivotal decision-making concerning surgical interventions, juxtaposing the benefits of abscess resolution against potential risks and complications, such as damage to adjacent structures and implications for future fertility. The review emphasizes the criticality of addressing PID’s risk factors and root causes to avert TOA development. It also ventures into the ramifications of the emergence of antibiotic-resistant bacterial strains for empirical antibiotic therapy selection, highlighting the imperative for continuous research and the adaptation of therapeutic guidelines. The complications associated with TOAs, including sepsis, infertility, and chronic pelvic pain, are meticulously examined to underscore the potential for significant long-term morbidity. Advocating for prompt diagnosis and encompassing management strategies to curtail these adverse outcomes, the review ultimately calls for intensified, quality research to refine TOA management further, particularly against the backdrop of evolving microbial resistance and the advancements in minimally invasive surgical technologies.

Uterine disorders in reproductive life

The development of new medical diagnostic technologies and procedures and the drop in the birth rate observed in the last decades represent the main causes of increased incidence of uterine disorders. Endometriosis, adenomyosis and uterine fibroids are benign uterine disorders whose understanding have greatly increased and clinical management have improved in recent times. Molecular pathogenetic aspects, new imaging technologies (transvaginal ultrasound and magnetic resonance), biochemical markers, hormonal drugs, minimally invasive surgical technologies were studied for diagnosis and treatment of endometriosis, adenomyosis and uterine fibroids. Sex steroid hormones, inflammation and fibrosis are key pathogenetic mechanisms of uterine disorders. Endometriosis is characterized by endometrial cells migrating outside the uterus and implanting in the pelvis, associated with inflammation, neuroangiogenesis and fibrosis causing dysmenorrhea, pelvic pain, dysuria and dyschezia. The painful symptoms may activate central sensitization and stress responses. Adenomyosis is caused by the presence of endometrial cells within the myometrium, characterized by pelvic pain, abundant menstrual bleeding and infertility. Heavy menstrual bleeding can cause the reduction of iron reserves and consequently iron deficiency anemia. Uterine fibroids are the most common benign tumors of the uterus in women of reproductive age. They can be asymptomatic, but they frequently manifest with abnormal uterine bleeding, pelvic discomfort, and challenges with fertility. Submucosal or intramural fibroids can hinder embryo implantation and potentially lead to pregnancy-related complications such as miscarriage, placenta previa, preterm labor, or postpartum hemorrhage. The increased incidence of uterine disorders has a major clinical impact on women’s health and a very poor quality of life is often reported. Therefore, prompt diagnosis and effective management are mandatory.

Antegrade ejaculation preservation in surgical treatment for benign prostatic hyperplasia: quest for balance between voiding and sexual function.

Surgical treatment of benign prostatic hyperplasia (BPH) carries a significant risk of ejaculation dysfunction. Preservation of antegrade ejaculation while providing effective, well tolerated, and durable treatment of BPH is a paramount component of physical and sexual well being for significant number of men. We reviewed available literature with an aim of providing status on antegrade ejaculation preserving BPH surgical therapies. Minimally invasive surgical therapies for BPH have been developed over the last decade, with significant marketing emphasis on their potential for preservation of antegrade ejaculation. However, the question about durability of relief of bladder outlet obstruction remains. Parallel to this technological development, the understanding of anatomical structures involved in ejaculation have resulted in technical modifications of well established surgical treatments modalities like transurethral resection of prostate, endoscopic enucleation of prostate and simple prostatectomy, thereby providing safe and durable relief of bladder outlet obstruction secondary to BPH with a satisfactory preservation of antegrade ejaculation. Preservation of antegrade ejaculation is an important goal for significant number of men needing BPH surgery. Novel minimally invasive surgical technologies have been developed for this purpose; but understanding of the anatomical structures essential for antegrade ejaculation have allowed technical modification of existing surgical techniques with excellent preservation of antegrade ejaculation.

