Laparoscopic Access Research Articles

Evaluation of the Effect of Surgical Access on the Innate Immune Response During Liver Resections of Various Volume, Experimental Study

Introduction. The major components of the immune system are affected in almost all surgical operations, including those related to the tumor removal. The volume of the operation correlates with the level of the immune system suppression and frequency of complications. The issue of the effect of surgical access for liver resection with different volumes on surgical trauma and severity of the innate immune response are still challenging nowadays. The aim of the study is to evaluate the effect of open and laparoscopic surgical approaches on the severity of the innate immune response in small and large liver resections in laboratory animals.Methods. The study included 4 groups of rabbits, 10 animals each, formed depending on the surgical approach and the volume of liver resection: laparoscopic small and large liver resections, open small and large liver resections. The following parameters of the innate immune response were studied: phagocytic, cytotoxic and proliferative activity in dynamics. The experimental data were processed using the STATISTICA 6.0 software package (StatSoft, 2001). The results were considered statistically significant at p0.05.Results. Open extensive liver resections are characterized by a more significantly decreased phagocytic activity of neutrophils - from 95.7% to 32.05% - than similar interventions using laparoscopic access - from 96.4% to 52.4%, respectively. Cytotoxic activity in the group of animals exposed to surgery with laparotomy access decreased by 40% compared to 23% in animals exposed to laparoscopy surgery. There was registered a more than twice increased spontaneous and decreased induced proliferation in the postoperative period. Conclusion. The study results allow concluding on a positive effect manifested as a reduced surgical injury for liver resections of various volumes due to laparoscopic access; this is evidenced by the parameters of immune reactivity.

Extravesical ureteral ectopia from an iliac dystopic hypoplastic left kidney in a girl

Extravesical ureteral ectopia (EUE) is a rare cause of urinary incontinence (UI) in girls. In 80% of cases, ectopia is associated with ureteral duplication. We are reporting a case of a 17-year-old girl with UI by EUE from an iliac dystopic hypoplastic left kidney. The girl received outpatient treatment for UI and left kidney agenesia since the age of 5, when her parents for the first time noticed the UI with background normal urination. The child underwent a complete range of medical tests: CT, cystoscopy, renal nuclear scan, uroflowmetry, ureteral cystometry and profilometry. Although the examination revealed no proof of renal tissue existence on the left side, a pad test with a dye was performed to exclude an EUE. The test gave a positive result, which determined further diagnostic search. Vascular CT was performed and made it possible to visualize a severely hypoplastic left kidney dystopic towards the iliac vessels. Laparoscopic nephrectomy was performed and UI manifestations were corrected. Availability of a wide range of visualisation methods in the urologist's toolkit does not always allow to verify hypoplastic renal dystopia when the kidney is drained by a ureter with an extravesical ectopic orifice. When a reasonable suspicion of an EUE is combined with lack of information about its location and dimensions after visualizing tests, a pad test with a dye appears appropriate prior to a diagnostic laparoscopy in our opinion. Once the UU is confirmed by the dye test results, further diagnostic search using laparoscopic access is justified and can be transformed into a treatment procedure if the kidney is revealed.

The Judicious Use of Stereotactic Ablative Radiotherapy in the Primary Management of Localized Renal Cell Carcinoma.

Localized renal cell carcinoma is primarily managed surgically, but this disease commonly presents in highly comorbid patients who are poor operative candidates. Less invasive techniques, such as cryoablation and radiofrequency ablation, are effective, but require percutaneous or laparoscopic access, while generally being limited to cT1a tumors without proximity to the renal pelvis or ureter. Active surveillance is another management option for small renal masses, but many patients desire treatment or are poor candidates for active surveillance. For poor surgical candidates, a growing body of evidence supports stereotactic ablative radiotherapy (SABR) as a safe and effective non-invasive treatment modality. For example, a recent multi-institution individual patient data meta-analysis of 190 patients managed with SABR estimated a 5.5% five-year cumulative incidence of local failure with one patient experiencing grade 4 toxicity, and no other grade ≥3 toxic events. Here, we discuss the recent developments in SABR for the management of localized renal cell carcinoma, highlighting key concepts of appropriate patient selection, treatment design, treatment delivery, and response assessment.

