[Laparoscopic right-side partial nephrectomy with fluorescence imaging in the near infrared spectrum using indocyanine green].

A clinical case of the use of fluorescence imaging in the near infrared spectrum with indocyanine green during laparoscopic right-side partial nephrectomy is presented in the article.

[Bilateral laparoscopic nephrectomy for polycystic kidney disease].

A clinical case of surgical treatment of a patient with autosomal dominant type of polycystic kidney disease, stage 5 of chronic kidney disease and secondary arterial hypertension is presented in the article. The technique of single-stage bilateral laparoscopic nephrectomy, patented by the authors, is described. The practicability and safety of a simultaneous bilateral procedures was demonstrated, as well as the advantage of laparoscopic access for this type of surgical interventions. The successful and prompt procedure allowed the patient to undergone to allotransplantation of a cadaveric kidney as soon as possible.

[Results of laparoscopic pelvic exenterations]. / Rezul'taty laparoskopicheskikh tazovykh ekzenteratsii.

OBJECTIVE: To analyze clinical outcomes after pelvic exenteration for advanced primary or recurrent pelvic cancer. MATERIAL AND METHODS: We analyzed the outcomes in 35 patients after pelvic exenteration for advanced primary or recurrent pelvic cancer (gynecological cancer, urologic cancers, colon cancer). There were 3 (8.57%) men and 32 (91.43%) women. Mean BMI was 26 kg/m2. RESULTS: Total exenteration was performed in 10 (28.57%) patients, anterior exenteration - 18 (51.43%) patients, posterior exenteration - 7 (20.0%) patients. Intraoperative complications (damage to the common iliac vessels) occurred in 1 (2.86%) patient. Mean surgery time was 280 minutes (range 180-600), mean intraoperative blood loss - 400 ml (range 100-2000). Mean postoperative ICU-stay was 24 hours. Major postoperative complications Clavien-Dindo grade 3-4 were detected in 3 (8.57%) patients. One (2.86%) patient died in 84 days after surgery from multiple organ failure due to progression of disease (Clavien-Dindo grade 5). There were 4 (11.43%) patients with complications Clavien-Dindo grade ≥3. Negative resection margin (R0) was achieved in 32 (91.43%) cases. The follow-up period ranged from 2 to 70 months (median 16.5 months). Overall survival was assessed in 25 patients. Other 10 patients or their relatives did not get in touch and therefore did not participate in assessment of survival. Overall 2-year survival assessed in 6 patients with cervical cancer was 24%. Overall 2-year survival estimated in 8 patients with bladder cancer was 100%. A patient with colon cancer lived for 23 months. Among 2 patients with vulvar cancer, 1 patient died in 25 months after surgery, the second one was followed-up for 11 months. Patients with primary multiple tumors were followed-up for 10-21 months. Overall 1-year survival was 100%. One patient died after 21 months. CONCLUSION: Analyzing own findings and world literature data, we can conclude that laparoscopic technique ensures better intra- and postoperative results compared to standard laparotomy. However, there are insufficient data to confirm superiority of laparoscopic approach regarding oncological results.

[Unilateral combined lap partial nephrectomy and pyelolithotomy for ipsilateral tumor & kidney staghorn stone]

OBJECTIVE: To discuss the feasibility, safety, and effectiveness of conventional laparoscopic partial nephrectomy combined with pyelolithotomy for patients with ipsilateral renal tumor and staghorn kidney stone. MATERIALS AND METHODS: Retrospective multicentral comparative study. Group "Combo" was presented by patients with the mentioned combined pathology (n=15). Group "Standart" (n=69) formed from common patients who underwent standard lap partial nephrectomy for renal tumor in the absence of kidney stones. Perioperative factors and results were studied and compared. Video presentation of combined surgical technique is available at: https://youtu.be/fAfYJDvGzsU. RESULTS: Of all patients, no positive margins, no conversions to open surgery or nephrectomy & any complications Clavien >III were detected. There were no any significant differences between the two groups except for OR time (150 [120; 210] vs 130 [100; 180] min; p=0,001). Differences between indexes of WIT (16,27+/-3,8 vs 15,9+/-4,5 min; p=0,107), EBL (200 [150; 300] vs 200 [150; 300] cc; p=0,981), length of stay (7 [6;9] vs 8[6;9] days; p=0,611), intraop complications (0,00 vs 4,3%; p=0,411) and values of postop Clavien III rate (0,00 vs 4,3%; p=0,411) for "Combo" & "Standart" respectively were comparable as well as oncological outcomes. Stone-free rate for combined procedures reached 93,3%. CONCLUSION: conventional laparoscopic partial nephrectomy combined with pyelolithotomy for patients with ipsilateral renal tumor and staghorn kidney stone is safe and efficient alternative to 2-step treatment of this rare disease.

