[The results of clinical application of the mesh with anti-adhesive fluoropolymer coating in laparoscopic intraperitoneal repair of primary ventral hernia]. / Rezul'taty klinicheskogo primeneniya setchatogo endoproteza s antiadgezivnym ftorpolimernym pokrytiem pri laparoskopicheskoi intraperitoneal'noi plastike pervichnykh ventral'nykh gryzh.

OBJECTIVE: The purpose of the study was to evaluate the results of using fluoropolymer-coated mesh during intraperitoneal onlay mesh hernia repair in patients with primary ventral hernias. MATERIAL AND METHODS: The multicenter, non-randomized, controlled clinical study included 88 patients of both sexes who were operated on using a laparoscopic approach using the IPOM technique for a primary ventral hernia. The duration of observation ranged from 3 to 12 months. In the main group, 48 patients received fluoropolymer-coated meshes (Ftorex). A comparison was made with a retrospective group of 40 patients who were treated with anti-adhesive collagen-coated meshes (Parietene composite, Parietex Composite, Symbotex). RESULTS: The number of early and late postoperative complications in the groups did not have significant differences, at the same time, their number was lower in the group of patients in whom fluoropolymer-coated meshes were used. Most of the complications corresponded to Clavien-Dindo class I and II and did not pose a significant threat to health. There were no recurrences of hernias observed in patients included in the study. There were slightly more adhesions in the fluoropolymer-coated mesh group (35.4% vs. 25.0% in the collagen-coated mesh group). The quality of life of patients in the study groups did not differ. CONCLUSION: In laparoscopic IPOM hernia repair fluoropolymer-coated meshes are not inferior in effectiveness and safety to traditionally used collagen-coated meshes and can be recommended for use in patients with primary ventral hernias.

[Histological changes in intraperitoneal onlay mesh (IPOM) with synthetic and biological meshes. Results of the chronic experiment]. / Gistologicheskie izmeneniya pri intraperitoneal'noi plastike (IPOM) sinteticheskimi i biologicheskimi endoprotezami. Rezul'taty khronicheskogo eksperimenta.

OBJECTIVE: The objective of the study was to analyze histological changes in the site of the meshes FTOREX, FTOREX coated with carboxymethylcellulose, Ventralight ST, Symbotex, REPEREN-16-2 and decellularized porcine peritoneum on the parietal peritoneum of the pig. MATERIAL AND METHODS: At laparoscopy, 6 different meshes were placed intraperitoneally in each of the 3 pigs. After 90 days, the animals were taken out of the experiment. After staining with hematoxylin and eosin, quantitative morphometry and counting the number of vessels and cells in the interstitium in the areas of the mesh and peritoneum were performed. An immunohistochemical study with an antibody to pancytokeratins assessed the state of the initial peritoneum and neoperitoneum. RESULTS: According to morphological characteristics, the meshes were divided into 3 groups: 1) with fluoropolymer coating FTOREX, 2) Ventralight ST and Symbotex, 3) REPEREN and decellularized peritoneum. In group 1, the surface area of the mesh threads was optimal in terms of the arrangement and arrangement of the threads relative to each other. This contributed to the formation of a relatively dense fibrous framework and a place to preserve the underlying peritoneum involved in the formation of the neoperitoneum. Despite the smallest surface area of the threads, in group 3, the greatest fibroblastic reaction was noted. Inflammatory changes were the least pronounced in group 1. They were the greatest in group 3, where there was a pronounced leukocyte reaction, combined with the processes of metaplasia, the development of fibrinoid necrosis, and the progression of the secondary inflammatory process. In group 1, the optimal ratio of newly formed vessels was noted, in group 2 - veins prevailed over arteries, in group 3 - the number of vessels was minimal. Immunohistochemical study showed that in group 1, mesothelial cells covered almost the entire surface of the implant, and there were also areas of preserved basic peritoneum. In group 2, mesothelium also covered most of the surface of the meshes, but the underlying peritoneum was absent. In group 3, on the contrary, a significant number of extended areas not covered with mesothelium were revealed. CONCLUSION: The conducted morphological and morphometric study showed that the most balanced ratio of the components of the newly formed fibrous tissue and blood vessels is observed when using implants with a fluoropolymer coating FTOREX. At the same time, the remaining basic peritoneum actively participated in the formation of the neoperitoneum. The Ventralight ST and Symbotex meshes also contributed to the formation of a full-fledged fibrous tissue and adequate vascular proliferation, however, they prevented the preservation of the underlying peritoneum, which practically excluded its participation in the formation of the neoperitoneum. The REPEREN mesh and decellularized porcine peritoneum led to the least balanced cell and vascular proliferation and the greatest fibroplastic reaction, which could further negatively affect the state of the formed scar.