Transgastric necrectomy for acute pancreatitis

The review is devoted to transgastric necrectomy in the treatment of infected forms of acute pancreatitis. The authors discuss the indications for transgastric necrectomy and technical features of these interventions (direct endoscopic necrectomy, laparoscopic and open transgastric necrectomy). Numerous studies devoted to results of transgastric necrectomy indicate advisability of this procedure in carefully selected patients and interdisciplinary interaction of various specialists before and after surgery. Regional specialized centers for the treatment of severe acute pancreatitis are necessary for wider introduction of minimally invasive surgical technologies and their personalization.

Minimally invasive surgical technologies in the treatment of anal fistulas (literature review)

Modern methods for the surgical treatment of anal fistulas are minimally invasive and aimed at minimizing damage to the external anal sphincter, reducing the frequency of relapses in the postoperative period, and eliminating anal incontinence. One of the most promising surgical interventions at the moment are sphincter-saving techniques. In recent decades, numerous studies about the clinical effectiveness of surgical methods of anal fistula treatment have been made. Therefore, the purpose of this literature review is to analyze and evaluate the long-term results of minimally invasive methods of treating anal fistulas, in particular, laser thermal obliteration of fistulas.

Pancreatic cysts in children: diagnostical and surgical tactics

BACKGROUND: Surgical treatment of pancreatic cysts is one of the most difficult procedures in pediatric surgery. In children with pancreatic cysts, the issues of differential diagnosis and determining the connection of the cyst cavity with the main pancreatic duct remain problematic. Recent publications have focused on the use of endoscopic ultrasonography in pediatric practice to visualize the parenchyma and the ductal system of the pancreas with high accuracy.
 AIM: This work aimed to study the results of treatment of children with cystic formations of the pancreas using modern radiation diagnostic methods and minimally invasive surgical technologies.
 MATERIALS AND METHODS: Analysis was conducted on the results of treatment of 66 patients consisting of 30 boys (45.5%) and 36 girls (54.5%) aged 6 months to 18 years (average age of 10.9 5.2 years) with extraparenchymatous and intraparenchymatous pancreatic cysts.
 RESULTS: Multispiral computed tomography (Se 90%, Sp 91%, and Ac 91%; p 0.05) and magnetic resonance imaging (Se 96%, Sp 94%, Ac 95%; p 0.05) are the most informative for the differential diagnosis of intra- and extraparenchymatous pancreatic cysts. For thin-walled extraparenchymatous cysts up to 6 cm in size, conservative therapy is effective in the early period of the disease. External (42.4%) and internal (51.3%) drainage of cysts can be performed when the existence of pancreatic pseudocysts is prolonged (more than 2 months). Indications for simultaneous longitudinal pancreaticoejunostomy may occur in 9.5% of patients. Excision of the pseudocyst with pancreatic resection may be required in 4.7% of cases. For intraparenchymatous cysts, 33.3% of cases require the enucleation of cystic formation, 25% require the distal splenoserving resection of the pancreas, 25% require the central resection of the pancreas with the imposition of distal pancreatoejunoanastomosis, and 12.5% require pylori-preserving pancreatoduodenal resection. Approximately 70.8% of surgical interventions on the pancreas in children can be performed by laparoscopic access with a conversion rate in 12.5% of cases.
 CONCLUSIONS: The choice of surgical intervention in children with pancreatic cysts is determined by the etiology, cyst size, localization, connection with the main pancreatic duct, and degree of involvement of the parenchyma in the tumor process. Most operations on the pancreas may be performed using minimally invasive approaches.

A modified method for percutaneous drainage of acute necrotic collections in patients with infected pancreatic necrosis

To develop a modified method for percutaneous drainage of acute necrotic collections in patients with infected pancreatic necrosis. Minimally invasive surgical technologies were used in 74 patients with infected acute necrotic collections at the Krasnodar Regional Clinical Hospital No. 2 between 2017 and 2019. Of these, 59 (79.7%) people underwent percutaneous drainage as a final treatment. In 11 (14.9%) patients, video sequestrectomy through the fistula was additionally used to increase efficiency of percutaneous drainage. PCD in our modification implies delivery of double-lumen drains 26-32 Fr in the same plane to zones of necrosis, their programmed replacement for prevention of obstruction and flexible endoscopy for control of pathological process. Local purulent-necrotic parapancreatitis occurred in 31 (41.9%) patients, widespread parapancreatitis - in 43 (58.1%) patients. There were 339 minimally invasive interventions. Laparotomy was required in 4 (5.4%) patients. Incidence of perioperative complications was 10.6%, mortality - 16.2%. A modified percutaneous drainage method may be used as final surgical treatment in 79.7% of patients with infected pancreatic necrosis.

