Laparoscopic Adrenalectomy: Preventive Principles in Intra- and Postoperative Complications

Background. Laparoscopic adrenalectomy is the current surgery of choice in most adrenal tumours, with a nearly 11 % complication rate and below 1 % mortality. Laparoscopy combines the advantages of minimally invasive surgery with well-known long-term prognosis of a traditional open surgery, at the same time requiring the surgeon’s skill of knowing the technique and avoiding complication.Aim. Concept definition of safe laparoscopic adrenalectomy.Materials and methods. A total of 28 patients with adrenal neoplasms were rendered laparoscopic adrenalectomy by same surgical team under benchmark recommendations during 2016–2019.Results. All patients have been discharged in satisfactory condition, with no intra-, postoperative complications or lethal outcomes.Discussion. Th e evidence presented displays feasibility of using the benchmark principles in laparoscopic adrenalectomy surgery. Laparoscopic adrenalectomy is superior in reducing the recovery time, surgical trauma, complication incidence, length of hospital stay, treatment cost, the improvement of overall wellbeing post-surgery and patients’ quality of life. Th ese principles proved effective to avoid intra- and postoperative complications of laparoscopic adrenalectomy and facilitated revamping of the operation technique in left -sided adrenalectomy.Conclusion. Th e benchmark principles of laparoscopic adrenalectomy enable the procedure higher efficacy and safety and require further implementation and long-term assessment of the outcome.

Ultrasound examination of myometrial changes after conservative myomectomy, with the aim of predicting the course of pregnancy and choosing the optimal method of delivery

Introduction. The article provides a methodology for assessing and predicting complications during pregnancy for selectionof the optimal method of delivery.Goals and objectives. The work assessed the degree of myometrium changes, according to ultrasound studies, after using standard instrumentation and electrocoagulation, in order to predict the course of pregnancy and select the optimal method of delivery.Materials and methods. The details of the surgical anatomy, the plan of the surgeon’s action before the operation, formed according to the data of ultrasound diagnostics and operative surgery, were analyzed. Ultrasound was performed using GE Logiq S8 (USA) and Medisan Accuvix (South Korea) devices with 3,5 MHz convex transducers for transabdominal examination and with a frequency of 5 MHz for transvaginal examination.Research results. Laparoscopic myomectomy was performed in 18 women, 31 patients underwent laparotomic myomectomy, in 11 patients a combined operation technique was used: laparoscopy with minilaparotomy. According to our data, in half of the cases considered, the effects of interventions were absent or minimal. We assigned these results to group I (A — A1, A2, A3). In all other observations, cicatricial changes were revealed — group II (B, C, D, E). To predict the possible consequences, we proposed a point assessment of the ultrasound postoperative changes in the uterus, with the help of which it is possible to assess the degree of risk when planning pregnancy for each patient individually. Each group corresponds to a certain number of points.Conclusions. The presented division according to the degree of severity into groups can make it possible to individualize the approach to each patient and ensure the safest possible management of her during pregnancy and childbirth. This assessment can be used by ultrasound doctors and obstetricians-gynecologists of antenatal clinics and hospitals. The assessment presented by us at the moment is of a recommendatory nature.

Surgical management of pancreatoduodenal tumors: the experience of using the developed operation technique

Relevance: The results of surgery in patients with pancreaticoduodenal cancer remain unsatisfactory. This complicates the choice of an optimal surgical technique in modern oncology. Surgery in the pancreaticoduodenal zone is associated with complications due to anatomical and physiological features of the pancreas and technical challenges of this surgical intervention. Despite preventive actions and innovative technologies, such a traumatic operation as pancreatoduodenal resection often produces complications, though recently fewer. This article describes a pancreaticoduodenal resection technique that reduces postoperative complication frequency and lethality in operable pancreaticoduodenal cancer. The purpose of the study was to assess the efficiency of an authorial pancreaticoduodenal resection technique (pancreaticojejunal invagination anastomosis) in pancreaticoduodenal cancer. The proposed pancreaticojejunal anastomosis-forming technique allowed reducing the postoperative complication frequency from 54.2% to 38,0% and postoperative lethality from 22.8% to 9,5%. Conclusion: This highly traumatic surgery is associated with postoperative complications (up to 50-70% of cases), which are quite severe and difficult to resolve and result in high fatality. The proposed pancreaticojejunal anastomosis forming technique has efficiently reduced postoperative complications and fatality to a significant extent.