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.

Efficacy of a continuous wound infiltration system for postoperative pain management in gynecologic patients who underwent single-port access laparoscopy for adnexal disease.

Single-port access (SPA) laparoscopy requires only one incision, unlike conventional laparoscopy. However, its umbilical incision is larger than that of conventional laparoscopy and can be vulnerable to postoperative pain. This study aimed to evaluate whether simultaneous use of a continuous wound infiltration (CWI) system and intravenous patient-controlled analgesia (IV PCA) effectively decreases surgical site pain in patients who underwent SPA laparoscopy due to gynecologic adnexal disease. A total of 371 patients who underwent SPA laparoscopy and who received IV PCA or CWI was retrospectively reviewed (combined group [CWI + IV PCA, n = 159] vs. PCA group [IV PCA only, n = 212]). To evaluate postoperative pain management, the numeric rating scale (NRS) pain score after surgery, total amount of fentanyl administered via IV PCA, and additional pain killer consumption were collected. The NRS scores at 12 h (1.90 ± 1.11 vs. 2.70 ± 1.08, p < 0.001) and 24 h (1.82 ± 0.82 vs. 2.11 ± 1.44, p = 0.026) after surgery were significantly lower in the combined group than in the PCA group. The total amount of PCA fentanyl was significantly smaller in the combined group than in the PCA group (p < 0.001). The total quantity of rescue analgesics was smaller in the combined group than in the PCA group (p < 0.05). Combined use of the CWI system and IV PCA is an effective postoperative pain management strategy in patient who underwent SPA laparoscopy for adnexal disease.

Left Laparoscopic Transperitoneal Adrenalectomy for Aldosteronoma

Primary hyperaldosteronism refers to the autonomous secretion of the hormone aldosterone from the adrenal gland, resulting in low renin levels. This usually occurs in individuals between the ages of 30 to 50 years old. The majority of these cases are caused either by a solitary, functioning adrenal adenoma or aldosteronoma (70%) or by idiopathic bilateral hyperplasia (30%). Other uncommon causes include adrenal carcinoma and familial hyperaldosteronism. Patients typically present with hypokalemia and long-standing hypertension that is difficult to control despite multi-drug therapy; nevertheless, further tests are required for diagnosis. An elevated plasma aldosterone level with a suppressed plasma renin level is strongly suggestive of the diagnosis. Once confirmed, further evaluation should be directed toward determining if the cause is a unilateral aldosteronoma or bilateral adrenal hyperplasia. This is done through imaging studies and adrenal vein sampling. Unilateral aldosteronoma is best managed by adrenalectomy, with the laparoscopic approach being the preferred method. Bilateral adrenal hyperplasia is often best treated medically, because only 20%–30% benefit from surgery. Here, we present the case of a 48-year-old woman who had long-standing hypertension and hypokalemia and was found to have hyperaldosteronism and low renin levels. A CT scan showed a small mass in the left adrenal gland, and adrenal vein sampling showed higher levels of aldosterone on the left side than on the right, confirming a unilateral aldosteronoma. Laparoscopic access was gained, the adrenal gland was exposed, dissected by controlling the periadrenal tissues with the harmonic scalpel, the adrenal vein was then ligated, and the adrenal gland was removed.

