3-D MODELING - THE FUTURE OF HEPATOBILIARY SURGERY(LITERATURE REVIEW)

3D-печать в хирургии печени является новым многообещающим инструментом хирургического планирования. В обзоре приведены шесть исследований, непосредственно связанных с 3D-визуализацией печени. Однако стоимость 3-Д визуализации и время являются основными ограничивающими факторами при создании надежной модели. Со временем эта техника осуществима и применима к резекции печени и может помочь в предоперационном планировании резекции печени. 3D printing in liver surgery is a promising new surgical planning tool. The review lists six studies directly related to 3D liver imaging. However, 3-D rendering cost and time are the main limiting factors in creating a robust model. Over time, this technique is feasible and applicable to liver resection and may aid in preoperative liver resection planning.

Interventional radiology techniques in the treatment of cholangiolithiasis: indications, efficacy, accessibility

Our days, the problem of treating complicated forms of cholelithiasis continues to be relevant despite the undoubted successes in the field of hepatobiliary surgery. Cholangiolithiasis is one of the most frequent and dangerous complications of cholelithiasis, it is detected in 8–26 % of patients with cholelithiasis. In some cases, it is impossible to perform an endoscopic retrograde method, these special situations require the development of new original minimally invasive methods for resolving cholangiolithiasis, which have all the advantages of «small access». The analysis of the treatment of 466 operated patients with cholelithiasis complicated by cholangiolithiasis and mechanical jaundice in the period from 2013 to 2019 was carried out. The patients were divided into 3 groups: 1 — the endoscopic retrograde method was used (n = 369), 2 — laparotomic access (n = 26), 3 — antegrade X-ray interventional method (n = 71). The results obtained allow us to conclude that the antegrade interventional radiology technique for the treatment of choledocholithiasis has a high clinical efficacy comparable to the endoscopic technique. The use of this treatment option avoids traumatic laparotomies and open interventions on the bile ducts. The use of method is justified in cases of impossibility of performing endoscopic intervention, or its ineffectiveness.

Y-en-Roux reconstruction in abdominal surgery: historical retrospective of operative method’s evolution. Part II

This historical review is more focused on the analysis of highly relevant, unique method proposed by A. Wölfl er, E. Doyen and C. Roux more than 140 years ago. We also try to present main facts and the chronology of Y-reconstruction of the digestive tube concept’s development. Hereby we present historical retrospective of theoretic concept creation, experimental confi rmation and initial clinical experience of Y-shaped reconstruction of the digestive tube on Roux-en-Y-loop, stages of concept evolution and development from the end of the 19th century and continuing into current times. Scientifi c research of surgical gastroenterology, oncology, pancreatology and hepatobiliary surgery founders, expand application of Roux-en-Y-reconstruction from distal resection of the stomach and gastroenterostomy to gastrectomy, repeated operations on the upper part of the digestive tube, the formation of biliary-enteric and pancreatic anastomosis, and the use in the routine practice of bariatric surgery.

779 USE OF INDOCYANINE GREEN TO ASSESS THE CORRECT VASCULARIZATION OF GASTROPLASTY IN MCKWEON ESOPHAGECTOMY

Cervical anastomostic leakage in esophageal surgery is one of the most serious complications and its incidence is 10–30% according to series. ndocyanine green is being used in multitude of surgical procedures in colorectal and hepatobiliary surgery. In this video we try to prove its usefulness to assess the adequate vascularization of the gastroplasty with the aim of reducing anastomotic leak due to not-well perfusion. Methods A left lateral cervicotomy was performed and proximal esophagus was divided. Then a handsewn purse-string suture was performed and the anvil of CEA 25 stapler was introduced into the esophagus. Gastroplasty was performed with endoGIA section by minilaparotomy. An intravenous infussion of Indocyanine green was used to assess the vascularization "in situ" of the gastroplasty. The gastroplasty was pull up through the retrosternal space and when the plasty was positioned in a correct way, the optimal site for the anastomosis was chosen. Mechanical T-L anastomosis with CEA 25 stapler was performed and it was covered with an omental flap. Video https://drive.google.com/file/d/1kqmNzJCdlJFOcxKBYRp0jamoHz6Gwgt7/view?usp=sharing.

Robotic Liver Surgery

Minimally invasive surgery has experienced a significant expansion in the last decades. Robotic surgery has evolved in parallel to traditional laparoscopic surgery offering additional technical advantages. Some specific aspect of Hepatobiliary Surgery led to a limited implementation of minimally invasive liver surgery in the early years of laparoscopic surgery whilst we are experiencing an exponential increase in the use of minimally invasive approaches to this type of intervention. In this chapter we describe the key aspect of robotic liver surgery with a meticulous description of the supporting evidence, its limitation and future perspectives.