[Robot-assisted operations for non-organ retroperitoneal tumors].

MATERIAL AND METHODS: Robot-assisted operations for non-organ retroperitoneal tumors were performed in 20 patients. The biggest tumor's diameter was 160 mm, the smallest--32 mm, mean value was 79.1±37.8 mm. According to morphological investigation data lymphangioma was diagnosed in 4 (20%) patients, lipoma--in 3 (15%) cases, peritoneal cyst--in 2 (10%) patients. Solitary lymphatic node, teratoma, leiomyosarcoma, accessory stomach, bronchogenic cyst, adenogenous cancer, ureterocele, megaureter, schwannoma, leiomyoma, malignant paraganglioma were observed in 1 (5%) case respectively. RESULTS: Surgery duration was 138±55.9 min. Blood loss was 69±112.7 ml (range 0-500 ml). Intraoperative complications (bleeding) were diagnosed in 3 (15%) patients. There were no conversions. Robot-assisted variant has been demonstrated in case of non-organ retroperitoneal tumors with diameter not more than 100-120 mm.

[Surgical treatment of patients with enteric fistulae].

AIM: To create multidisciplinary diagnostic and curative approach to patients with intestinal fistulae. MATERIAL AND METHODS: Additional nutritive support was applied in all patients preoperatively. 35 patients with intestinal fistulae were operated. Unformed and formed intestinal fistulae were observed in 10 and 25 patients respectively. Radical one-stage surgery was performed in 30 cases, two-stage - in 3 patients. Unformed fistulae opened into granulating wound were not eliminated in 2 patients. RESULTS: Postoperative complications were observed in 10 patients. 2 of them required re-intervention. There were no deaths.

[Surgical treatment of the unformed intestinal fistulae].

Treatment results of 5 patients with unformed intestinal fistulae are represented. High unformed intestinal fistulae are acknowledged to be completely unsuitable for conservative treatment and should be operated on. Complex treatment should include complete parenteral feeding, adequate fecal diversion with the use of aspirational drainage. Surgical treatment must be y the increase of fistula discharge or absence of fistula formation. Low intestinal fistulae should better be surgically dissected after their organization, otherwise urgent surgery is to be performed by complications development, such as purulent leakage into the abdominal cavity or severe wound infection.

[Enlarged sinistral hemihepatectomy and prosthetic repair of the inferior vena cava in locally disseminated hepatic alveococcosis].

High risk of surgical management for disseminated forms of alveococcosis appears to be associated with invasive growth of the parasite and the related necessity to perform vast resections of the liver and adjacent organs, as well as resections and prosthetic repair of the major vessels. The only alternative method of treatment could be liver transplantation. The purpose of this study was to demonstrate successful prosthetic reconstruction with the an allograft of the hepatic segment of the inferior vena cava in the course of enlarged hemihepatectomy for locally disseminated hepatic alveococcosis with the involvement of the inferior vena cava. The "Goretex" prosthesis was used as an allograft. The immediate postoperative period was accompanied and followed by mild-degree postresection liver insufficiency. During 6 months of dynamic follow up, the prosthesis was patent, with no relapses of the disease on the background of antiparasitic chemotherapy being noted. The use of allografts in vascular prosthetic repair in hepatic alveococcosis appears justified, requiring, however, further investigation.

[Hilar glissonean access to vascular-secretory elements in anatomical segmental liver resections].

It still remains unclear which patients with hepatic tumors can favour anatomical segmental liver resections instead of major liver resection. Short term results of anatomical segmental liver resection are evaluated and analyzed. Ten patients underwent the anatomical segmental liver resection performed by posterior approach with taping of anterior right hepatic vein. Seven patients had liver metastases of colorectal cancer, one had primary hepatic carcinoma and two had benign lesions, anatomical segmental liver resection were performed without Pringle maneuver. There was no significant difference in blood loss, duration of the procedure, postoperative hospital stay and morbidity in comparison with the segmental liver resection performed by anterior approach. Multiple, large and deep-embedded lesions were removed completely, with tumor-free resection margins. Anatomical segmental liver resection performed by hilar glissonean approach is recommended in patients with compromised liver function "unfavourable" liver anatomy to replace major liver resection provides removal of only affected part of the liver accordingly to its true anatomical borders.

[Radio-frequency ablation appliance in resection of the liver]. / Ispol'zovanie apparata radiochastotnoi ablatsii pri rezektsii pecheni.

Pilot experience with "Radionics Cool-Tip RF System" appliance for radio-frequency ablation (RFA) in hepatic resection in the patients with focal lesions of the liver is presented. Advantages of RFA as an alternative method for hemostasis are demonstrated. With this technique bisegmentectomy (II - III) was performed in 4 patients, right-sided hemihepatectomy - in 2 patients. RFA permitted to minimize intraoperative blood loss without increase of surgery time. There were no severe complications during surgery and in early postoperative period. The method permits to perform combined surgeries without a significant increase of surgical risk.