Laparoscopic correction of combined forms of genital prolapse

BACKGROUND: The significance of pelvic organ prolapse is determined by the absence of a downward trend in its frequency and severity and by the steadily high number of recurrences in every third woman who underwent surgery. According to most authors, surgical correction is the primary treatment for genital prolapse. Therefore, the search for an effective and safe surgical treatment of this pathology is important. Currently, various minimally invasive surgical interventions have been performed via laparoscopic access, which reduces the risk of tissue or adjacent organ damage, possible intraoperative bleeding, and potential complications.&#x0D; AIM: This study aimed to assess the efficiency and safety of laparoscopic techniques for the correction of genital prolapse.&#x0D; MATERIALS AND METHODS: The study included 12 patients with pelvic organ prolapse quantification system grades IIIV who underwent surgical correction using a combined laparoscopic approach. The inclusion criterion was the presence of prolapse, including recurrent forms. At the outpatient stage, the patients medical history was collected, and complaints, and degree of pelvic organ prolapse were assessed. Genital prolapse was diagnosed based on medical history, clinical data, and additional methods of examination.&#x0D; RESULTS: With this surgical intervention technique, intraoperative bleeding was avoided, the number of possible postoperative complications was reduced, and disease recurrence was prevented. The criteria for assessing the surgical intervention included improvement of the pelvic floor anatomy, elimination of symptoms, patients satisfaction with treatment results and quality of life, and reduced risk of recurrence of complications. Mesh-associated complications were excluded by avoiding contact of the synthetic implanted material with the vaginal mucosa.&#x0D; CONCLUSIONS: Through laparoscopic access, the length of hospital stay was reduced, and compared with abdominal access, a better cosmetic effect was achieved. A comprehensive system considering the assessment of the anatomical outcome, functional status of the pelvic floor, and patients quality of life may become the most objective tool to evaluate the success of surgical treatment of genital prolapse.

Transperitoneal Laparoscopic Right Adrenalectomy for Cortical Adenoma

Primary hyperaldosteronism, or Conn's syndrome, is a disease in which one or both adrenal glands produce excess amounts of aldosterone, leading to hypertension and hypokalemia. Common conditions resulting in this disorder include adenoma of the adrenal gland or hyperplasia of both adrenal glands. In rare cases, it is caused by malignant growth in the adrenal cortex or familial hyperaldosteronism. High blood pressure may cause headaches or blurred vision. Low potassium may cause fatigue, muscle cramps, muscle weakness, numbness, or temporary paralysis. Primary hyperaldosteronism is diagnosed by measuring serum levels of aldosterone, renin, and potassium. Patients classically have high aldosterone levels, suppressed renin levels, and low potassium levels. Once the diagnosis is established, localization of the source is performed using imaging studies. Adrenal vein sampling is also performed to determine more precisely and directly the side that is producing excess aldosterone. Primary hyperaldosteronism caused by an adrenal gland tumor is treated with adrenalectomy. Approximately 95% of patients will notice significant improvement in their hypertension after successful surgery. Here, we present the case of a 58-year-old woman with hypokalemia and long-standing hypertension refractory to medical treatment. Her blood tests showed high aldosterone levels and low renin levels, confirming the diagnosis of hyperaldosteronism. On CT scan, an adrenal nodule was noted on both sides. Adrenal vein sampling identified the right adrenal nodule as the cause. Laparoscopic access was gained, the adrenal gland was dissected and exposed, the adrenal vein ligated, and the adrenal gland was removed.

Transvaginal needle versus laparoscopic ovarian drilling in hormonal profile and pregnancy outcomes of polycystic ovary syndrome: A systematic review and meta-analysis.

Polycystic ovary syndrome (PCOS) is a prevalent hormonal disorder distinguished by a persistent absence of ovulation. Ovarian drilling is a recognized therapeutic approach for PCOS patients who are unresponsive to medication and can be performed through invasive laparoscopic access or less-invasive transvaginal access. The aim of this systematic review and meta-analysis was to assess the efficacy of transvaginal ultrasound -guided ovarian needle drilling with conventional laparoscopic ovarian drilling (LOD) in patients with PCOS. PUBMED, Scopus, and Cochrane databases were systematically searched for eligible randomized controlled trials (RCTs) from articles published from inception to January 2023. We include RCTs of PCOS that compared transvaginal ovarian drilling and LOD and reported on ovulation and pregnancy rates as the main outcome variable. We evaluated study quality using the Cochrane Risk of bias 2 tool. A random-effects meta-analysis was performed and the certainty of the evidence was assessed according to the GRADE approach. We registered the protocol prospectively in PROSPERO (CRD42023397481). Six RCTs including 899 women with PCOS met the inclusion criteria. LOD was found to significantly reduce anti-Mullerian hormone (AMH) (SMD: -0.22; 95% CI: -0.38, -0.05; I2=39.85%) and antral follicle count (AFC) (SMD: -1.22; 95% CI: -2.26, -0.19; I2=97.55%) compared to transvaginal ovarian drilling. Our findings also indicated that LOD significantly increased the ovulation rate by 25% compared to transvaginal ovarian drilling (RR: 1.25; 95% CI: 1.02, 1.54; I2=64.58%). However, we found no significant difference between the two groups in terms of follicle stimulating hormone (SMD: 0.04; 95% CI: -0.26, 0.33; I2=61.53%), luteinizing hormone (SMD: -0.07; 95% CI: -0.90, 0.77; I2=94.92%), and pregnancy rate (RR: 1.37; 95% CI: 0.94, 1.98; I2=50.49%). LOD significantly lowers circulating AMH and AFC and significantly increases ovulation rate in PCOS patients compared to transvaginal ovarian drilling. As transvaginal ovarian drillingremains a less-invasive, more cost-effective, and simpler alternative, further studies are warranted to compare these two techniques in large cohorts, with a particular focus on ovarian reserve and pregnancy outcomes.

