Objective. The purpose of this study was to investigate safety and feasibility of some surgical approaches to the supradiaphragmatic inferior vena cava (IVC) and the right atrium through the diaphragm from the abdominal cavity. Materials and Methods. The material of the anatomical study included 35 fresh cadavers. Several options of surgical access to the supradiaphragmatic IVC were successively performed. Feasibility and risk level of each of the approaches were evaluated with the use of a special scale. Results. The isolation of the supradiaphragmatic IVC and cavoatrial junction was most easily performed via T-shaped or circular diaphragmotomy (grade “easy” was registered in 74.3% and 80% of patients, resp., compared to 31.4% for transverse diaphragmotomy and 40% for isolation of the IVC in the pericardial cavity). The risk analysis has demonstrated the highest safety level for T-shaped diaphragmotomy (grade “safe” was registered in 60% of cases). The intervention via transverse diaphragmotomy, circular diaphragmotomy, and IVC isolation in the pericardial cavity was graded as “risky” in 80%, 62.9%, and 82.9% of cases, respectively. Conclusions. In our opinion, T-shaped diaphragmotomy is the most safe and easy-to-perform access for mobilization of the supradiaphragmatic IVC through the abdominal cavity.

The work presents a rare case of spontaneous migration of an 11-week fetus from the uterine cavity into the urinary bladder cavity through the long-standing vesicouterine fistula.

Introduction: We conducted a retrospective assessment of diagnostic and therapeutic approaches in patients with iatrogenic ureteral injury, who were treated in a specialized medical center. The aim: The aim of the research was to determine the optimal treatment method for correction of iatrogenic ureteral defects. Materials and methods: The study included 73 patients with iatrogenic ureteral injury. In 70 cases ureteral reconstruction was carried out with the help of Boari bladder flap. The effectiveness of this approach was assessed retrospectively by analysis of the complications and long-term results of the treatment. Results: The length of the bladder flap varied from 3 to 21 cm and averaged 9.8 ± 1.4 cm. In 6 (8.2%) cases a successful reconstructive surgery of the ureter up to the level of its upper third was performed. The overall frequency of intraoperative complications did not exceed 12.9%. The total frequency of early postoperative complications was high (75.8%), however, they were not severe and required surgical correction only in one (1.4%) case. The total number of positive long-term results (good + satisfactory) amounted to 91.5%. Nephrectomy was required only in 2 (2.3%) cases. Conclusions: The Boari bladder flap operation should be considered as the basis of the algorithm for providing medical care to patients with iatrogenic ureteral injury. This type of surgery makes it possible to completely replace the damaged or having doubtful blood supply portion of the ureter even with the defects extending to its upper third. The main advantages of this surgery technique are good blood supply of tubularized bladder flap and a high level of positive long-term results.

Objectives. To assess the outcomes of cavoatrial tumor thrombus removal using the liver transplantation technique for thrombectomy, a retrospective study was conducted. Materials and Methods. Five patients with atrial tumor thrombi who underwent piggy-back mobilization of the liver, surgical access to the right atrium from the abdominal cavity, and external manual repositioning of the thrombus apex below the diaphragm (milking maneuver) were included into the study. Extracorporeal circulation was used in none of the cases. The average length of the atrial component of the tumor was 20.0 ± 11.7 mm (10 to 35 mm), and the width was 14.8 ± 8.5 mm (10 to 30 mm). In this work, the features of patients and surgical interventions as well as perioperative complications and mortality were analyzed. Results. External manual repositioning of the tumor thrombus apex below the diaphragm was successfully performed in all patients. Tumor thrombi with the length of the atrial part up to 1.5 cm were removed through the extrapericardial approach. For evacuation of the thrombi with the large atrial part (3.0 cm or more), a transpericardial surgical approach was required. Specific complications associated with the access to the right atrium from the abdominal cavity (paresis of the right phrenic nerve, pneumothorax, and mediastinitis) were not detected in any case. The average clamping time of the supradiaphragmatic inferior vena cava (IVC) was 6.3 ± 4.6 min. The volume of intraoperative blood loss varied from 2500 to 5600 ml (an average of 3675 ± 1398.5 ml). Conclusion. Our work represents the initial experience in the liver transplantation technique for thrombectomy in distinct and well-selected patients with atrial tumor thrombi. The effectiveness of this approach needs further study. The video presentation of our research took place in March 2019 at the 34th Annual EAU Congress in Barcelona.