[Integration of ICG-fluorescence cholangiography into the safety system of laparoscopic cholecystectomy]. / Integratsiya ICG-fluorestsentnoi kholangiografii v sistemu bezopasnosti laparoskopicheskoi kholetsistektomii.

THE AIM OF THE STUDY: Is evaluating the possibility of integrating ICG-fluorescent cholangiography into the general safety system for laparoscopic cholecystectomy to prevent damage to the extrahepatic bile ducts by working out the methodological aspects of navigation technologies. MATERIALS AND METHODS: The analysis of literature data on various approaches to improve the perioperative identification of anatomical structures during laparoscopic cholecystectomy, including the ICG-fluorescent cholangiography, was carried out. This program was implemented during the provision of elective surgical care to 24 patients with cholelithiasis who underwent laparoscopic cholecystectomy with ICG-fluorescent navigation. RESULTS AND DISCUSSION: The developed program included: preoperative assessment of the anatomy of the biliary tree using MRCP; intraoperative technique of safe laparoscopic cholecystectomy with mandatory application of the concept of «critical view of safety¼ (CVS), which allows the most effective identification of the necessary anatomical structures; the use of ICG-fluorescent cholangiography, which allows to improve the control of anatomical structures at all stages of the operations. CONCLUSIONS: The first experience of using ICG-fluorescent cholangiography testifies to the high informative value of the method, the possibility and prospects of integrating the technology into a comprehensive safety system during laparoscopic cholecystectomy.

[Optimal dates of surgery for acute calculous cholecystitis]. / Vybor optimal'nykh srokov vypolneniia operativnogo vmeshatel'stva pri ostrom kal'kuleznom kholetsistite.

OBJECTIVE: To analyze the results of surgical treatment of acute calculous cholecystitis depending on dates of surgery. MATERIAL AND METHODS: There were 123 patients with acute calculous cholecystitis in 2017. The sample enrolled 111 females (90.2%) and 12 (9.8%) males. Mean age of patients was 63.4±5.7 years. Patients were divided into 4 groups depending on dates of surgery. Group A - 18 (16.2%) patients with destructive forms of cholecystitis. These patients underwent surgery after a short preoperative preparation. Group B comprised of 32 patients (28.8%) who were operated within 72 hours. Group C enrolled 34 patients (30.7%). These patients underwent operation within 7-12 days after clinical manifestation of disease. Group D enrolled 27 patients (24.3%). Delayed surgical strategy was applied in this group. Surgical treatment was scheduled 2-3 months later. Duration of surgery, intraoperative technical features, length of hospital-stay and postoperative morbidity were studied. RESULTS: Similar outcomes were observed in groups A and B. Group B was characterized by less duration of surgery and hospital-stay. The most significant technical difficulties arose in group C. The best results were achieved in group D. CONCLUSION: Surgical treatment of acute calculous cholecystitis within 72 hours after clinical manifestation is the most preferable. However, surgical treatment should be performed in few months if medication is effective.

[The training concept of laparoscopic surgery in post-graduate education of doctors].

The active use of virtual devices and laparoscopic boxes for the control of the achieved skills level are the general idea of the suggested concept of the laparoscopic surgical training. The in vivo training make sense only after finishing the "virtual" course. The complete realization of these new concept of laparoscopic surgery training is possible only in frames of the endoscopic surgery department of the mighty hospital center. The organization of such center promise to rise the level of doctors' training.

[The double-port laparoscopic cholecystectomy].

The modern laparoscopic surgery trents the minimization of the access, which led to the workout of the novel surgical access for the laparoscopic cholecystectomy using only two ports. The advantages of the access, empowered by the positive authors' experience is cited.

[Evolution of operative approach in abdominal surgery]. / Evoliutsiia operatsionnogo dostupa v abdominal'noi khirurgii.

The severity of postoperative course after surgery of abdominal organs in the majority of cases depends rather on the length of the incision of anterior abdominal wall that on the extent of surgical manipulations directly on the viscera. Various methods of low invasive surgical procedures possess not only undeniable advantages in comparison with routine surgical technique, but also some defects. Combination of laparoscopic technique and surgical operation from mini-approach permits to avoid disadvantages characteristic to each of them. Assisted low-invasive operations could be successfully used on many organs of abdominal cavity.