Laparoscopy-assisted percutaneous correction of abdominal wall defects in the umbilical region in a cadaveric model of bovine fetus.

Abdominal wall defects in calves are commonly diagnosed and treated via laparotomy. This technique has witnessed several advancements in the management of these disorders. This study aimed to create a study model and evaluate the feasibility of video-assisted percutaneous correction of abdominal wall defects in bovine fetuses (corpses) compared with the conventional technique. Sixteen bovine fetuses from pregnant cows slaughtered in slaughterhouses were included in this study. The fetuses were categorized into the control group (CG, n = 8), which was subjected to umbilical abdominorrhaphy via laparotomy, and the video-surgical group (VG, n = 8), which received video-assisted percutaneous sutures with two lateral accesses on the right flank. An abdominal wall defect was created in the VG group to generate a study model, which was corrected using the laparoscopic technique. The procedures were performed in two steps. The first step consisted of creating an abdominal wall defect in the umbilical region by laparoscopic approach in an iatrogenic manner (Step 1: E1). The second stage consisted of conventional abdominorrhaphy of the umbilical region wall defect in the CG group and video-assisted percutaneous suturing of the edges of the iatrogenic abdominal wall defect in the VG group, until reversal of the laparoscopic accesses (Step 2: E2). Step 1 showed no statistically significant difference between the two groups. However, a significant statistical difference (p < 0.0001) was observed between the two groups in step 2. The surgical time of step 2 was longer in the CG group (33.10 ± 0.43 minutes) than that in the VG group (10.13 ± 0.68 minutes, p < 0.0001), and the total surgical time was also longer in the CG group (38.48 ± 0.35 minutes) than that in the VG group (15.86 ± 0.67 minutes). The proposed laparoscopic technique allowed the creation of a study model for video-assisted percutaneous suturing with two portals and reduced the surgical time compared with the conventional technique. However, this method needs to be studied further in live animals.

Features of the endothelial status in patients with gastric cancer and its impact on surgical treatment outcomes

BACKGROUND: The incidence of gastric cancer is still high and holds the leading place in the structure of oncological pathology in the world. Prognostic aspects in the treatment of generalized forms of gastric cancer are currently under revision.&#x0D; AIM: To study functional status of vascular endothelium in patients with gastric cancer in perioperative period and evaluate its influence on the outcomes of surgical treatment.&#x0D; MATERIALS AND METHODS: A prospective, randomized study was conducted from 2009 to 2019. Two populations were studied: healthy individuals (control group, n=40); patients diagnosed with gastric cancer (general group, n=122). Patients with gastric cancer underwent gastrectomy with lymphodissection.&#x0D; The functional state of the vascular endothelium was studied: the volume of circulating endotheliocytes (CCE); the level of von Willebrand factor (VF) and the degree of endothelium-dependent vasodilation (EDV). To study their prognostic significance we calculated a conventional cut-off point.&#x0D; RESULTS: The general group patients were divided into 2 subgroups: the main group the laparoscopic access (n=54) and the comparison group the laparotomy access (n=68).&#x0D; Endothelial dysfunction (EDF) correction with Glutargin 1.0 g per day in combination with Enalapril 2.5 mg per day was additionally used in the main subgroup.&#x0D; In the main group, the values of CCE and VF were lower (8.33.0 and 84.621.3, respectively) and the values of EDV were higher (13.73.9) in contrast to the comparison group (p 0.0001).&#x0D; Use of the EDF correction method in the main group resulted in a 4.4-fold and 5.1-fold decrease in CCE and VF concentrations, respectively, and a 4.3-fold normalization of EDV (p 0.0001). Increase of CCE concentration more than 7.0 per 103 platelets; PV more than 120 g/ml, as well as decrease of EDV below 14% in the study stages increased the risk of postoperative complications by 2.9; 1.7 and 1.8 times, respectively (p 0.0001).&#x0D; The incidence of surgical complications was 19.7% and non-surgical complications 31.1%. Hospital mortality was 3.3% and out-of-hospital mortality with up to three years follow-up was 13.1%.&#x0D; The number of purulent-septic complications in the main group was 2.9 times lower, and the rate of thrombotic complications was 4 times lower than in the comparison group (p 0.05).&#x0D; CONCLUSION: Combined use of laparoscopic technique by EDF medication correction reduces manifestations of stress reaction and decreases the potential risk of complications development in the postoperative period. Elevation of CCE, as well as EDV decrease beyond the relevant excision points in patients with gastric cancer in the perioperative period are prognostic predictors of the risk of purulent-septic and thrombotic complications development.