[The current status of surgical treatment of benign prostatic hyperplasia with volume over 80 .]

According to European Association of Urology (EAU), an open simple prostatectomy, holmium laser and bipolar enucleation represent current standard methods for surgical treatment of benign prostatic hyperplasia (BPH) with volume over 80 ml. The transurethral resection of prostate, thulium laser enucleation and laser vaporization are second-line methods. In addition, some novel interventions are currently being developing. The aim of our work was to systematize all current procedures for more convenient use in clinical practice.

[Horseshoe kidney tumor laparoscopic surgery. First 19 cases].

INTRODUCTION: Although horseshoe kidney (HSK) is the most common congenital anomaly of the upper urinary tract, renal cell cancer (RCC) in HSK develops extremely rarely. Until 2012 y. there were less than 200 cases of RCC in HSK published in PubMed. Only five cases of laparoscopic partial nephrectomies and some cases of heminephrectomies have been described in PubMed. AIM: To conduct a multicenter retrospective analysis of laparoscopic surgery for tumors in HSK. MATERIAL AND METHODS: From January 2013 to December 2018 a total of 19 conventional laparoscopic interventions were performed in patients with RCC in HSK, including 1 isthmusectomy, 5 partial nephrectomies and 13 heminefrectomies. In addition, 16 divisions of isthmus were done in 15 patients. The video describing our operation technique is available on: http://youtu.be/nk-WlbjNtIs . RESULTS: There were no conversions to open surgery and mortality as well as intra- and postoperative complications of Clavien grade 3 or higher. Warm ischemia time during partial nephrectomy didnt exceed 19 minutes. Operative time ranged from 110 to 270 min, while max estimated blood loss was 400 ml. All patients were followed for 6 month and no case of disease recurrence or progression was noted. CONCLUSIONS: The small number of laparoscopic interventions in patients with RCC in HSK doesnt allow to carry out a proper statistical analysis and draw certain conclusions. We presented the largest experience available in the literature and our results demonstrate the efficacy and safety of conventional laparoscopic technologies in the treatment of RCC in HSK.

[Laparoscopic ileal ureteral substitution. Results of the first 40 operations].

INTRODUCTION: Despite the twenty-year history of laparoscopic ileal ureteral substitution, the literature is lacking studies reporting its outcomes, and those few are mainly case reports. Besides, they usually describe surgery from combined access, when the ileal segment resection and ileo-ileal anastomosis are performed from mini-laparotomy, and the remaining stages are done endoscopically. AIM: To conduct a multicenter retrospective analysis of our series of patients undergoing laparoscopic ileal ureteral substitution using only endoscopic access. MATERIAL AND METHODS: From 2010 to 2017, 48 ureters were replaced completely laparoscopically in 40 patients. Of them, 33 patients underwent total ureteric replacement, and the others had a subtotal ileal ureteral substitution. Video describing the operation technique is available on https://youtu.be/IeA60pSiUBE. RESULTS: The mean operating time was 335 minutes, and the estimated blood loss was 221 ml. Intraoperative complications (7.5%) were resolved during surgery. No patients required conversion to open surgery. There was no mortality. Postoperative Clavien III complications were observed in 7.5% of patients. The mean length of hospital day was 13.5 days. Functional results were followed from 6 months to 7 years. CONCLUSIONS: The presented material is the largest available in the literature, and the results, including long-term functional outcomes, demonstrate the efficacy and safety of laparoscopic technologies in the treatment of extensive strictures and obliterations of the ureter.

[Comparative study of extraperitoneoscopic adenomectomy and monopolar transurethral resection in surgical management of benign prostatic hyperplasia with prostate volume of 100180 cm3].

