[Bile duct repair after complete intersection]. / Opyt vosstanovleniya nepreryvnosti zhelchnykh protokov pri polnom ikh peresechenii.

OBJECTIVE: To determine the training period for imposing hepaticojejunostomy for bile duct repair. MATERIAL AND METHODS: Reconstructive surgery on the bile ducts was performed in 53 patients. We analyzed the learning curves based on the incidence of anastomotic leakage after hepaticojejunostomy. RESULTS: The learning curve has a downward nature. The number of anastomotic failures decreases by 2 times after 42 procedures. Surgeon had to perform 39-42 operations to reduce the incidence of this complication. CONCLUSION: Treatment of patients with iatrogenic intersections of the bile ducts should be provided in appropriate hospitals.

[Diagnostic efficiency of transcutaneous laryngeal ultrasound in assessing the mobility of vocal cord in patients with thyroid disease]. / Diagnosticheskaya effektivnost' ul'trasonografii gortani u patsientov s zabolevaniyami shchitovidnoi zhelezy.

OBJECTIVE: To assess the diagnostic efficiency of transcutaneous laryngeal ultrasound. MATERIAL AND METHODS: Ultrasound examination of the larynx and laryngoscopy was performed in 103 patients with thyroid disease. 26 (34.21%) patients who underwent surgery on the thyroid gland direct laryngoscopy and ultrasound of the vocal folds were performed twice, before and after the operation. RESULTS: Voice folds were visualized in 76 (73.8%) people. Of the 24 men, these anatomical structures were visualized in 8 (33.3%) and in 68 (86.1%) women out of 79 cases. Violations of the function of the vocal cords during laryngoscopy were detected in 5 people, sonographically in 6 people. The coincidence of the revealed pathology with ultrasound was in 4 patients, in 3 - with sonography the diagnosis was erroneous, in 1 patient it was falsely negative and in 2 cases it was falsely positive. CONCLUSIONS: In connection with the diagnostic capabilities of the method, it is advisable to use it as a screening study in the perioperative period in patients with diseases of the thyroid gland. Laryngoscopy is indicated for patients with non-visualized vocal folds, with identified pathology with ultrasound, and with clinical signs of dysfunction of the vocal cords.

[Joint work of surgeon and assistant in minimally invasive video-assisted hemithyroidectomy and its effect on duration of surgeries and learning period]. / Sovmestnaya rabota khirurga i assistenta pri vypolnenii mini-invazivnykh videoassistirovannykh gemitireoidektomii i ee vliyanie na prodolzhitel'nost' vypolnennykh operatsii i perioda osvoeniya metodiki.

OBJECTIVE: To analyze assistants` influence on duration of surgery and learning period in minimally invasive video-assisted hemithyroidectomy. MATERIAL AND METHODS: The same surgeon performed 67 minimally invasive video-assisted hemithyroidectomies. Duration of surgery was analyzed in assistants with various number of interventions. Learning curves were designed using logarithmic function. RESULTS: Eight specialists with the same professional skill assisted to surgeon. Each of these specialists performed certain number of operations. Learning period made up 19, 26 and 44 procedures for mean numbers of assistances 21, 8 and 3, respectively. Duration of surgery in the group with 21 assistances was 63.96±2.94 min, for 3 assistances - 80.53±7.07 min in each of 6 assistants (z= -2.38; p<0.017). CONCLUSION: Constant surgeon`s assistants is a factor reducing surgery time. Higher number of operations with the same assistant has a reliable inverse correlation with surgery time and duration of learning period.

[Learning curves in acquisition of experience for new technologies]. / Izuchenie opyta osvoeniya novykh tekhnologii metodom postroeniya krivykh obucheniya.

OBJECTIVE: Analysis of national and foreign trials investigating accumulation of experience in innovative technologies using the learning curves. MATERIAL AND METHODS. S: Earching for Russian-language manuscripts was carried out within the references of the articles and in the ELIBRARY database. Foreign trials were selected from the PubMed database according to the keywords «learning curves in surgical practice¼. The discovered publications were studied for accordance with the objectives of this study. RESULTS: Accumulation of experience in new technologies by using of learning curves is valuable to improve the training, determine duration of development of new technology and the factors affecting its characteristics. CONCLUSION: The method is high-quality for comprehensive analysis of experience accumulation in new surgical technologies.

[Evaluation of experience acquisition in video-assisted hemithyroidectomy]. / Sposoby otsenki priobreteniya opyta pri osvoenii videoassistirovannykh gemitireoidektomii.