[Major resections of the liver in patients with high surgical risk]. / Obshirnye rezektsii pecheni u bol'nykh s vysokim khirurgicheskim riskom.

Experience with 75 major anatomic resections of the liver in patients with high surgical risk due to low functional reserve of the liver, spontaneous disruption of hepatic tumor, chronic purulent infection in patients with hepatic abscesses, posttraumatic sequestration of the liver with hemobilia, giant hepatic hemangiomas, old age and severe concomitant diseases was analyzed. General postoperative lethality was 14.7% which was determined mainly by unfavorable outcomes in postoperative patients in spontaneous disruption of tumor and massive intraabdominal bleeding, and also by severe postoperative hepatic insufficiency in patients after right-sided hemihepatectomy for hepatocellular carcinoma with postnecrotic cirrhosis of the liver. Immediate results of surgery in patients with obstructive jaundice and biliary hepatic cirrhosis were better that ones of patients with postnecrotic cirrhosis. There were no lethal outcomes in group of patients after surgery for giant hemangiomas, abscesses and posttraumatic sequestration of the liver. Thorough selection of patients based on detailed study of functional hepatic reserves and also volume of removed hepatic parenchyma is necessary for improvement of immediate results of surgical treatment. It is valid to perform portal venous embolization before right-sided hemihepatectomy in patients with postnecrotic, biliary cirrhosis, and also in old patients to decrease the risk of postresection hepatic insufficiency. Roentgenondovascular occlusion of the hepatic artery, Cell-Seiver use for intraoperative blood reinfusion and in some cases--use of methods of complete vascular isolation of the liver are indicated for patients with giant hepatic hemangiomas.

[Rationale for removal of fibrous capsule in echinococcectomy from the liver]. / Obosnovanie udaleniia fibroznoi kapsuly pri ékhinokokkéktomii iz pecheni.

Experience of radical surgical treatment in 253 patients with hepatic echinococcosis is presented. Twenty-six patients underwent hepatic resection; 218, pericystectomy, 9 patients, combined interventions. Based on comparative analysis of the results of surgical treatment in 109 patients from the study and control groups, it is concluded that radical operations have significant advantages and show fever postoperative complications and recurrences. Removal of fibrous capsule is a token of successful treatment for hepatic echinococcosis.

[Ultrasound-assisted puncture method of treatment of hepatic hydatid cysts]. / Punktsionnyi metod lecheniia ékhinokokkovykh kist pecheni pod kontrolem ul'trazvukovogo issledovaniia.

Results of treatment of 31 hepatic hydatid cysts in 28 patients were analyzed. The size of the s ranged from 3 to 25 cm. In 26 cases the cysts contained flive es, in 2 cases they were suppurated after US-assisted intraoperative puncture. Simple hydatid cysts (type I by M. Milcevic) were diagnosed in 24 patients (solitary--in 22, multiple--in 2), solitary cysts of type II--in 2 patients. In 23 cases aspiration-catheter treatment with complete removal of chitin membrane by one-stage (4) or two-stage (19) methods was performed. After removal of chitin membrane in 3 patients lateral fistula between spurious cysts cavities and peripheral branches of intrahepatic bile ducts were revealed which spontaneously. Glue composition "Rabrom" was used in 2 cases for closure of the residual cavity. In 4 patients who had cysts less 6 cm in size puncture irrigation of chitin cavity with 30% NaCl (PAIR technique) without it removal was performed. In one patient transcutaneous catheter (PAIR-PD technique) was used for irrigation of the cyst larger than 6 cm. The duration of two-stage aspiration-catheter treatment with removal of chitin membrane was 25.6 +/- 9.6 days. In moderate calcinosis of the fibrous membrane and bile fistulas period of hospitalization was 34 +/- 8.1 days. Treatment with PAIR and PAIR-PD took 1 and 3 days respectively. Complications of percutaneous methods were regarded as mild: hyperthermia (12), right-sided hydrothorax (6), subcapsular hematoma (1), urticaria (1). All the complications were treated conservatively and with US-assisted punctures. Long-term (from 6 months to 9 years) results of treatment were followed up in 26 patients: there were no recurrences. Suppuration of the residual cavity 6 months after the glue occlusion was eradicated by transcutaneous catheter drainage. One lethal outcome was not associated with complications of aspiration-catheter treatment. Both methods of transcutaneous treatment of hepatic hydatid cysts are effective and safe. A hypertonic solution of NaCl I produces a reliable antiscolecidal and sclerosis effect.

[Perioperative management of focal liver diseases by ofloxacin]. / Izuchenie perioperatsionnogo primeneniia ofloksatsina pri ochagovykh obrazovaniiakh v pecheni.

