[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.

[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.

[The minimally invasive video-assisted parathyroidectomy for primary hyperparathyroidism]. / Miniinvazivnaia videoassistirovannaia paratireoidéktomiia pri pervichnom giperparatireoze.

AIM: To study feasibility, effectiveness and safety of minimally invasive video-assisted parathyroidectomy in patients with primary hyperparathyroidism; to define the advantages and disadvantages of this technique compared with conventional open surgery. MATERIAL AND METHODS: The study includes the results of 33 minimally invasive video-assisted parathyroidectomies performed in patients with primary hyperparathyroidism. The control group included 36 patients who underwent conventional open surgery. RESULTS: There were significantly increased time of surgery in the main group (41.2±12.7 min vs. 28.4±10.9 min, p<0.05), decreased need for postoperative analgesia (1,2±0.3 vs. 1.9±0.5 days, p<0.05) and significantly longer postoperative scar (1.8±0.2 vs. 6.2±0.5 cm, p<0.01). Incidence of complications was similar in both groups (6.1% vs. 8.3%, p>0.05). CONCLUSION: Minimally invasive video-assisted parathyroidectomy for primary hyperparathyroidism is feasible, safe and effective intervention that improves early postoperative course and cosmetic outcomes.

[Strategy of surgical treatment of strangulated inguinal hernias in elderly and senile age.]

We analyzed the results of treatment of 80 patients of elderly and senile age with strangulated inguinal hernias, which were divided into two groups. From 2011 to 2014 were treated 58 patients (group 2) - in the treatment of this group used the traditional approach without the use of endovideosurgical technologies. From 2015 to 2016, it treated 22 patients (group 1) in the treatment of this group used individual diagnostic and treatment tactics with the use of diagnostic laparoscopy and laparoscopic hernioplasty. In the course of work were developed indications and contraindications to the use of prosthetic hernioplasty and endovideosurgical methods. The proposed algorithm allowed to reduce the level of complications from 27,6% (16) to 4,5% (1) (p<0,05) and local complications from 24,1% (14) to 4,6% (1) (p<0,05), as well as the fatality rate from 10,3% (6) to 0%.

[Potentialities of edovideosurgery in treatment of patients with acute adhesive intestinal obstruction].

The article analyses an experience with treatment of 96 patients with acute intestinal obstruction caused by peritoneal commissures. The technique of laparoscopic operations and principles of their realization are described. The observation of these principles is shown to give high effectiveness and safety of endovideosurgical interventions for acute intestinal obstruction. Their advantages consist in minimal invasiveness, short periods of postoperative rehabilitation and little frequency of postoperative complications.

[Programmed sanation laparoscopy in treatment of peritonitis].

An analysis of experiences with endovideosurgical sanation of the abdominal cavity was analyzed in 168 patients with diffuse peritonitis which complicated the course of different acute diseases. Relaparoscopy might be programmed and "on request". Programmed laparoscopy allowed adequate sanation of the abdominal cavity in most cases. It was impossible in 11.3% of cases associated with a pronounced commissural process and uncared peritonitis with formed pyogenic abscesses in the abdominal cavity. The indications and contraindications to laparoscopic sanation of the abdominal cavity are described.

[The place of endovideosurgical interventions in treatment of inguinal hernias].

Endovideosurgical hernioplasty was performed in 3020 patients. Complex forms of inguinal hernias were diagnosed in 280 of them. These forms included: bilateral and combined inguinal hernias, inguinoscrotal hernias, sliding hernias, fixed and irreducible inguinal hernias, recurrent inguinal hernias after traditional herniorrhaphy and recurrent hernias after endovideosurgical hernioplasty. Original technical maneuvers are described, indications and contraindications were established, complications and results of treatment of patients with inguinal hernias were analyzed and evaluated. Recommendations are given for the treatment of patients with complex forms of hernias.

[Endovideosurgery in treatment of Meckel's diverticulum].

The authors made an analysis of using endovideosurgery in diagnosing and treatment of Meckel's diverticulum and its complications in 18 patients. They describe signs and diagnostic criteria of the disease. Adequate treatment was proved to be possible by laparoscopy.

[Features of video laparoscopic interventions in patients operated earlier on abdominal organs]. / Osobennosti videoéndokhirurgicheskikh vmeshatel'stv u bol'nykh, ranee operirovannykh na organakh briushnoi polosti.