INTRODUCTION: Monopolar transurethral resection (M-TUR) is a standard for comparing various endoscopic techniques for benign prostatic hyperplasia (BPH), including extraperitoneoscopic adenomectomy (EA). AIM: To compare the effectiveness and safety of M-TUR and EA in the surgical management of BPH with a prostate volume of 100-180 cm3. MATERIALS AND METHODS: Medical records of 797 patients, who underwent surgery for BPH from 2011 to 2016, were retrospectively evaluated. The study comprised patients with a prostate volume of 100-180 cm3, who received either EA (group 1, n=34) or M-TUR (group 2, n=24). RESULTS: The groups did not statistically significantly differ in age (69.3+/-6.9 vs 71.4+/-6.4 years in group and 2, p=0.328); complication rate (4 (11.7%) and 6 (25%), respectively, p=0.31); increase in the maximum urinary flow (10 ml/ s (Q1-Q3: 10.0-10.5), 13.5 ml/s (Q1-Q3: 7.5-17), respectively, p=0.538); postoperative hospital stay (11 (Q1-Q3: 10-14) and 10.5 (Q1-Q3: 8-17), respectively, p=0.875). There was statistically significant difference in operative time (190 and 82.5 min in the 1st and 2nd groups, respectively, p=0.041), and in blood loss (200 ml (Q1-Q3: 150-300) and 400 ml (Q1-Q3: 400-500), respectively, p=0.008). During 12 month follow-up, only 5 (20.8%) patients in the 2nd group (p=0.012) needed repeat surgery. Urinary incontinence of different severity at the time of discharge from hospital was also observed only in 4 (16.6%) patients the 2nd group (p=0.036). CONCLUSION: EA and M-TUR have similar safety and effectiveness in the surgical management of patients with BPH with the prostate volume of 100-180 cm3. EA is associated with longer operative time than M-TUR, but is accompanied by less blood loss, does not require repeat surgery, and confers less risk for urinary incontinence.

[Laparoscopic pyelolithotomy for staghorn kidney stones. multi-center study].

AIM: To analyze the effectiveness and safety of laparoscopic pyelolithotomy (LP) in treating staghorn stones. MATERIALS AND METHODS: A multicentre retrospective analysis of the results of LP performed from January 2004 to December 2016 was conducted. INCLUSION CRITERIA: patients with staghorn calculi K3-K4, who underwent LP as an alternative to percutaneous nephrolithotripsy. The analysis included the incidence and structure of intra- and postoperative complications, the causes of access conversion, operating time, duration of postoperative hospital stay and stone clearance. RESULTS: A total of 137 patients met the inclusion criteria, including 78 (56.93%) men. There was no mortality and access conversion. Intraoperative complications occurred in 2 (1.46%) patients. Operating time was 130 [100; 150] min, blood loss was 150 [100; 200] ml. No need for blood transfusion was observed. The cumulative rate of postoperative complications was 5.11%, stone clearance was achieved in 86.13% of observations, the duration of postoperative hospital stay was 7 [7; 11] days. CONCLUSION: In cases of dense staghorn calculi located in a large "extra-renal" pelvis and have calyceal branches equal to the diameter of their necks, laparoscopic pyelolithotomy is an alternative not only to open, but also to percutaneous surgery.

[An injury of major vessels during laparoscopic procedure in urology. Surgical management by analyzing of clinical cases].

An injury of major vessels is a life - threating complication in laparoscopic urology. Review of the literature and analysis of own cases have been performed. The authors offer original surgical management with using hand-assistant technic. It has advantages of open and laparoscopic approach.

[The role of extraperitoneoscopic adenomectomy in the management of benign prostatic hyperplasia greater than 80 cm3].

INTRODUCTION: The current standard of surgery for benign prostatic hyperplasia (BPH) greater than 80 cm3 includes open adenomectomy and holmium enucleation. Transurethral resection and laser vaporization are second line interventions, while the role of laparoscopic extraperitoneal adenomectomy is not fully understood. AIM: To evaluate the role of laparoscopic technique as a surgical modality for BPH greater than 80 cm3. MATERIALS AND METHODS: This study retrospectively evaluated the results of 79 patients (mean age 68 years) who underwent transcapsular extraperitoneoscopic adenomectomy from 2011 to 2016. RESULTS: The mean operative time was 206 (100-450) min; the prostate volume was 134 (80-300) cm3, blood loss was 256 (30-1200) ml. The I-PSS score after surgery decreased by an average of 18.3 points, the maximum urinary flow rate increased by 12 ml/s, the residual urine volume reduced from 147 to 28 ml. 35 (44%) patients underwent simultaneous operations (inguinal hernioplasty, cystolithotomy, etc.). There was one intraoperative complication, and 10 (12.6%) patients had postoperative complications. There were no conversions to open surgery. Incidental prostate cancer was detected in one patient. None of the patients required repeat surgery for infravesical obstruction. CONCLUSION: Extraperitoneoscopic adenomectomy is efficient, safe and reproducible surgical modality able to take the place of open surgery. There is a need for an evidence base to support the optimal choice between various minimally invasive techniques. Currently, laparoscopic procedure is more justified in patients with concomitant diseases, which can be simultaneously corrected.