Features of the formation of postoperative scars under the influence of rehabilitation programs in patients with chronic paraproctitis in the early postoperative period after minimally invasive surgical hospital-replacing technologies

BACKGROUND: The study of the features of the formation of postoperative scars under the influence of rehabilitation programs in patients with chronic paraproctitis in the early postoperative period after minimally invasive surgical hospital-replacing technologies expands our understanding of the pathological condition and methods of its treatment.
 AIM: To study the effect of various rehabilitation programs on the formation of postoperative scars in patients with chronic paraproctitis in the early postoperative period after minimally invasive surgical hospital-replacing technologies.
 MATERIAL AND METHODS: The study summarized and analyzed the experience of surgical treatment of 180 patients with chronic paraproctitis using minimally invasive surgical hospital-replacing technologies and rehabilitation programs in the early postoperative period. Laser ablation of the fistula tract the classic FiLaC technology was performed in 90 patients; modified FiLaC technology 90. Each of the subgroups was divided into 3 groups: group 1 (main) included 30 patients who underwent a 4-component rehabilitation complex from the second day after the operation; group 2 (comparison) 30 patients who underwent a 2-component rehabilitation complex from the second day after the operation and group 3 (control) 30 patients, without an additional physiotherapeutic rehabilitation program. A comprehensive assessment of the features of the formation of postoperative scars was carried out as a criterion for the effectiveness of treatment, one of the tools of which was a complex transrectal ultrasound with color Doppler mapping, Dopplerography and sonoelastography at different stages of treatment.
 RESULTS: All patients tolerated the course of treatment well: there were no cases of interruption of rehabilitation programs. The dynamic analysis of the data showed a statistically significant result: the best in patients of the main group against the background of a 4-component rehabilitation program, the formation of postoperative scars accelerated, the formation of a mature scar occurred earlier, the risks of developing postoperative complications and relapses of the disease decreased.
 CONCLUSION: The use of rehabilitation programs in patients with chronic paraproctitis in the early postoperative period after minimally invasive surgical hospital-replacing technologies can improve clinical results due to the complex physiotherapeutic effect. Complex transrectal ultrasound with color Doppler mapping, Dopplerography and sonoelastography in patients with chronic paraproctitis is an effective non-invasive diagnostic method: monitoring the formation of a postoperative scar and assessing the ongoing treatment.

The choice of tactics of rehabilitation measures in patients with chronic paraproctitis, depending on the volume of surgical intervention based on quality of life indicators

BACKGROUND: The development of medical technologies puts forward requirements for the improvement and optimization of treatment and rehabilitation algorithms for providing surgical care to proctological patients and, in particular, patients with chronic paraproctitis. The criteria for the effectiveness of therapy are the period of wound healing, the frequency of recurrence of the disease and the preservation of the function of the anal sphincter. The development of minimally invasive surgical technologies is a new promising area of outpatient coloproctology.
 AIMS: was to evaluate the effectiveness of the use of physiotherapy programs for postoperative rehabilitation according to the SF-36 quality of life assessment scale in groups of patients operated on by various methods of surgical interventions and to develop an Algorithm for surgical treatment and postoperative rehabilitation of patients with chronic paraproctitis.
 MATERIAL AND METHODS: The study included observation and control in the pre- and early postoperative period for 270 operated patients with extra- and transsphincter pararectal fistulas with various options for surgical treatment and rehabilitation programs used in the early postoperative period. As a criterion of effectiveness, an assessment of the quality of life b according to the SF-36 questionnaire was used. The surgical-physiotherapeutic Algorithm of surgical treatment and rehabilitation of patients with chronic paraproctitis is proposed for wide introduction into clinical practice.
 RESULTS: As a result of the analysis of the data obtained, it was found that the quality of life depends on the type of operation: the advantage of using minimally invasive surgical interventions and the rehabilitation program used has been proven: the advantage of using an extended 4-component rehabilitation program has been proven.
 CONCLUSION: The data obtained made it possible to determine the tactics of rehabilitation measures in patients with chronic paraproctitis depending on the volume of surgical intervention and display it in a visual, schematic form ― Algorithm for surgical treatment and rehabilitation of patients with chronic paraproctitis.