P130 HYBRID OPERATION TECHNIQUE FOR INCISIONAL HERNIA REPAIR, A SYSTEMATIC REVIEW AND META-ANALYSIS OF INTRA- AND POSTOPERATIVE COMPLICATIONS

Aim Incisional hernia (IH) occurs approximately in 15% of patients after midline surgery. Surgical treatment for IHs include a solely open or solely laparoscopic approach with mesh placement. Recently, hybrid (combined laparoscopic and open) approaches are being performed. This systematic review evaluates the perioperative complications of hybrid incisional hernia repair (HIHR). Material and Methods EMBASE, Medline via OvidSP, Web of Science, Cochrane and Google Scholar databases were searched. Studies providing data on intra- and postoperative complications in patients who underwent HIHR were included. Data on intra- and postoperative complications were extracted and meta-analyses were performed. Study quality was assessed with the Newcastle Ottowa Scale, ROBINS-I tool, and Cochrane risk of bias. PROSPERO registration: CRD42020175053. Results Results: Nine studies (n = 1596 patients) were included. Five studies compared intra-operative complications between HIHR and laparoscopic incisional hernia repair (LIHR) with a pooled incidence of 1.8% in HIHR group and 2.8% in LIHR group (p = 0.13). Comparison of postoperative prevalence of surgical site occurrences (SSOs) (24% versus 31%, p = 0.02) and surgical site occurrences requiring interventions (SSOPIs) (1.5% versus 4.1%, p < 0.01) were in favour of the HIHR group. Overall postoperative complications seemed to occur less frequent in the HIHR group, though no hard statements could be made due to the vast heterogeneity in reporting between studies. Conclusions Although the majority of studies were retrospective and included a small number of patients, HIHR led to less SSOs and SSOPIs compared to LIHR. This systematic review forms a strong invitation for more randomized controlled trials to confirm the benefits of this approach.

The history of the development of elbow arthroplasty

Total elbow arthroplasty is a good alternative surgical solution for many patients with severe traumatic and inflammatory joint injuries. In case of bones multiple fractures of the elbow joint, arthroplasty can restore the stability of the joint and provide early mobilization of the limb, which is not always possible when performing osteosynthesis. This literature review provides information on the design features of foreign and domestic endoprostheses of the elbow joint, long-term results of operations. The turbulent history of the development of elbow arthroplasty goes back over 60 years. At the same time, due to insufficient understanding of the biomechanics of the joint, the first attempts at its arthroplasty failed. Only in the early 70s, in connection with the improvement of the endoprostheses design and the operation technique, publications on the successful results of total elbow arthroplasty appear in the literature. In the 80s of the XX century implants with a semi-connected design and cemented placement technique have been developed, which still demonstrate better long-term results in comparison with implants with anatomical design. The analysis of publications on the topic of total elbow arthroplasty showed that significant achievements were observed only in the early 1990s, which is largely due to a better understanding of the biomechanics of the elbow joint, as a result, to the improvement of implant design and surgical technique.

Surgical management of pancreatoduodenal tumors: the experience of using the developed operation technique

Relevance: The results of surgery in patients with pancreaticoduodenal cancer remain unsatisfactory. This complicates the choice of an optimal surgical technique in modern oncology. Surgery in the pancreaticoduodenal zone is associated with complications due to anatomical and physiological features of the pancreas and technical challenges of this surgical intervention. Despite preventive actions and innovative technologies, such a traumatic operation as pancreatoduodenal resection often produces complications, though recently fewer. This article describes a pancreaticoduodenal resection technique that reduces postoperative complication frequency and lethality in operable pancreaticoduodenal cancer. The purpose of the study was to assess the efficiency of an authorial pancreaticoduodenal resection technique (pancreaticojejunal invagination anastomosis) in pancreaticoduodenal cancer. Results: The proposed pancreaticojejunal anastomosis forming technique allowed reducing the postoperative complication frequency from 54.2% to 38.0% and postoperative lethality from 22.8% to 9.5%. Conclusion: This highly traumatic surgery involves quite severe and difficult to resolve postoperative complications (up to 50-70% of cases) and the resulting high fatality. The proposed pancreaticoduodenal anastomosis forming technique has efficiently reduced postoperative complications and fatality to a significant extent