[Safety of mesh with fluoropolymer coating during intra-abdominal placement in large animals: results of the pilot study]. / Bezopasnost' setchatykh endoprotezov s ftorpolimernym pokrytiem: rezul'taty pilotnogo issledovaniya.

OBJECTIVE: When performing laparoscopic intraperitoneal hernioplasty (IPOM), endoprostheses made of fluoropolymers are often used. However, there is no data in the literature on the intra-abdominal use of inexpensive polyester prostheses with a fluoropolymer coating compared to composite implants. Thus, the aim of the pilot study was a preliminary assessment of the safety profile of FTOREX mesh endoprostheses during intra-abdominal placement in large animals. MATERIAL AND METHODS: 6 endoprostheses were installed laparoscopically intraperitoneally in each of the 3 pigs: 1) FTOREX; 2) FTOREX with a layer of carboxymethylcellulose; 3) REPEREN-16-2; 4) SYMBOTEX; 5) VENTRALIGHT ST; 6) decellularized pork peritoneum. Fixation was performed with a herniator, transfascial sutures were not used. Relaparoscopy was performed after 45 days, and withdrawal from the experiment was performed after 90 days. Performance characteristics, signs of deformation and retraction, parameters of spike formation were evaluated. RESULTS: All the animals survived, no complications were observed. There were no clinical manifestations or behavioral reactions indicating the presence of adhesions. The most convenient to use were the SYMBOTEX and FTOREX implants (5.0 points each). By the end of the experiment, deformation and retraction were noted in both variants of the FTOREX implants and the REPEREN prosthesis. These changes were completely absent only when using the SYMBOTEX endoprosthesis. According to the number of implants with adhesions, by the end of the observation, both variants of FTOREX prostheses occupied an intermediate position between the Reference (the worst indicator) and VENTRALIGHT ST (the best indicator). However, both FTOREX endoprostheses showed the best performance among all implants in the integral assessment of adhesions, as well as in terms of parameters such as the area and appearance of adhesions, and in terms of the strength of the joints, they were second only to the VENTRALIGHT ST endoprosthesis (0.67 vs. 0.5 points). During the study, there was no reliable dependence of deformation, retraction and adhesion formation indicators on the type of implant. CONCLUSION: The results of the pilot study showed that all the implants used did not cause any clinically significant adverse reactions or complications. FTOREX endoprostheses with their intraperitoneal installation have anti-adhesive properties that are not inferior to VENTRALIGHT ST or SYMBOTEX composite implants. However, having less rigidity, they are more often deformed and subjected to retraction.

[Robotic-assisted surgery: yesterday, today, tomorrow]. / Roboticheskaya khirurgiya: vchera, segodnya, zavtra.

OBJECTIVE: Analysis of development of «robotic surgery¼ on the basis of historical prerequisites, review of the possibilities of the new Senhance robotic surgical system and determination of further perspective. MATERIAL AND METHODS: A prospective group of 51 patients with surgical pathology who underwent surgical interventions using the new Senhance robotic system was analyzed. The study included 51 patients. Robot-assisted cholecystectomy was performed in 20 patients, 31 patients underwent robotic transabdominal preperitoneal plastic surgery. RESULTS: A short-term analysis of intraoperative and early postoperative data showed the safety of using the Senhance robotic complex for the patient. The ergonomics of this system contributes to significantly less fatigue of the surgeon during the operation, increasing its efficiency and safety. CONCLUSION: The emergence of competitive robotic systems contributes to the dynamic development of robotic surgery, which in turn will lead to a reduction in the cost of these technologies in the future. Innovative solutions used in modern robotic complexes are based on the principles of machine learning, which in due time will make the «robot surgeon¼ not just a tool, but a full-fledged member of the operating team.

[The first clinical experience of using the new Senhance remote-controlled robotic system in general surgery in Russia]. / Pervyi klinicheskii opyt ispol'zovaniya novoi teleupravlyaemoi robotizirovannoi sistemy Senhance v obshchei khirurgii v Rossii.

