[Surgical treatment of a patient with syphilitic aortitis]. / Khirurgicheskoe lechenie patsienta s sifiliticheskim aortitom.

Syphilitic aortitis is a rare disease caused by Treponema pallidum affecting the aorta and leading to inflammation. Syphilitic aortitis is one of the causes of aortic aneurysms. This article presents surgical treatment of a patient with syphilitic aortitis and thoracic aortic aneurysm. This clinical case confirms the difficulties of surgical treatment.

[Minimally invasive carotid artery surgery]. / Maloinvazivnaya khirurgiya sonnykh arterii.

OBJECTIVE: To determine the criteria for choosing a surgical approach and compare an effectiveness of carotid endarterectomy (CEAE) via 3 approaches. MATERIAL AND METHODS: The study included 120 patients who underwent CEAE via 3 different approaches. Intraoperative skin marking included lower jaw angle, skin fold closest to common carotid artery bifurcation. Carotid artery bifurcation and borders of atherosclerotic plaque were visualized using ultrasound. An effectiveness of each access was evaluated in accordance with the following criteria: neurological complications, cosmetic effect and quality of life after 1 and 12 months. The patients were divided into 2 groups. Group I - 80 patients with CEAE with access through the natural skin fold (NSF); group II - 40 patients with CEAE using the classical longitudinal access. The 1st group was divided into 2 subgroups. Subgroup I A - 39 patients with CEAE using mini-access via NSF; subgroup I B - 41 patients with CEAE using extended access via NSF. RESULTS: There were no strokes and transient ischemic attacks in a month after surgery in both groups. After 12 months, stroke occurred in 2 (%) patients of group II, cranial neuropathy - 8 (21%) patients in the same group. The best cosmic effect was achieved in subgroup I A after 1 and 12 months (37.1±6.7 scores). Mean score of physical health was 51.59±5.9 scores in subgroup I A, 46.03±7.53 scores - in subgroup I B, 38.84±5.28 scores - in group II. Index of mental health was 49.63±6.69, 45.68±5.6, and 48.59±7.29 scores, respectively. CONCLUSION: Considering these data, we developed a personalized computer program ensuring fast choice of optimal surgical approach.

[Advantages of minimally invasive approach for carotid endarterectomy]. / Preimushchestva mini-dostupa pri karotidnoi éndarteréktomii.

OBJECTIVE: To identify the advantages and disadvantages of different approaches for carotid endarterectomy (conventional, longitudinal and transverse incision). MATERIAL AND METHODS: There were 58 patients who underwent carotid endarterectomy. Patients were divided into 2 groups depending on surgical approach. Group 1 (n=37) - minimal skin incision (less than 5 cm). There were subgroup 1A (transverse minimal skin incision along the natural skin wrinkle, n=17) and subgroup 1B (longitudinal minimal skin incision, n=20). Group 2 (n=21) - conventional longitudinal incision. Surgical outcomes were analyzed after 1 month and 1 year. End-points were mortality, stroke, TIA, cranial nerve neuropathy. Cosmetic effect was evaluated using POSAS scale (Patient and Observer Scar Assessment Scale, Draaijers, 2004). RESULTS: Mortality, stroke and TIA were absent after 1 month. Cranial nerve neuropathy was not observed in subgroup 1A and diagnosed in 2 (10%) patients of subgroup 1B and 6 (28.5%) patients of group 2. Cosmetic effect: subgroup 1A - 48.4±9.5 scores, subgroup 1B - 52.4±9.2, group 2 - 63.1±11.1 (p<0.05). The outcomes after 12 months: mortality was absent in subgroups 1A and 1B, 2 patients died in group 2 from AMI. Stroke was absent in subgroups 1A and 1B, group 2 - 1 patient. Cranial nerve neuropathy was absent in 1A and 1B subgroups and diagnosed in 4 (21%) patients of group 2. Cosmetic effect: subgroup 1A - 37.2 scores, subgroup 1B - 40.0 scores, group 2 - 55.1 scores. Physical component of QOL: subgroup 1A - 51.63±6.31 scores, subgroup 1B - 46.01±7.53 scores, group 2 - 38.85±5.33 scores. Psychological component of QOL: subgroup 1A - 49.64±6.72 scores, subgroup 1B - 45.68±5.63 scores, group 2 - 48.6±7.36 scores (p<0.05). CONCLUSION: Transverse minimal skin incision for carotid endarterectomy is a safe alternative to classic longitudinal incision and reduces the risk of postoperative complications with significant cosmetic effect.

[Robot-assisted operations in vascular surgery]. / Robot-assistirovannye operatsii v sosudistoi khirurgii.

The article contains a systematic review of the literature dedicated to vascular robot-assisted operations, also discussing the use of robotic technologies in vascular surgery, their advantages and disadvantages. In so doing, we studied the experience of Russian and leading international surgical centres, comparing the reported outcomes by such parameters as the average duration of the operation, mean time of aortic cross-clamping, time spent for anastomosis formation, frequency of postoperative complications, etc. Benefits of robot-assisted operations allowed the latter to occupy the leading positions in various fields of surgery, although the use of robots in vascular surgery has only begun to gain popularity. A robotically assisted system eliminates the main shortcomings of laparoscopy and opens opportunities for expanding robot-assisted surgery in this field.