Perioperative use of ofloxacin for prophylaxis was investigated in 20 patients with focal hepatic formations (hemangioma, adenocarcinoma, echinococcosis). First dose of ofloxacin (200 mg) was given intravenously 15 min before operation. After operation ofloxacin was used intravenously (400 mg daily) for 5 days. Pharmacokinetic investigation demonstrated that perioperative intravenous use of ofloxacin provided concentrations in blood and hepatic tissue satisfactory for potential microflore inhibition. Immunological monitoring demonstrated positive dynamics on 5-7 days after operation. dynamics depended on nosology of the focal hepatic formation. Ofloxacin use for prophylaxis in the operated patients with focal hepatic formations was efficient for profilaxy of postoperation infective complications.

[First experience in treatment of hepatic echinococcal cyst by percutaneous puncture drainage]. / Pervyi opyt lecheniia ékhinokokkovykh kist pecheni punktsionnym chreskozhnym drenirovaniem]

The article deals with the new possibilities of bloodless management of parasitic cysts of the liver by means of ultrasonic examination and computed tomography. The authors suggest a puncture-aspiration method of goal-oriented percutaneous drainage of a hydatid cyst which prevents possible complications. The method was applied in four patients with hydatid cysts of the right hepatic lobe. The outcomes in two cases were successful, the death of one patients was associated with the use of the method.

[A method for forming and the morphological characteristics of artificial liver cysts]. / Metodika formirovaniia i morfologicheskaia kharakteristika iskusstvennykh kist pecheni.

Application of ultrasound surgical aspirator promotes rapid formation of major cavities with dry inner surface in the depth of hepatic parenchyma. Filling of the latter with sutured copolymer of monovinyl ether of ethyleneglycol in the ratio of one filler volume to three cavity volumes results in the formation of cysts with the given stable dimensions. Good aspiration of necrotic tissues promotes rapid formation of thin-walled cysts. The given hepatic cyst model may be used in the development of new surgical and puncture methods of treatment, as well as testing of new drugs.

[Means of preventing suppurative complications following surgery of the liver]. / Puti profilaktiki gnoinykh oslozhnenii posle operatsii na pecheni.

The article analyses the results of antibiotic prevention of postoperative infectious complications and the use of special techniques and operative manipulations in 60 patients with localized affections of the liver. It was found that the most effective method of antibiotic prevention of complications is a purposeful transport of antibiotics in autologous erythrocytic shadows, which are infused intravenously once before the operation and, in extensive resection of the liver, on the second or third postoperative day. With the use of special techniques and operative manipulations in combination with purposeful transport of antibiotics the frequency of infectious complications reduces and the results of treatment in surgery of localized affections of the liver improve.

[The dynamics of the morphological changes in the liver after resections using the Soviet ultrasonic surgical aspirator]. / Dinamika morfologicheskikh izmenenii pecheni pri ee rezektsiiakh s pomoshch'iu otechestvennogo ul'trazvukovogo khirurgicheskogo aspiratora.

The possibility of hepar resection by means of Soviet-made ultrasound device URSK-7N-18 was investigated in experiment on 13 mongrel dogs. The device was adapted to this surgery and was supplied with a special working part with a vacuum pump and channel for inspiration of liquid. The working part frequency is 26.5-30.0 kHz, resonance frequency is 26.5 kHz. The device does not damage blood vessels, nerves, and ducts but on the basis of morphology it provides both hemostasis at the early period after surgery owing to changes in microcirculation, and rapid wound healing by means of aspiration of necrotized tissues.

[Intraoperative ultrasonic study in surgery of hepatic echinococcosis]. / Intraoperatsionnoe ul'trazvukovoe issledovanie v khirurgii ékhinokokkoza pecheni.

The authors analyse the results of intraoperative ultrasonic examination (IOUSE) of the liver in 31 patients with echinococcosis of the liver; 21 of them had multiple hydatid cysts in the liver. The authors came to the conclusion that IOUSE is a highly informative method for noninvasive diagnosis in surgery of the liver. IOUSE is indicated when information must be obtained during the operation concerning the location of invisible and nonpalpable pathological structures, the borderlines of their extension, the anatomical relations with the vascular-ductal structures of the liver. Exact echographic localization of these structures and their grading ensure safety of various types of operations in this disease.

[Changes in the external respiration function and hemodynamics after surgery of the pancreas]. / Izmenenie funktsii vneshnego dykhaniia i gemodinamiki posle operatsii na podzheludochnoi zheleze.

Pancreatic surgical operations, being very traumatic, cause considerable and lasting disorders on the part of external respiration, gas exchange, and central and regional hemodynamics. Patients with pancreatic tumors show systolic myocardial strain, which may be related to increased sympatho-adrenal influences. In the early days after pancreatoduodenal resection for pancreatic tumors, patients develop hyperdynamic circulation. Extensive use of neuropeptides is indicated as part of combined treatment preventing postoperative complications after pancreatic surgery.