Until recently, clinical studies in the field of robotic-assisted surgery have been conducted in Russia only on the basis of the DaVinci system. The advent of a new robotic system separated the concept of «robotic surgery¼ from DaVinci. An increase in the number of alternative surgical robots will expand the possibilities of studying the functionality of these systems, differences in their operation, safety and efficiency for patients, and convenience for surgeons. OBJECTIVE: Evaluation of own initial experience of using Senhance robotic surgical system in the work of the general surgery department. MATERIAL AND METHODS: A prospective collection of data on the surgical treatment of patients with various pathologies using the Senhance robotic system was carried out, followed by its analysis in relation to the duration of the operation, the incidence of intraoperative complications and the need for conversion, as well as the volume of blood loss and early postoperative complications. RESULTS AND DISCUSSION: Now, only perioperative, and early postoperative data are available for analysis. While accumulating our own experience with the Senhance system, we concluded that, since the transition from robotic to manual laparoscopic surgery and vice versa does not require changing of access points and is performed quickly, it is practically expedient to perform some stages of the operation manually, and others using surgical robot. For example, with the help of manual laparoscopy, it is more ergonomic to perform wide tractions and movements of organs and tissues. At the same time, robotic surgery has undeniable advantages when performing lymph node dissection, performing manual sutures, including anastomoses, which does not lead to an increase in the duration of the intervention. CONCLUSION: Presented experience of using the Senhance system has shown that it meets the declared indicators of convenience, efficiency and safety of operations in general surgery.

[One-anastomosis gastric bypass with a short limb]. / Zheludochnoe shuntirovanie s odnim anastomozom na korotkoi petle.

OBJECTIVE: To develop an acceptable method of surgical treatment of patients with obesity grade 1 and 2 in accordance with the following criteria: high safety, no risk or minimal risk of intestinal malabsorption, no limitations for postoperative gastrointestinal examination, no need for organ resection and surgical reversibility in case of necessity. MATERIAL AND METHODS: In accordance with the above-mentioned criteria, we have modified OAGB (one-anastomosis gastric bypass). A gastric tube was formed from a lesser curvature using 33Fr stomach catheter with a length of at least 25 cm. Manual retrogastric retrocolic anastomosis in «end-to-side¼ fashion was performed within 20 cm from the ligament of Treitz. This type of anastomosis made it possible to preserve gastric tube length as much as possible that reduces the risk of jejunogastroesophageal reflux. RESULTS: There were 16 patients (15 females and 1 male) aged 23-48 years for the period from June 2019 till March 2020. Mean weight of patients was 86.12 kg (range 62-124). Mean BMI was 35.15 kg/m2 (ranged 21.96-39.62). In 6 months after surgery, all patients achieved normal BMI. Man BMI dropped to 23.8 kg/m2. Minimal excessive weight loss was 81.8%, maximal excessive weight loss - 125%. Control esophagogastroduodenoscopy was performed in 5 patients after 6 months and later. During retrograde duodenoscopy, we visualized major duodenal papilla in all cases using a flexible endoscope with standard optic system. CONCLUSION: The proposed modification of one-anastomosis gastric bypass with a short limb is a safe and effective procedure in bariatric surgery. This surgery ensures postoperative diagnostic and therapeutic endoscopic procedures in all parts of stomach and duodenum. This method could be recommended for surgical treatment of patients with obesity grade 1 and 2 after additional clinical trials and analysis of long-term results.

[Existing and forward-looking ways to prevent adhesions in IPOM hernia repair. A research overview]. / Profilaktika obrazovaniya spaek pri intraperitoneal'noi gernioplastike (IPOM).

IPOM intraperitoneal hernia repair, in comparison with other abdominal wall reconstruction methods, has a number of significant advantages. Among them are a reduction in operative time, low rate of surgical site infections, quick rehabilitation, and good cosmetic results. At the same time, one of the main constraining factors for its widespread use is the rather high frequency of adhesion formation between the implant and the abdominal organs. The first way to solve this serious problem is to improve the structure of the implant itself, and in the first place, its anti-adhesive layer. The second is the search for adjuvant tools that work in «problematic¼ areas, prone to adhesions formation, such as the points of implant fixation, its edges, or the areas of damage to antiadhesive layer due to a violation of the operative technique. It is desirable that they could exert their effect also in other parts of the abdominal cavity, which, despite the absence of a zone of «active¼ intervention, can also undergo adhesions. Based on this, the purpose of this review was to summarize modern data on the anti-adhesive activity of both composite implants and specialized membranes and liquid agents.

[Minimally invasive ventral hernia repair: apply or save?] / Maloinvazivnye tekhnologii v gerniologii: primenyat' nel'zya ekonomit'.

Treatment of patients with ventral hernias remains one of the most pressing problems of abdominal surgery. Surgeons are trying to find a «gold standard¼ for the treatment of this pathology. Great hopes are placed on minimally invasive techniques, however, due to their high cost, they do not yet find mass distribution in everyday practice. In our opinion, this is short-sighted. We tried to analyze the feasibility of using minimally invasive techniques in the treatment of patients with ventral hernias of various locations, from the position of clinical and economic efficiency.

[Are large adrenal neoplasms technical limitation for laparoscopic adrenalectomy?] / Iavliaiutsia li bol'shie razmery novoobrazovaniia nadpochechnika tekhnicheskim ogranicheniem k vypolneniiu laparoskopicheskoi adrenaléktomii.