[DELAYED PORT DEPLOYMENT FOR HAND-ASSISTED LAPAROSCOPIC DONOR NEPHRECTOMY. CASE REPORT AND LITERATURE REVIEW].

The standard method of surgical treatment of end-stage renal failure is kidney transplantation. A laparoscopic method of organ retrieval from a living donor is currently preferred. The techniques of laparoscopic surgery include hand-assisted nephrectomy and "pure" laparoscopic nephrectomy. We present analysis of the literature data and our own data on the use of the advantages of each of the techniques. A case of complication associated with the use of hand-port from our own practice is described.

[Laparoscopic transperitoneal and retroperitoneal partial nephrectomy].

The article presents a modern approach to partial nephrectomy, and evaluation of individual results of laparoscopic partial nephrectomies. The study included 38 patients who underwent laparoscopic partial nephrectomy in the period from 2006 to 2011. Kidney cancer was diagnosed in 30 patients, other diseases--in 8. Mean duration of surgery was 225 min. Warm ischemia time was less than 36 minutes. The average postoperative period was 8,7 days. Despite the technical difficulties in the development and implementation of laparoscopic partial nephrectomy, the benefits of minimally invasive techniques are obvious, and the operation can comply with all the principles of oncology and become an alternative to open surgery.

[Laparoscopic transperitoneal and extraperitoneal reconstructive plastic surgery on the ureter].

The results of laparoscopic reconstructive operations on ureter distal of ureteropelvic junction are analyzed. The study included 19 patients with different obstructive lesions of the ureter who underwent surgery in the period from 2003 to 2012. According to the method of surgical treatment, the patients were divided into three groups. Ureteroureteroanastomosis was formed in 6 patients, ureterocystoanastomosis--in 5 patients, and ureterolysis was performed in 8 patients. Mean duration of operations ranged from 113 to 210 minutes. There were no requirements of conversion to open surgery in any case. Significant blood loss and other intraoperative complications were not observed. It is concluded that laparoscopic reconstructive plastic surgery in these patients can be performed with good effect equal to open surgery.

[Glial tumors of the brain: classification, present-day aspects of immunopathogenesis and immunogenetic diagnostics].

Glial tumors of the brain present a complicated problem in neurosurgery due to the peculiarities of their growth biology, their prevalence, infiltrative growth and diagnostic difficulties. The complexity of treatment, which includes surgical removal of a tumor, radiotherapy, chemotherapy, and immune correction, makes the problem even more topical. Modem classification of glial neoplasms is of no less importance, because treatment depends on the histologic structure of a tumor. Thereupon, the authors of the article pay special attention to the modem WHO classification of gliomas. As immune diagnostics and treatment are indispensable in modern neurooncology, application of neurospecific oncologic markers is being widely introduced into clinical and scientific practice in many scientific centers. However, there are no objective tests to verify the diagnosis of astrocytic glioma with reliable accuracy. Hereditary syndromes associated with glial tumors have been distinguished and are being studied. The most interesting and promising direction is research into genetic anomalies in patients with glial processes.

[Transabdominal laparoscopic nephrectomy and renal cyst fenestration]. / Transabdominal'naia laparoskopicheskaia nefréktomiia i fenestratsiia kist pochek.

Since November 1994, when the first laparoscopic nephrectomy was made in Russia, 36 laparoscopic operations have been made on the kidney. 11 were nephrectomies, 21 were fenestrations of renal cysts, 4 transabdominal laparoscopies were unsuccessful.

[Immunoenzyme analysis of ferritin in diagnosing brain tumors]. / Immunofermentnyi analiz ferritina v diagnostike opukholei golovnogo mozga.

A procedure was developed to purify ferritin from the human brain tissue. The preparation is a heavy chain of ferritin. The level of ferritin in biological fluids was evaluated using the sandwich solid-phase immunoassay. This fraction of ferritin was found in the cerebrospinal fluid of patients with brain tumors. Content of the ferritin heavy chain in cerebrospinal fluid correlated with the rate of brain tissue malignancy.