Hybrid operation technique for incisional hernia repair: a systematic review and meta-analysis of intra- and postoperative complications

Background Incisional hernia (IH) occurs approximately in 15% of patients after midline surgery. Surgical treatment for IHs include a solely open or solely laparoscopic approach with mesh placement. Recently, hybrid (combined laparoscopic and open) approaches have been introduced. This systematic review evaluates perioperative complications of hybrid incisional hernia repair (HIHR). Methods EMBASE, Medline via OvidSP, Web of Science, Cochrane and Google Scholar databases were searched. Studies providing data on intra- and postoperative complications in patients who underwent HIHR were included. Data on intra- and postoperative complications were extracted and meta-analyses were performed. Study quality was assessed with the Newcastle Ottowa Scale, ROBINS-I tool, and Cochrane risk of bias. PROSPERO registration: CRD42020175053. Results Eleven studies (n = 1681 patients) were included. Five studies compared intra-operative complications between HIHR and laparoscopic incisional hernia repair (LIHR) with a pooled incidence of 1.8% in HIHR group and 2.8% in LIHR group (p = 0.13). Comparison of postoperative prevalence of surgical site occurrences (SSOs) (23% versus 26%, p = 0.02) and surgical site occurrences requiring interventions (SSOPIs) (1.5% versus 4.1%, p < 0.01) were in favour of the HIHR group. Overall postoperative complications seemed to occur less frequent in the HIHR group, though no hard statements could be made due to the vast heterogeneity in reporting between studies. Conclusion Although the majority of studies were retrospective and included a small number of patients, HIHR seemingly led to less SSOs and SSOPIs. This systematic review forms a strong invitation for more randomized controlled trials to confirm the benefits of this approach.

Nerve-sparing surgery in current gynecologic oncology

Nerve-sparing surgery is currently a very important topic in gynecologic oncology. In this review, it is shown that radical hysterectomy is not the only operation where the nerve-sparing technique can be used. Most surgical procedures in modern gynecologic oncology should spare the autonomic nerve structures. The review includes recently published articles precisely describing the nerve-sparing techniques in paraaortic and pelvic lymphadenectomy, and the modern approach to radical nerve-sparing hysterectomy. It has been shown in the literature that the quality of life of patients is directly dependent on the operation technique and its extension. As mentioned above, the nerve-sparing technique needs to be used not only in surgical procedures for cervical cancer, but more extensively also for endometrial and ovarian cancers. Modern techniques demonstrate that such an operation can be suitable both for the radicality and improved quality of life. Results of such operations are comparable to the old – not nerve-sparing techniques – both in terms of progression-free survival and overall survival. Nerve-sparing surgery in gynecologic oncology is our future. Better quality of life and greater patient satisfaction should be our goals. Studies are needed for better examination and comparison of the presented systematic nerve-sparing operations of lymphadenectomy in ovarian and endometrial cancers, and also combined with nerve-sparing radical hysterectomy.

Use of modern energetic methods of bone tissue removal during endoscopic dacryocystorhinostomy

The article presents the results of surgical treatment of 22 patients with chronic dacryocystitis accompanied by proximal obstruction of the nasolacrimal duct. A new method of nasolacrimal anastomosis bone window during endonasal endoscopic dacryocystorhinostomy using ultrasound bone dissection is described. The questions of operation technique using SONOCA 185 ultrasound bone dissector and specific features of postoperative treatment are discussed. The obtained data allow to conclude that low temperature process of bone dissection with ultrasound cavitation gives a possibility of adequate bone window formation, reduces surgical trauma of bone structures, surrounding soft tissues and nasal cavity vessels as well as reduces the risk of bleeding and operation time needed for its stopping. It also enables better healing of soft tissues in shorter terms, provides anatomical and functional success of operation in 91 % of cases. Key words: chronic dacryocystitis; endonasal endoscopic dacryocystorhinostomy; ultrasound bone dissection; dacryostoma.