Laparoscopic buccal plasty of the pyeloureteral segment and proximal ureter

BACKGROUND: With recurrent extended strictures of the pyeloureteral segment and the proximal ureter, when standard operations are ineffective or technically impossible, the narrowed area can be replaced with a flap from the cheek mucosa.&#x0D; AIM: The aim of the study is the results of laparoscopic plastic surgery of the pyeloureteral segment and proximal ureter with buccal graft.&#x0D; MATERIALS AND METHODS: Minimally invasive plastic surgery of the extended stricture of the pyeloureteral segment, upper and middle third of the ureter with a flap from the cheek mucosa was performed in 27 patients. There were 16 men, 11 women, and the average age was 51 years. The cause of narrowing in 16 patients was previously performed pyeloplasty, in 10 contact ureterolithotripsy in the proximal ureter, in 1 his injury during laparoscopic excision of a parapelvical kidney cyst. Laparoscopic access was used in 24 patients, and robot-assisted access was used in 3 patients. In 17 of them, the narrowed area was replaced by the onlay technique, in 10 patients, anastomosis augmentation was performed with a buccal graft.&#x0D; RESULTS: There were no intraoperative complications. The duration of operations ranged from 115 to 340 minutes. There were no cases of urine leaking through the drainage. Fever up to 38.0 C was observed in 5 (18.5%) patients, 3 (11.1%) of them underwent antibacterial therapy (grade II according to Clavien), and 2 (7.4%) without nephrostomy drainage, puncture nephrostomy (grade IIIa according to Clavien) was performed. There were no complications according to Clavien IIIb degree. On excretory urograms and computed tomography, the area of the ureter replaced by a buccal flap is wide and well passable. In patients with pyeloureteral segment strictures, a decrease in the size of expanded cups and pelvis was observed in dynamics. Clinically, all operations were successful, as it was possible to relieve patients from nephrostomy drainage and symptoms of upper urinary tract obstruction.&#x0D; CONCLUSIONS: Buccal ureteroplasty may be the method of choice in patients with extensive narrowing of the pyeloureteral segment and proximal ureter. It is a relatively simple operation and does not require extensive mobilization of the ureter and provides good functional results.

Diagnostics and surgical management of periampullary duodenal duplication cysts in children: a report of cases