Laparoscopic operations in patients who have undergone earlier "open" operations on abdominal organs are described. Before 1994 open laparoscopy by Hassan was used for penetration into the abdominal cavity. There were 46 such manipulations (2.14% of all 9100 endosurgical operations), in 5 cases of them the conversion to open operation was necessary. From 1994 the optic trocar "Visiport" was used permitting to image tissues in its passage through anterior abdominal wall. 195 operations with optical trocar were performed. All the patients had been operated earlier. Trocar was introduced without damages of abdominal organs in all the cases. Trocar was introduced in the left iliac area, where the comissures were found in 4 cases only. In 147 patients during revision unions of intestinal loops and great omentum with anterior abdominal wall were revealed. In one patient significant comissural process was revealed, so conversion to laparotomy was necessary. In 2 other patients laparotomy was performed because of damage of ileum and ceclim during endoscopic operation. Main criterion of rejection laparoscopic operation in patients operated earlier on abdominal organs is the results of laparoscopy with trocar.

[Male reproductive function after inguinal hernia]. / Reproduktivnaia funktsiia muzhchin posle pakhovogo gryzhesecheniia.

Reproductive function and treatment results have been analysed for 59 patients aged 17 to 32 years after herniotomy. 28 and 31 of them underwent standard and endosurgical interventions, respectively. The control group consisted of 30 healthy males matched for age. As shown by 6-month follow-up, the endosurgical herniotomy was not associated with such complications as hydroscheocele, hydrocele, testicular atrophy, diminution of blood flow along the testicular arteries. Ejaculate, levels of sex hormones in the blood, cremasteric reflex remained intact. After routine herniotomy there appeared defects in scrotal and testicular microcirculation with partial testicular atrophy in 25% of cases, testicular circulation fell 2.2-2.5-fold, deterioration of spermogram and cremasteric reflex parameters, reduction of serum testosterone were observed.

[Laparoscopy in the differential diagnosis and treatment of acute appendicitis and acute gynecological diseases]. / Laparoskopiia v differentsial'noi diagnostike i lechenii ostrogo appenditsita i ostrykh ginekologicheskikh zabolevanii.

Laparoscopy was used in differential diagnostics of acute appendicitis in 524 female patients. Acute gynecological diseases were diagnosed in 123-of them, inflammatory processes in appendages being most frequent. The laparoscopic technology allowed not only to avoid diagnostic errors in all the cases, but also to take all necessary surgical measures. The effectiveness of laparoscopic operations for acute gynecological diseases was confirmed by the absence of complications and recovery within short terms.

[Immediate results of laparoscopic hernioplasty in inguinal and femoral hernias]. / Blizhaishie rezul'taty laparoskopicheskoi gernioplastiki pri pakhovykh i bedrennykh gryzhakh.

In 1992-1994 laparoscopic hernioplasty was performed in 403 patients with inguinal (371) and femoral (32) hernias. Mean duration of hospital-stay 2.3 days, period of incapacity 9.7 days. Complication were encountered in 25 (3.7%) patients, including perforation of the small intestine and commissural ileus for which laparotomy had to be performed. Recurrent hernias occurred in 7 (1.7%) patients in periods of 2 weeks to 1.5 month due to poor fixation of the implant and choice of an inadequate operative method.

[Laparoscopic extraperitoneal hernioplasty in the treatment of patients with an inguinal hernia]. / Laparoskopicheskaia venbriushinnaia gernioplastika v lechenii bol'nykh pakhovoi gryzhei.

The first experience with using laparoscopic extraperitoneal hernioplasty with implant Prolene" in 300 patients since November 1992 is analyzed. The analysis of the original method of laparoscopic extraperitoneal hernioplasty has shown its efficiency and safety for patients with inguinal hernias (recurrences were noted in 2,3%).

[Laparoscopic appendectomy in acute appendicitis]. / Laparoskopicheskaia appendéktomiia pri ostrom appenditsite.

Laparoscopic technology was applied as diagnostic method in 608 patients, 50 patients have undergone laparoscopic appendectomy. There were no diagnostic errors in laparoscopy application. Laparoscopic technology allowed to perform appendectomy quite safely and without any complications. This method permitted considerably reduce terms of treatment of the acute appendicitis patients and quickly restore their ability to work.