AIM: To study surgical features of laparoscopic adrenalectomy in patients with large adrenal neoplasms. MATERIAL AND METHODS: The results of 32 laparoscopic adrenalectomy procedures were analyzed in patients with adrenal neoplasms over 5 cm. The control group consisted of 67 patients with adrenal neoplasms up to 5 cm. RESULTS: There were significant differences in duration of operations (96.3±13.44 min vs. 67.2±11.07 min; p<0.05) and some postoperative variables. Postoperative morbidity was similar (9.4% vs. 7.5%; p>0.05). CONCLUSION: Laparoscopic adrenalectomy for adrenal neoplasms from 5 to 8-9 cm is feasible, effective and safe surgical procedure.

[Pectoral-retroauricular approach for endoscopic parathyroidectomy (experimental study)]. / Pektoral'no-retroaurikuliarnyi operativnyi dostup dlia éndoskopicheskoi paratireoidéktomii.

AIM: To develop and investigate in the experiment the method of endoscopic parathyroidectomy in order to prevent intraoperative 'conflict of the instruments' and to reduce surgical trauma via extracervical approach. MATERIAL AND METHODS: The results of 10 experimental endoscopic parathyroidectomies with original pectoral-retroauricular approach were analyzed. RESULTS: Mean time of surgery was 77.8±10.2 minutes (65-97), mean time of surgical exposure - 50.3±6.7 minutes (41-59). Visualization and identification of parathyroid glands were achieved in 100% of cases. Recurrent laryngeal nerve was preserved in 100% of cases. CONCLUSION: Original endoscopic pectoral-retroauricular approach for parathyroidectomy is methodologically and technically justified and can be recommended for clinical application.

Pneumoperitoneum risk prognosis and correction of venous circulation disturbances in laparoscopic surgery. A pilot study.

BACKGROUND: This study was initiated to find a method of determining the prognosis for possible changes in hemodynamic and respiratory parameters in patients with pneumoperitoneum (PP). METHODS: We devised a model for a pseudopneumoperitoneum (PPP), which is created by encircling the wide pneumochamber on the entire abdomen and inflating it to a preset pressure. To verify the prognostic possibilities of the proposed model, we studied the pneumotachygraphy parameters, noninvasive and invasive monitoring parameters of PPP after induction of anaesthesia, and venous circulation disturbances, as well as the medical effect of the intermittent sequential compression device. RESULTS: In healthy patients, the restrictive lung syndrome did not approach the risky limit. In patients >/=60 years old, this syndrome was very close to the limit. In a number of patients with serious cardiovascular and pulmonary pathology, the pressure of >10 mmHg was considered to be intolerable. Lung compliance, which was the parameter most sensitive to the increased intraabdominal pressure, was 47 +/- 10 at baseline, and 29 +/- 4 (p > 0.05) at both PPP and real PP (14 mmHg). CONCLUSIONS: The PPP model is quite similar to the real PP and can be used for preoperative prognosis in laparoscopic surgery. The elevated intraabdominal pressure results in a significant disturbance of venous blood flow in the lower extremities. The use of the device for peristaltic pneumomassage of the lower limbs is effective in correcting negative changes in venous hemodynamics in laparoscopic surgery.

Protein proteinase inhibitor therapy in experimental pancreatitis: pharmacological characterization of the inhibitor.

The pharmacodynamical properties of the duck ovomucoid and its effect on the development of experimental pancreatitis in rats have been studied. It has been shown that after intravenous injection the ovomucoid initially accumulated in the liver, kidneys and blood, while after intraperitoneal injection--mainly in the pancreas and kidneys. The inhibitor is removed from circulation by renal filtration, one-half of the injected protein being removed for 4 hr. For the treatment of experimental pancreatitis two modes of ovomucoid administration were used: intravenous and combined (intravenous/intraperitoneal). The ovomucoid intravenous injection in a dose of 16,300 ATU/kg/24 hr resulted in decrease of both the trypsin-like activity and the level of the trypsinogen activation peptide in the blood to the level in intact rats and also in reduction of the primary pancreas destruction. The same effect observed in the case of the ovomucoid combined injection, but with a lower intravenous dose.

[The effect of exogenous protein--a proteinase inhibitor--on the development of experimental pancreatitis in dogs]. / Vliianie ékzogennogo belka--ingibitora proteinaz--na razvitie éksperimental'nogo pandreatita u sobak.

Small doses of an exogenous protein inhibitor of proteinases ovomucoid, isolated from duck egg-white, exhibited distinct therapeutic effects in acute pancreatitis of dogs. The inhibitor decreased the lethality rate and exceeded the base Kunitz trypsin inhibitor in its efficiency.