BACKGROUND: Obstructive variants of chronic duodenal obstruction may be caused by congenital malformations, such as rare periampullary duodenal duplication cysts. This localization of gastrointestinal duplications is the rarest and is not described in the domestic literature.&#x0D; AIM: This study aimed to present the experience of the management of periampullary duodenal duplication cysts in children.&#x0D; CASES REPORT: Seven children with periampullary duodenal duplication cysts underwent surgery between 2007 and 2022. All patients suffered from prolonged abdominal pain, vomiting of food, and bile. Two children had recurrent pancreatitis, and one child underwent repeated operations for high intestinal obstruction and biliary obstruction in other hospitals. An abdominal cyst was suspected in one patient at another hospital, and the child underwent exploratory laparoscopy, but no formation was found. Ultrasound, gastroduodenoscopy, computed tomography, and magnetic resonance imaging were performed on these children. Ultrasound examination showed a peristaltic cystic formation up to 4 cm in diameter with a double wall. Gastroduodenoscopy showed formation in the second portion of the duodenum in the region of the major duodenal papilla. This formation covers the intestinal lumen by two-thirds and up to nearly complete obturation. The relationship between duodenal duplication and the bile and pancreatic ducts was clarified on magnetic resonance cholangiopancreatography: the relationship was suspected in two children. All patients underwent wide transduodenal excision of periampullary duodenal duplication cyst; in four cases, laparoscopic access was used. No intra- and postoperative complications occurred. Histological examination revealed true duplications in all cases. The children were discharged on days 1112. In the follow-up after 3 months and 10 years, no complications were noted.&#x0D; CONCLUSIONS: Periampullary duodenal duplication cysts can be a cause of chronic duodenal obstruction. Transduodenal excision of periampullary duodenal duplication cysts is the optimal treatment, and this operation can be performed laparoscopically.

Robot-assisted bladder diverticulectomy in a 9-year-old boy

Pediatric urologists rarely encounter bladder diverticulum in children. If the bladder diverticulum has clinical manifestations such as pain, urinary tract infection, hematuria, voiding dysfunction, vesicoureteral reflux, or obstruction of the ureterovesical anastomosis, then surgical treatment is indicated. Recently, numerous publications began to appear on the removal of the bladder diverticulum using laparoscopic or vesicoscopic access. Several foreign publications have reported on the removal of a bladder diverticulum in children using a robotic approach. A 9-year-old boy who was diagnosed with a bladder diverticulum underwent robot-assisted bladder diverticulectomy in January 2020 at the Almazov National Medical Research Centre. Ports of da Vinci 12 and two 8-mm ports, as well as an assistant 5-mm port, were used, which were installed in typical places for lower abdominal surgery. The duration of the operation was 135 min, and the console time was 75 min. The blood loss volume was 20 mL. The patient was in the intensive care unit for 1 day. The urethral catheter was removed on day 7 after the operation. Urination independence, delays, and incontinence were not noted. The patient was discharged on postoperative day 9 in satisfactory condition. At the control examination after a year at the patients residence, she had no complaints, urination was not disrupted, and there were no pathological changes in the ultrasound of the kidneys and bladder. Robot-assisted bladder diverticulectomy in children is a feasible, effective, and safe treatment option in expert centers with extensive experience in robotic surgery. The described clinical case of bladder diverticulectomy is the first in Russia, which was performed using a robotic system in pediatric practice.

The damages of processus vermicularis and Meckel’s diverticulum in gun–shoot abdominal woundings

Objective. Determination of the damages peculiarities in processus vermicularis and Meckel’s diverticulum in a gun–shot abdominal woundings and tactics of their surgical treatment.&#x0D; Materials and methods. Analysis of the gun–shot abdominal woundings has been witnessed the presence of isolated and combined damages of processus vermicularis and Meckel’s diverticulum in 0.18 and 0.06% patients, accordingly. All the wounded persons were the men, their average age have constituted (32±0.3) yrs old. The shrapnel woundings have occurred in 92.4% patients, and the bullet – in 7.6%. Damages of the processus vermicularis base have dominated in its descendent localization, the damages of processus vermicularis and Meckel’s diverticulum were combined with such intestinal affections.&#x0D; Results. All the damages of Meckel’s diverticulum and processus vermicularis were revealed intraoperatively. All the hospitalized patients have had the pain syndrome, the peritonitis signs and free liquid in a small pelvis. Surgical tactics consisted of resection of processus vermicularis (in 2 patients using laparoscopic approach), and in the Meckel’s diverticulum woundings the operative intervention volume have included a wedge–like resection of the small intestine part with diverticulum or segmental intestinal resection with formation of the side to side ileo–ileoanastomosis.&#x0D; Conclusion. The damages of processus vermicularis and Meckel’s diverticulum constitute a rare combat woundings, which occurs in combined intestinal trauma, what constitute the need for its detailed intraoperative revision. Operative tactics in damages of processus vermicularis and Meckel’s diverticulum constitutes their resection and restoration of intestinal integrity and may be realized through laparoscopic access.