OBJECTIVE: To determine validity and adequacy of the assessment of experience acquisition in video-assisted hemithyroidectomy, to compare surgical outcomes at the learning stage and in delayed period. MATERIAL AND METHODS: Experience acquisition was studied via assessment of the duration of video-assisted hemithyroidectomy in 67 patients who were operated by the same surgeon. Time of surgery was analyzed through between-group comparison of surgical outcomes. These groups were defined arbitrarily, in exponential fashion, using the logarithm method and moving average. Risks of failure regarding duration of surgery and postoperative complications were investigated using CUSUM analysis. RESULTS: Minimum period of experience accumulation in video-assisted hemithyroidectomy (26 procedures) was determined using logarithmic analysis, maximum period (66 interventions) - using CUSUM analysis. Other approaches also showed sharp nature of the learning curve.CUSUM analysis of failures at the learning stage showed 2-fold decrease of their probability after 66 operations. However, even experience acquisitiondoes not exclude risk of failures in hemithyroidectomy. CONCLUSION: Arbitrary division of the cohort of patients seems to be unreasonable because clear number of operations necessary to achieve sustainable results does not follow it.Mathematical methods adequately reflect experience accumulation and allow determining the required number of interventions for stable results and minimum complication rate.

[Experience of reconstructive laparoscopic procedures in patients with terminal colostomy]. / Opyt osvoeniia vosstanovitel'nykh operatsii laparoskopicheski-assistirovannym sposobom u bol'nykh s kontsevoi kolostomoi.

AIM: To analyze the ways and terms of training for laparoscopy-assisted reconstruction operations via learning curves analysis and to compare the outcomes obtained both during training for technique and after that. MATERIAL AND METHODS: There were 93 reconstructive laparoscopic procedures in 58 (62.36%) patients with terminal colostomy. All patients were operated by the same surgeon. Learning curves have been created and analyzed. RESULTS: Analysis showed that all surgical features are achieved by the 30th intervention indicating the end of learning period. Significantly less surgical trauma has been observed along with development of surgery. CONCLUSION: Improved results are achieved by reduced dissection of adhesions, the use of mechanical suture for intestinal anastomosis and increased number of anastomoses made in intracorporeal fashion.

[Damage of reconstructive operations in patients after urgent obstructive resection of colon].

It was performed comparative analysis of results of reconstructive operations in 116 patients with terminal colostomy after urgent obstructive resection of colon. Damage of reconstructive operations which differ by only access was estimated. Midline access was used in 49 patients, parastomal - in 51 cases. Laparoscopic operation was applied in 16 patients. The most traumatic method was middle laparotomy for restoration of colonic integrity. Laparoscopic operations and parastomal access are less invasive. Laparoscopic operations are accompanied by longer duration, greater blood loss and later restoration of intestinal motility pattern in comparison with surgery through parastomal access. It is associated with duration and damage of adhesiotomy stage.

[Adhesive process in the abdominal cavity in patients with end colostomies and its influence on the reestablishment of the large intestine continuity].

Under analyses there were reparative operations on 79 patients with end colostomies performed using medial access in 42 patients and parastomal access in 37 patients. The investigation of prevalence of the adhesive process in 61 patients has shown that marked adhesions were formed in the area of the medial scar in 41 (67.2%) patients, the stump of the suppressed gut--in 31 (50.9%) patients and colostomy--in 27 (44.3%) Reestablishment of intestine continuity from the parastomal access allowed avoidance of adhesions in the zone of the medial postoperative scar which shortened the time of operation and decreased the level of intra- and postoperative complications.

[Urgent resection of the colon with compressive anastomosis and afferent colostoma].

Thirty patients with colon disease in need of urgent surgery have undergone resection of the colon with formation of terminal afferent colostomy and compressive colon-colon anastomosis using oval and linear nikelid-titanium implants. Complications were seen in 6 (20%) patients, lethality was 6,7% due to multiorgan failure in the presence of generalized peritonitis. There were no complications due to colon-colon anastomosis. The above method permits one to reduce surgical trauma of future reconstructive surgeries.

[Initial experiences in creation of anastomoses in abdominal surgery using implants with shape "memory"]. / Pervyi opyt formirovaniia anastomozov v briushnoi khirurgii implantatami s "pamiat'iu" formy.

The article analyses the first experience in 230 operations for creation of compression anastomoses in abdominal surgery of the esophagus, stomach, gallbladder, and common bile duct by means of implants with shape "memory". Complications occurred in 10% of cases, the mortality rate was 3.04%. The suggested method simplifies the operative technique, shortens the duration of the operation, and reduces the incidence of postoperative complications (anastomositis, incompetence of sutures, reflux gastritis, dumping syndrome).