Long-term results of minimally invasive surgical treatment of extra- and transsphincteric perianal fistulas using postoperative rehabilitation programs

Introduction. A modern promising trend in coloproctology is the use of minimally invasive surgical technologies in the surgical treatment of extra- and transsphincteric perianal fistulas, in particular laser technology FiLaC (Fistula Laser Closure). Surgical treatment of patients with extra- and transsphincteric perianal fistulas requires proper routing, stratification of the used methods of surgical treatment, postoperative rehabilitation and dynamic evaluation of the obtained results, including in the long-term period. Purpose of the study. In a comparative aspect, to evaluate the long-term results of surgical treatment of trans- and extrasphincteric perianal fistulas using the standard FiLaC technology and the developed modified FiLaC technology and the use of 2 or 4-component complex programs of physiotherapeutic postoperative rehabilitation. Material and methods. The study included 180 operated patients with trans- and extrasphincteric perianal fistulas, who were divided into two groups depending on the method of surgical intervention. In the 1st group (90 patients), the standard FiLaC technology was used for minimally invasive surgical treatment of fistulas; in the 2nd group (90 patients), a modified FiLaC technology, which provides for the opening of purulent streaks and laser coagulation of the intrasphincteric part of the fistula with a Biolitec laser (power 12 W, 100 J/cm), was applied. Each group was divided into 3 subgroups depending on the postoperative rehabilitation program used: in the 1st (main group), a 4-component program of postoperative rehabilitation was used, in the 2nd (comparison group) — a 2-component program, and in the 3rd (control group), the program of postoperative rehabilitation was not used. To evaluate the results obtained, the authors used a basic set (clinical examination with an assessment of the general condition, laboratory tests, high-resolution anoscopy, examination of the fistula tract with a button probe), additional instrumental methods (transrectal ultrasound (TRUS) with sonoelastometry, examination of the functional state of the rectal obturator), as well as a subjective assessment of the degree of improvement after treatment on the Clinical Global Impression Scale (Srikrishna S., Robinson D., Cardozo L. (2010)) and an assessment of the quality of life according to the SF-36 questionnaire (Ware JE et al. SF-36 Health Survey. Manual and interpretation guide. The Health Institute, New England Medical Center. Boston, Mass. 1993), which allow assessing the dynamics of the patient’s clinical and functional status in the process of rehabilitation, which is an urgent topic of scientific research. Long-term results were tracked over a period of 19 months up to 3 years (median 31 months). Results and discussion. The comparative analysis of the long-term results (up to 3 years), depending on the type of minimally invasive surgical treatment and the postoperative rehabilitation program used, showed that in the group of patients operated on using the FiLaC technology, the majority had good results — 96.7% of patients in the main group, 90,1% in the comparison group and 84% in the control group. In the comparative analysis of the long-term results of treatment (up to 3 years) in the patients with chronic paraproctitis after performing surgery using a modified FiLaC technology under the influence of the developed postoperative rehabilitation programs, it was found that: 59 people (65,5%) had good characteristics, 19 people (21.1%) had satisfactory characteristics, and 12 people (13,4%) had unsatisfactory characteristics. The differences were statistically significant p=0,002, which indicates that the long-term results were statistically significantly better in the main group than in patients of the control group who did not have rehabilitation measures. Conclusions. The obtained results demonstrated the benefits of using the modified FiLaC technology in the surgical treatment of transsphincteric and extrasphincteric fistulas of the rectum, which was confirmed by a 1,3-fold decrease in the incidence of relapses compared with the data obtained using the traditional FiLaC technology. The proportion of relapses in the main group of patients (when using a 4-component program of postoperative rehabilitation) decreased by 5,8 (comparison group) and 16,1 (control group) times, respectively (median observations 31 months), which allows us to recommend the developed modified FiLaC technology and comprehensive postoperative rehabilitation programs for wide introduction into the clinical practice of coloproctologists in the surgical treatment of transsphincteric and extrasphincteric perianal fistulas.

