This review article presents a comparative assessment of various types of energies used in the surgical treatment of cervical pathology, with their positive and negative sides. The mechanisms of action of the damaging agent, indications and contraindications, as well as results of treatment of cervical diseases and follow-up complications are presented. Attention is drawn to current promising areas in the treatment of cervix disorders. In particular, the article reviews the modern method of treatment using ultrasonic ablation, presents an idea of the methodology for conducting high-intensity focused ultrasound therapy, and discusses the possibility of conducting non-invasive this therapy. The article displays the world and domestic literature data.
The article describes a clinical case of successful surgical treatment of a patient with deep endometriosis involving the rectum using the Da Vinci Surgical System. The use of the Da Vinci robotic complex allows for increasing the radicalism of the operation by improving visualization and expanding the surgeons manual capabilities. This starts to be possible thanks to the technical advantages of this technology, specifically 3D imaging and the use of EndoWrist instruments with artificial wrists and seven degrees of freedom that provide greater precision when manipulating in a minimally invasive environment. Surgical treatment of colorectal endometriosis includes three types of operations focus shaving, discoid and circular bowel resections with anastomosis. When choosing a treatment strategy, one needs to take into account the clinical course of the disease, the results of conservative treatment and instrumental methods of research (ultrasound, MRI), and the womans reproductive plans. The excision of the infiltrate is an effective method of treating patients with colorectal endometriosis in terms of pain relief, improving the quality of life and restoring reproductive function. Performing such operations is optimal in medical institutions with a multidisciplinary approach.
BACKGROUND: One of the modern methods of organ-saving non-invasive remote treatment of uterine fibroids is ablation of myomatous nodes with high-intensity focused ultrasound (HIFU).
AIM: The aim of this study was to analyze changes in the parameters of ultrasonic ablation when using intraoperative control with the help of an ultrasound contrast agent.
MATERIALS AND METHODS: In the period from 2016 to 2018, a total of 208 patients with symptomatic uterine myoma underwent HIFU ablation of myomatous nodes. The two groups of patients were compared: group I included 98 patients aged 36 to 52 years (mean age: 44.39 7.12 years) with intraoperative control with an ultrasound contrast agent (sulfur hexafluoride); group II consisted of 110 patients aged 20 to 55 years (mean age: 38.33 8.72 years), whose treatment was not controlled by the contrast agent.
RESULTS: Using the Mann-Whitney test, we obtained statistically significant differences in the following parameters: the duration of ultrasound ablation was 215.28 70.57 min (from 70 to 390 min) in group I, and 610.84 56.26 min (from 290 to 1230 min) in group II (p 0.005); the average energy was 329.06 33.06 W in group I, and 293.68 64.51 W in group II (p 0.001); good tolerance of the operation was shown in 91% of cases in group I, and in 61.8% of cases in group II; satisfactory tolerance of the operation was shown in 7.7% of cases in group I, and in 37.3% of cases in group II (p 0.001).
CONCLUSIONS: The data obtained indicate that the performance of HIFU ablation with the use of an ultrasonic contrast agent allowed halving the insonation time, while using submaximal and maximum ultrasound exposure powers with better tolerance of intervention by patients.
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