Laparoscopic and open liver resection in children: comparison of results

Aim. To compare the results of laparoscopic and open resections in children with hepatic neoplasms. Materials and methods. A retrospective analysis of the immediate and long-term results of laparoscopic and open liver resections for the period from 2018 to 2021 was performed. In order to apply pseudorandomization, the observations were compared according to 10 cofounders, taking into account anamnestic data, anatomical and physiological features. Results. 30 children were operated on laparoscopically and 77 – by the open method. After pseudorandomization, 26 pairs of comparable observations were obtained. Statistically significant differences were identified in the period of safety drainage removal, duration of analgesic therapy and postoperative period with the advantage of laparoscopic access both before and after pseudorandomization. The authors reported no significant differences in the incidence of postoperative complications, lethal outcomes and long-term treatment results. Conclusion. Shorter postoperative period indicates further study of the results of laparoscopic liver resections with specialized institutions to be involved. This will enable indications for such interventions to be finally formulated.

Comparative analysis of pain levels, preoperative anxiety, depression and laboratory parameters during uterine surgery

Introduction. Studies show a low efficiency of postoperative pain relief, especially in gynecological patients. The psychogenic component is of no small importance in the formation of postoperative pain syndrome. Purpose of the study was to determine the factors influencing the development of uncontrolled pain syndrome in patients who underwent uterine surgery. Materials and methods. We examined 30 patients who underwent elective surgery for hysterectomy, conservative myomectomy by laparoscopic or laparotomy access or in combination with perineal plastic surgery. Patients of the study subgroups did not differ in age, BMI, and somatic status. Epidural analgesia with 0.2 % ropivacaine solution was performed. We studied preoperative anxiety and depression scores (HADS scale), the dynamics of C-reactive protein level, glucose, lactate, acid-base status, hemostasis, and pain level initially and in the postoperative period, postoperative recovery rate of the patients and satisfaction with anesthesia. Results. The greatest number of reliable differences in the subgroups was obtained when dividing by the level of preoperative anxiety. Patients with an elevated level of preoperative anxiety were less active in the postoperative period and had three times higher levels of C-reactive protein on the day of discharge. Patients with depression had significantly higher glucose levels compared to the subgroup without signs of preoperative depression on the third postoperative day, and C-reactive protein levels on the second day. The data of regression analysis show the relationship between the level of preoperative anxiety and uncontrolled pain in the postoperative period in gynecological patients. Discussion. The dynamics of the laboratory indices testify in favor of adequate anesthesia and pain control in the study group. The protocol of pain control during uterine surgery that we use allows us to reduce the level of postoperative pain to acceptable values and increase patients' satisfaction with the recommended analgesia. The impact of anxiety and depression on the severity of pain and the course of the postoperative period among gynecological patients necessitates the use of the HADS scale in the preoperative period. Patients with symptoms of clinically pronounced preoperative anxiety should be prescribed counseling by a psychotherapist and anxiolytics at the preoperative examination stage. Conclusions. Prehospital anxiety level is a significant factor influencing the development of uncontrolled pain syndrome. The HADS scale identifies a "high risk" group for the development of uncontrolled pain in the postoperative period in patients awaiting uterine surgery and is a screening test.

One-stage transcrotal orchidopexy in bilateral inguinal cryptorchidism in children