Efficacy, Safety, and Sexual Dysfunction Outcomes of Water Vapor Thermal Therapy (Rezum) in Patients with Lower Urinary Tract Symptoms Secondary to Benign Prostatic Hyperplasia: An Updated Systematic Review

ABSTRACT Introduction Benign prostatic hyperplasia (BPH) is an exceedingly common condition affecting a large portion of men, often leading to progressive development of lower urinary tract symptoms (LUTS). Water vapor thermal therapy, also known as The Rezum System (Boston Scientific Corporation, Marlborough, MA, USA), is a novel, minimally invasive surgical technology used to treat LUTS secondary to BPH. Rezum utilizes convective radiofrequency water vapor to ablate the lateral and median lobes of the prostate, decreasing prostate size and improving LUTS. Despite its FDA approval in 2015, there is a sparsity of studies, particularly systematic reviews, describing outcomes. Objective To evaluate the latest efficacy and safety profile of Rezum in patients with LUTS secondary to BPH. Methods PubMed/MEDLINE and The Cochrane Library databases were systematically searched, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement, for relevant articles in the English language till June 1, 2021. Search strategy included the following terms: “water vapor thermal therapy” OR “Rezum” OR “convective water vapor thermal therapy” OR “convective radiofrequency water vapor thermal therapy”. Randomized and non-randomized studies that evaluated urinary outcomes and/or adverse events of Rezum in patients with LUTS secondary to BPH were deemed eligible. Results 16 studies (N=1,703), published in 22 papers, met the inclusion criteria and were included in the systematic review. Of the 16 studies, one was an RCT, five were prospective studies, eight were retrospective studies, and two were case series. When compared to baseline, international prostate symptom score (IPSS), quality of life (QoL), and maximum urinary flow rate (Qmax) significantly improved as early as 1-month post-treatment and remained durable for up to 5 years. Significant percent improvements from baseline to 3-month in IPSS, QoL, and Qmax ranged between 39 to 86% (median: 55%), 45 to 86% (median: 65%), and 32 to 74% (median: 62%), respectively. Most adverse events were transient and non-serious and occurred in between 0 to 83% of patients (median: 47%), with dysuria, urinary retention, urinary tract infection, and hematuria being the most common. Five studies reported no de novo erectile dysfunction, while three studies reported rates between 2.4 to 3.1%. One study reported de novo anejaculation rate of 2.9% while another study reported it at 10.8%. Three studies reported decreases in ejaculatory volume rates between 2.9 to 10.8%, one study reported retrograde ejaculation rate at 3.1%, and one study reported painful ejaculation rate at 1.6%. The surgical retreatment rate ranged between 1.0 to 3.1% at 1 year and between 4.4% and 7.5% at 5 years (Table 1). Conclusions Rezum effectively improved LUTS secondary to BPH with durable outcomes at 5 years post-operatively. Real-world outcomes showed that non-serious adverse events were considerable, but transient, and with low rates of sexual dysfunction. In light of these findings, Rezum remains an attractive surgical modality for men with LUTS secondary to BPH. Disclosure No

ALGORITHMIZATION OF PRACTICAL SKILLS IN EXPERIMENTAL ENDOSCOPIC SURGERY – THE GUARANTEE OF THEIR SUCCESSFUL AND FULLTERM ASSIGNMENT

