[Tracheobronchial stenting in patients with non-resectable tumors complicated by airway stenosis]. / Endoskopicheskoe stentirovanie trakheobronkhial'nogo dereva u patsientov so stenoziruyushchei nerezektabel'noi opukhol'yu.

OBJECTIVE: To study the results and efficiency of tracheobronchial stenting in patients with unresectable tumors complicated by stenosis of central airways. MATERIAL AND METHODS: We analyzed the results of tracheobronchial stenting in 23 patients with unresectable tumors complicated by stenosis of central airways between 2016 and 2021. RESULTS: Technical and clinical success rate was 100%. No intraoperative complications were noted. Dyspnea regressed in all patients in early postoperative period. Moreover, there was objective improvement in lung ventilation with increase in lung capacity (from 2.1±0.4 to 2.7±0.5 l; p<0.05), forced expiratory volume (from 1.2±0.5 to 1.8±0.4 l; p<0.05), partial pressure of oxygen in arterial blood (from 47±7.4 to 85±6.3 mm Hg; p<0.05) and arterial oxygen saturation (from 86.1±8.2 to 93.1±5.1%; p<0.05). One patient developed massive bleeding due to tumor decay on the 3rd day after surgery. In 2 patients, stent obturation with a «mucus plug¼ was observed after 2-3 postoperative days. In 3 months after surgery, 21.8% of patients had disturbances of external respiration accompanied by mild dyspnea due to granulation tissue growth. Stent migration in 3 months after endoscopic stenting was recorded in 1 patient. Three-month mortality was 26.1%. CONCLUSION: Tracheobronchial stenting is a safe and effective minimally invasive surgical intervention. As a part of palliative care, this procedure improves functional and clinical parameters of pulmonary ventilation and reduces the incidence of complications. Thus, quality of life in patients with unresectable tumors complicated by airway stenosis is improved.

[Technical features of esophageal stent deployment]. / Tekhnicheskie osobennosti ustanovki pishchevodnykh stentov v zavisimosti ot tipa dostavochnogo ustroistva.

OBJECTIVE: To work out the optimal technique of endoscopic stenting of the esophagus (ESE) using various delivery devices (DD); to analyze immediate and long-term results of stenting depending on the type of DD. MATERIAL AND METHODS: ESE results were studied in 83 patients. Group 1 included 41 patients with implantation of metal stents delivered on a knitted tubular casing (21 stents with proximal opening and 20 stents with distal opening). Group 2 consisted of 42 patients who underwent ESE using a DD in the form of a contracting outer shell. RESULTS: In the 1st group, DD «stumbling¼ in 6 cases (14.6%) required additional tubular hollow rigid conductor. In the 2nd group, there was no need for additional conductor (p=0.011). Intraoperative stent repositioning after its initial installation was required in 7 cases (17.1%) of the 1st group and 16 cases (38.1%) of the 2nd group (p=0.033). Higher likelihood of stent repositioning was observed in distal stent opening. Technical success rate was 100% in both groups. Clinical success rate was 100% in the 1st group and 97.6% in the 2nd group (p>0.05). Incidence of early and long-term postoperative complications was similar (p>0.05). CONCLUSION: ESE with various DDs is safe and effective in patients with malignant unresectable esophageal tumors and symptoms of dysphagia. However, certain features of stent installation should be considered. In our opinion, DD with proximal disclosure is more convenient due to better visual positioning of stent.

[Surgical care during the new coronavirus (Covid-19) pandemic]. / Khirurgicheskie operatsii v usloviyakh pandemii novoi koronavirusnoi infektsii (Covid-19).

Safe and reasonable surgical care in the context of COVID-19 pandemic is difficult task. The main current issues are selection of patients for surgical treatment, principles of surgical treatment in cancer patients, possibilities of endoscopic surgery, organization of surgical department and operating theatre, surgical strategy in infected patients. Own experience and rational implementation of the recommendations developed by international research and practical communities are extremely important for optimizing surgical treatment of patients in a pandemic, as well as for ensuring the safety of patients and medical staff.

[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.

[Pectoral-retroauricular approach for endoscopic parathyroidectomy (experimental study)]. / Pektoral'no-retroaurikuliarnyi operativnyi dostup dlia éndoskopicheskoi paratireoidéktomii.

AIM: To develop and investigate in the experiment the method of endoscopic parathyroidectomy in order to prevent intraoperative 'conflict of the instruments' and to reduce surgical trauma via extracervical approach. MATERIAL AND METHODS: The results of 10 experimental endoscopic parathyroidectomies with original pectoral-retroauricular approach were analyzed. RESULTS: Mean time of surgery was 77.8±10.2 minutes (65-97), mean time of surgical exposure - 50.3±6.7 minutes (41-59). Visualization and identification of parathyroid glands were achieved in 100% of cases. Recurrent laryngeal nerve was preserved in 100% of cases. CONCLUSION: Original endoscopic pectoral-retroauricular approach for parathyroidectomy is methodologically and technically justified and can be recommended for clinical application.

[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.