[The first experience of robot-assisted bariatric surgery using the Senhance system in patients with morbid obesity]. / Pervyi opyt robot-assistirovannoi bariatricheskoi khirurgii s ispol'zovaniem sistemy Senhance v lechenii patsientov s morbidnym ozhireniem.

OBJECTIVE: To study the results of robot-assisted bariatric surgery using the Senhance system in patients with morbid obesity. MATERIAL AND METHODS: A prospective cohort study included 74 patients who underwent bariatric surgery (Senhance digital laparoscopy system) between January 2022 and May 2023. Of these, 12 patients underwent robot-assisted longitudinal gastrectomy, 20 patients - robot-assisted Roux-en-Y gastric bypass, 36 patients - robot-assisted gastric bypass with one anastomosis/mini-gastric bypass, 6 patients - surgical exploration. We assessed duration of surgery, docking, placement of trocars and robotic manipulators, the need for their intraoperative displacement, incidence of intraoperative complications and conversions to laparoscopic surgery, intraoperative blood loss and early postoperative complications, severity of pain syndrome on the 1st day after surgery. RESULTS: Mean surgery time was 87 [67, 120], 116 [78, 139], 96 [79, 125] and 141 [112, 184] min, respectively. Intraoperative blood loss was less than 50 ml. There were no complications requiring surgical treatment, cardiovascular, respiratory and other complications within 1 month. CONCLUSION: Robot-assisted bariatric surgery using the Senhance system is feasible and safe for patients. Immediate results of robotic surgery are comparable to those after laparoscopy. However, large experience and cost-effectiveness analysis are required to assess the feasibility of robotic systems in bariatric surgery.

[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.

APPLICATION OF LAPAROSCOPIC LIFTING SYSTEMS IN PATIENTS WITH HIGH CARDIORESPIRATORY RISK.

Intra-abdominal hypertension during laparoscopic operations increased the risk of complications from cardiovascular and respiratory systems. An application of laparolifting systems allowed doctors to avoid changes of pneumoperitoneum, although it was associated with technical difficulties in operation performance. The authors used a test in order to determine cardiorespiratory reserve in preoperative period. The reserve was characterized by decrease of stroke volume of the heart against the background of intra-abdominal hypertension. There was noted a reliable increase of complication rate in these patients in case of application of standard laparoscopic operation compared with operation using lifting systems.

[Comparative research of traumatic injury of open hand-assisted laparoscopic anterior resection of the rectum].

The article made a comparative assessment of traumatic injury of open hand-assisted laparoscopic anterior resection of the rectum in lateral and spinal positions. The presented technique of hand-assisted laparoscopic colon and rectal surgery is simple. There are advantages in case of obesity presence (IMT more than 30 kg/m2), in significant shortening of the mesocolon and mesentery, high fixation of splenic flexure and intimate fixation of the spleen, in case of bad preparation of the bowels in partial intestinal obstruction or in case of emergency operation, big cancer size, expressed perifocal inflammation. A comparative analysis of dynamics of hormone stress content and metabolism (cortisol, adrenaline, thyrothrophic hormone) showed their expressed increase in blood during operation after traditional surgery. Less stressed reaction was noted after hand-assisted surgery, especially in overweight patients. An application of low invasive method allowed reduction of hemorrhage, pain syndrome, terms of patient's activation and restoration of intestinal motility after operation.

[Topographically oriented mobilization of the thyroid].

The analysis of clinical experience of the operative treatment of 600 patients with a thyroid pathology has allowed to develop technics of allocation of a return laryngeal nerve depending on the type of an anatomic structure of a gland. It gave the opportunities for the extrafascial removal of a share of a thyroid gland, the more accurate visualization and preservation of the parathyroid glands, located near the nerve and safe central lymphadenectomy.