The infl uence of algorithmization of practical skills in experimental endoscopic surgery on the completeness of their mastering is analyzed in the work. For this purpose, a pedagogical experiment was conducted, which was attended by 194 cadet doctors who mastered endoscopic technologies in courses at the training center of minimally invasive surgical technologies of I. Horbachevsky Ternopil National Medical University and were divided into two groups. The 1-st group consisted of 112 (57.7%) persons who strictly adhered to the algorithm of laparoscopic cholecystectomy, the 2-nd – 82 (43.3%) cadets who for various reasons violated the algorithm of this operation. The completeness of the acquisition of practical skills in performing laparoscopic cholecystectomy was assessed by the number of errors and complications that occurred during the performance of this operation. A survey of these individuals was also conducted. In the 1-st group of observations in 5 (5.6%) cases conversion was performed due to anomalies in the development of the biliary tract and hepatic and vesical vessels. In the 2-nd group, the conversion was performed in 7 (8.5%) cases, which was due to various errors in performing this operation and various deviations from the algorithm. Perforation of the gallbladder during laparoscopic cholecystectomy by cadets of the 2-nd group was performed in 9 (10.9%) animals, damage to the vessels of the liver and gallbladder in 12 (14.6%), and damage to the common bile duct and other extrahepatic ducts in 11 (13.4%), liver and intestines in 6 (7.3%) cases. The above shows that clear and strict adherence to the algorithm of surgical intervention signifi cantly aff ects the quality of its implementation. Based on the results of the pedagogical experiment and analyzed survey data, it can be concluded that the eff ective acquisition of practical skills by cadet doctors when performing laparoscopic operations depends on clear and specifi c compliance with the algorithm of these operations and signifi cantly reduces the number of posterrors and postoperative complications.

Surgical Complications in the Management of Benign Prostatic Hyperplasia Treatment.

There are a variety of treatment options for men with symptomatic benign prostatic hyperplasia (BPH); transurethral resection of the prostate (TURP) remains the gold standard surgical treatment. The field continues to evolve with the introduction of new energy and laser technologies, increasing adoption of enucleation techniques, in addition to the advent of minimally invasive surgical technologies (MIST) that enable office-based treatments. The choice in surgical management has become very nuanced depending on a variety of patient and anatomic factors. There continues to be high success rates for surgical treatment of BPH; however, the risk profiles vary across the various surgical treatments. We sought to evaluate contemporary series and summarize the experience of complications associated with BPH treatment and management of these complications. A comprehensive literature review was performed, and identified 79 manuscripts, published between 2005 and 2021 characterizing the diagnosis and management of complications following BPH surgery. Commonly cited issues included bleeding, ureteral orifice injury, bladder neck injury, rectal injury, TURP syndrome, bladder neck contractures, urethral stricture disease, refractory OAB symptoms, and complications unique to new modalities of treatment. The practicing urologist has multiple surgical options to choose from in treating patients with symptomatic BPH. The surgical management of BPH is generally well tolerated with high objective success rates that allow for significant improvement in urinary quality of life. It is critical to understand the potential complications associated with these various treatment options, which will enable trainees and practicing urologists to better counsel patients and manage these potential complications.

Hiatal hernia surgery: laparoscopic versus robotic approach?

Aim. Evaluate the advantages and disadvantages of laparoscopic and robot-assisted anti-reflux operations.General findings. Reflux esophagitis in the association with hiatal hernia on the third place in the structure of gastroenterological diseases. The development of minimally invasive surgical technologies has led to an increase in the number of laparoscopic and robot-assisted anti-reflux operations. The literature review includes 12 studies, the results of which were published from 2002 to 2020, with a total number of patients 1633. In most of them, when comparing laparoscopic and robot-assisted anti-reflux operations, the advantages of one or another technique were not revealed. In some studies, the high cost and duration of the operation were noted when using the da Vinci robotic surgical complex. Other studies have reported possible improvements in the treatment outcomes of patients with large or recurrent hiatal hernias due to the high precision of movement and improved visualization characteristic of therobot-assisted surgeries.Conclusion. It is necessary to conduct more researches on this problem to develop indications for the choice of a particular surgical approach, as well as to create a single transparent algorithm for the surgical treatment of patients with reflux esophagitis and hiatal hernia.

Emerging outcomes of water vapor thermal therapy (Rezum) in a broad range of patients with lower urinary tract symptoms secondary to benign prostatic hyperplasia: A systematic review.