BACKGROUND: The frequency of cryptorchidism varies and depends on gestational age, affecting 1.04.6% of full-term and 1.145% of preterm newborns. Treatment of this defect is currently surgical. Orchiopexy is one of the frequent surgical aids in the practice of a pediatric surgeon and a pediatric urologist. The need for bilateral inguinal cryptorchidism to perform several incisions or separate operations on each side by time forces pediatric surgeons to continue searching for the optimal way to correct bilateral cryptorchidism.&#x0D; AIM: To determine the possibilities of fixation of both testicles with bilateral cryptorchidism in a physiological position in the scrotum through a single surgical approach with fewer complications and improved cosmetic result in comparison with the previously proposed methods.&#x0D; MATERIALS AND METHODS: From 2012 to 2021, we treated 92 male children with bilateral inguinal cryptorchidism. All boys underwent the developed method of single-stage transcrotal bilateral orchiopexy, accompanied, if necessary, by laparoscopic assistance using the method of single-acar laparoscopic access.&#x0D; RESULTS: The results of treatment of 92 children with bilateral inguinal cryptorchidism (184 gonads) in several clinics using this method are presented. Thanks to the improvement of the technology of orchiopexy in the form of single-acar laparoscopic assistance in cases that do not allow the testicle to be freely lowered into the scrotum, the number of complications associated with surgical access, such as pronounced postoperative edema and inflammation of the postoperative wound area, decreased to 1.62% of cases, and there were no relapses of the disease and persistent inguinal hernias.&#x0D; CONCLUSIONS: The article describes a new method of single-stage transcrotal orchiopexy with laparoscopic assistance and statistically substantiates its use in bilateral inguinal cryptorchidism, which allows fixing both testicles in a physiological position in the scrotum at any position of the testicles in the inguinal region with fewer complications and improved cosmetic result in comparison with the previously proposed methods.

Complications in Laparoscopic Access in Standing Horses Using Cannula and Trocar Units Developed for Human Medicine.

First cannulation is a critical manoeuvre in equine laparoscopy. This retrospective study aimed at the comparison of the frequency and type of complications detected when using different human laparoscopy devices for laparoscopic access in standing horses, and the influence of body condition in such complications. Forty-four procedures were included, and retrieved data comprised cannula insertion technique, body condition, and type and frequency of complications. Laparoscopic access techniques were classified into five groups: P: pneumoperitoneum created using Veress needle prior to cannulation; T: sharp trocar; D: direct access via surgical incision; V: Visiport optical trocar and H: optical helical cannula (OHC). In groups T, D, V and H, access was achieved without prior induction of pneumoperitoneum. Complications were registered in 13/44 procedures, of which retroperitoneal insufflation was the most common (6/13). Statistically significant association was found between the complication incidence and the type of access, with group D showing the highest complication frequency (80%) and group H the lowest frequency (0%). The majority of complications (9/13) were observed in overweight horses. We conclude that devices designed for human patients can be used for laparoscopic access in standing horses, with the use of OHC minimizing the appearance of complications, especially in overweight horses with OW.

Challenges to implement laparoscopic appendectomy as the first-line treatment for acute appendicitis: a fifteen-year experience in a tertiary hospital in Brazil.

the barriers to implement emergency laparoscopy in public teaching hospitals involve issues such as resident learning curves and resource costs and availability. This study was designed to describe the issues facing the implementation of laparoscopic approach for acute appendicitis over 15 years in a single academic center in Brazil. retrospective study of patients undergoing emergency appendectomy from 2004 to 2018. Clinical data were compared to four major actions implemented in the emergency surgical service: minimally invasive surgery training for residents (2007), laparoscopic stump closure using metal clips (2008), 24/7 availability of laparoscopic instruments for emergency surgeries (2010), and third-party contract for maintenance of the laparoscopic instruments and implementation of polymeric clips for stump closure (2013). We evaluated the increase in laparoscopic appendectomy after the implementation of those major changes. we identified 1168 appendectomies during the study period, of which 691 (59%), 465 (40%), and 12 (1%) were open, laparoscopic, and converted, respectively. The implementation of the major changes since 2004 resulted in an increase of laparoscopic appendectomies from 11% in 2007 to 80% in 2016. These actions were decisive in the widespread use of laparoscopy for acute appendicitis (p<0.001). The standardization of the hem-o-lok clip in the treatment of the appendiceal stump made the procedure more feasible, reducing the surgical time using laparoscopic access and increasing the team's adherence, so that this became the route of choice in about 85% of cases in the period from 2014 to 2018, 80% performed by 3rd year resident physicians. No intraoperative complications were noted related to laparoscopic access, even in more complicated appendicitis. There was no mortality reported, no reoperations or readmissions to hospital during a 30-day postoperative period. the development of a feasible, reproducible, and safe technical standardization, associated with continuous cost optimization, are the cornerstones for a consistent and viable change in the current practice for appendectomies in middle and lower-income countries.