Water vapor thermal therapy (Rezum) is a novel, minimally invasive surgical technology used to treat lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH). The objective of this systematic review is to evaluate the latest efficacy and safety profile of Rezum in patients with LUTS secondary to BPH. PubMed/MEDLINE and the Cochrane Library databases were systematically searched, in accordance with the PRISMA statement, for relevant articles in the English language till 1 August 2021. Randomized and nonrandomized studies that evaluated urinary outcomes and/or adverse events were deemed eligible. Nineteen studies (N=1942), published in 25 articles, were included. International Prostate Symptom Score (IPSS), quality of life (QoL), and maximum urinary flow rate (Qmax) significantly improved as early as 1 month postoperatively and remained durable for up to 5 years. Significant median percent improvements in IPSS, QoL, and Qmax at 3 months were 51%, 51%, and 66%, respectively. Patients with obstructive median lobes, large prostates (>80 g), small prostates (<30 g), and urinary retention also experienced significant relief in LUTS, with 83% of urinary retention patients becoming catheter independent at a median of 14 days. Most adverse events were transient and nonserious and occurred in 0% to 76% of patients (median 29%), with de novo erectile dysfunction rates ranging between 0% and 3.1%. Surgical retreatment rate ranged between 4.4% and 7.5% at 5 years postoperatively. Rezum provides durable improvements in symptoms, irrespective of prostate volume and urinary retention status, and has low rates of sexual dysfunction.

Современные минимально инвазивные технологии в гинекологической практике

Abstract. A comparison of surgical techniques (SILS, NOTES, Da Vinci robotic system, 3D modeling, Radius Surgical System) showed that they will provide endovideosurgery with new ways of performing surgical interventions in the near future. The aim of the research. Conducting a comparative analysis of minimally invasive surgical methods of treatment used in modern gynecological practice, as well as identifying their advantages and disadvantages, indications and contraindications for use, possible complications. Material and methods. A review of the data in PubMed, eLibrary, Cyberleninka, Scopus and WoS on the keywords “minimally invasive surgery”, “NOTESsurgery”, “SILS-surgery”, “Da Vinci system”, “3D modeling”, “gynecology” for 2016-2021 was performed. In addition, a manual search for articles in journals was carried out. Exclusion criteria from the analysis: description of individual clinical cases, books and documents. The final analysis included 60 sources out of 127 initially identified. Results. Minimally invasive surgical technologies have become the method of choice in the diagnosis and treatment of many gynecological pathologies

Modern surgical technologies in the treatment of patients with chronic paraproctitis

Conducting a comparative retrospective and prospective cohort study of immediate and long-term results of treatment of complicated transsphincteric and extrasphincteric fistulas using the developed modified FiLaC technology with the «traditional» FiLaC technology, and standard excision of the fistulous tract with plasty of the internal fistula opening with a full-thickness flap of the rectal wall. The study included 270 patients with trans- and extrasphincter pararectal fistulas, which were divided into three groups. In group 1 (n=90) the traditional FiLaC technology was used for the treatment of fistulas, in group 2 (n=90) the modified FiLaC technology was used, providing for the opening of purulent streaks and laser coagulation (FiLaC) of the intrasphincter part of the fistula with a Biolitec laser, 12 W, 100 J/cm, in group 3 (n=90), excision of the fistula tract with plastic surgery of the internal fistula opening with a full-thickness flap of the rectal wall was used. The results of treatment in patients of the three groups were monitored for 19-36 months. after surgery (median 31 months). The analysis of the results showed that in group 2 (modified FiLaC technology) healing of fistulas occurred faster (7.3±0.5 weeks versus 12.6±0.7 weeks) compared to group 3 (excision of the fistula with plasty of the internal fistula opening). The indicators of sphincterometry in the long-term period in patients of the 2nd group were restored in relation to the initial ones, and in the th group 3 they were reduced compared to the initial values. Postoperative complications were most common in patients of group 3 (32.2%), and least often in patients of group 2 - 8.9%. At the same time, late postoperative complications were most common (24.4%) in patients of group 1. None of the patients in group 2 had late postoperative complications, while 11.1% of postoperative complications were recorded in group 3. In patients who underwent excision of the AC (group 3), relapses were most common: early - 15.6%, late - in 21.1%. The least frequent relapses were observed in patients who underwent modified FiLaC technology (Group 2): 6.7% - early relapses and 11.1% - late relapses. The use of the modified FiLaC technology in the treatment of trans- and extrasphincteric fistulas of the rectum made it possible to minimize postoperative complications, fully preserve the function of anal holding, and achieve healing of fistulas in 82.5% of cases with a median follow-up of 31 months.

Transtumoral endoprothesis in surgery of colorectal cancer, complicated with colonic obstruction: advantages and disadvantages. A review of the literature

A multifactorial analysis of the literature data on the treatment of acute tumor colonic obstruction using minimally invasive endoscopic surgical technology was carried out. On the basis of the analysis of special publications, the effectiveness of stenting of the large intestine, as a minimally invasive endoscopic method of decompression, is presented. Indications and contraindications for colorectal stenting, advantages and disadvantages, possibilities and prospects of endoscopic decompression of the colon are described in detail. It is postulated that stenting, used in acute tumor obstruction of the colon as a «bridge to surgery», being a worthy alternative to classical colostomy, allows an effective antegrade decompression of the colon and prepares the patient to surgical treatment with the performance of oncological justified primary radical and one-stage restorative operations in more optimal conditions with minimal risk. It is shown that in the late stages of the malignant process and in the presence of neresect-leucorrhoea colorectal cancer, as well as in the presence of absolute contraindications to a radical surgeon Colon stenting can serve as the final treatment for inoperable patients.

Опыт лечения синдрома диабетической стопы в клинике общей хирургии Военно-медицинской академии им. С.М. Кирова

We examined 180 patients with purulent-necrotic complications of diabetic foot syndrome, in whom the proposed diagnostic algorithm was used. Magnetic resonance imaging of the feet, ultrasound Doppler with duplex angioscanning, magnetic resonance and computed angiography of the lower extremities, as well as assessment of transcutaneous oxygen tension were performed. Surgical treatment tactics depended on the form of the diabetic foot syndrome, as well as the severity of the disease. As a local treatment, physical methods were used to accelerate the course of the wound process. The proposed diagnostic algorithm for the diagnosis and selection of surgical treatment for various forms of diabetic foot syndrome has made it possible to reduce the number of “high” amputations and maintain a supporting limb. Purpose of the study is to improve treatment outcomes for purulent-necrotic complications of diabetic foot syndrome by developing and applying a diagnostic algorithm and differentiated treatment tactics. The main group consisted of 180 patients with purulent-necrotic complications of diabetic foot syndrome, in whom the developed diagnostic algorithm and differentiated tactics of surgical treatment were used, as well as physical methods of influencing the wound process (ultrasonic cavitation and local ozonation) were used as local treatment. The control group included 40 patients with purulent-necrotic complications of diabetic foot syndrome, whose treatment involved the use of drugs that improve the rheological properties of blood and tissue microcirculation (rheopolyglucin, trental, actovegin) according to conventional schemes. Local treatment included sanitation and treatment of wound and ulcerative surfaces with antiseptic solutions and ointments, depending on the phase of the wound process. Data analysis in this group was carried out based on a retrospective study of case histories and an assessment of long-term results of treatment by follow-up examinations and telephone interviews. Control group included 25 (63%) men and 15 (37%) women; the average age was 67.3±10.3 years. The developed unified approaches in diagnosing and treating patients with purulent-necrotic complications of diabetic foot syndrome, who, in complex treatment, underwent staged necrectomy with simultaneous ultrasonic cavitation of purulent wounds and their ozonization, can reliably reduce the number of ulcer recurrences from 28% to 2.7%, high amputations by 34%, and the number of re-amputations ― 10 times. The use of minimally invasive surgical technologies for the rehabilitation of deep purulent foci of the foot, in comparison with the classical principles of treatment of purulent wounds, makes it possible to achieve a complete cleansing of wounds, preparation for plastic surgery, and an increase in the number of functional supportable lower limbs by 42.7%. According to the data obtained, it is optimal to perform sanitizing operations after revascularization of at least one artery no earlier than 3–4 days, which makes it possible to increase their efficiency and reduce the number of repeated surgical interventions. The approach to managing patients with diabetic foot syndrome at all stages of treatment and rehabilitation should be interdisciplinary and include the following specialists: endocrinologist, orthopedist, surgeon, psychologist, trained nursing staff.