Antegrade interventional approach for minimally invasive procedures is technically feasible, has the same effectiveness as the retrograde endoscopic method and also all advantages of minimally invasive techniques.

Aim. To identify a perspectives for using a single incision laparoscopic technologies in surgery.Materials and methods: Today we have a several questions relating to a single incision laparoscopic surgery such as the possible spectrum of their application, safety and economic efficiency. The main is: does this technologies have a perspectives in future.In paper was performed a retro and prospective analysis of the data of modern literature and authors own experience in surgical treatment using a single incision laparoscopic technologies.Results: The study included 74 patients who underwent: cholecystectomy – 64 (86,5%), nephrectomy – 4 (5,4%), ovarian cyst removal – 4 (5,4%), kidney resection – 2 (2,7 %), using various kind of ports: “X-Cone Karl Storz” (28), “Covidien” (18), “PPP” (7), and 21 cases of multi-trocar access.Conclusions: Our opinion that the perspectives for the development of single incision laparoscopy, is the further development of endoscopic devices, including robotic ones, and we believe that it will be a real future and endoscopic surgeons should be ready for this.

Background: KRAS mutations influence survival after hepatectomy for colorectal liver metastases (CRLM). However, their prognostic significance has never been evaluated in patients who undergo Associating Liver Partition and Portal vein occlusion for Staged hepatectomy (ALPPS). Methods: Between June 2011 and March 2016, twenty-six patients underwent ALPPS for CRLM. Complications were classified according to the Dindo-Clavien classification. Biand multivariate cox analyses were performed to evaluate variables potentially associated with survival. Results: Overall, morbidity grade !3a and 90-day mortality were 38.5% and 0%, respectively. Median follow-up from the time of discharge was 21.5 months (IQR 9.6-35.6). One and 3-years overall survival (OS) was 83.4 and 48.9 %, respectively. Patients with mutated KRAS had a median OS of 15.3 months versus 38.3 months for those with wild-type KRAS (p<0.0001). Median disease-free survival was 7.9 months, 5.6 versus 12.3 months for mutated and wild-type KRAS, respectively (p=0.023). KRAS mutation was found to be an independent risk factor for OS (HR 7.15, 95% CI 1.50-34.11;p=0.014). Conclusion: KRAS mutation is an independent predictor of poor survival after ALPPS. This finding will help to optimize patient selection, both avoiding futile surgical indication and maximizing the benefit for patients with extensive disease who are subjected to high-risk aggressive surgery.

Aim. To improve the results of surgical treatment of patients with cholelithiasis complicated by cholangiolithiasis and obstructive jaundice, using percutaneous technologies.Materials and methods. The results of treatment of 50 patients with cholelithiasis complicated by cholangiolithiasis and obstructive jaundice, which was not possible to use the endoscopic retrograde method of treatment was analyzed. Two representative clinical groups were formed according to the para-copy method: patients of the 1st group used the percutaneous method of treatment of cholangiolithiasis, patients of the 2nd group used the rendezvous technique.Results. The duration of the operation in the first clinical group was 85.60 ± 8.50 minutes, in the second – 64.80 ± 6.41 minutes. Intraoperative blood loss in both groups is minimal. The duration of postoperative hospital stay was: in the first group – 12.10 ± 1.25 days, in the second – 12.00 ± 1.25 days. In the first clinical group, the complication rate is 12%, in the second – 16%. No deaths were observed. The use of percutaneous laser lithotripsy allowed us to achieve the effectiveness of treatment of cholangiolithiasis in all patients in both clinical groups. The average consumption of a contrast agent per patient in the first group is 250.00 ml ± 25.00 ml, in the second – 370.00 ml ± 35.00 ml. Repeated debridement interventions in the first group were required by 2 (8%) patients, in the second – 8 (32%) patients.Conclusion. The frequency of complications, the duration of hospital stay and the effectiveness of treatment are comparable in both groups. If there is percutaneous access, hardware, instrumental and personnel support for percutaneous lithoextraction, there is no need to switch to a retrograde method for resolving cholangiolithiasis. The percutaneous method is an alternative minimally invasive method for treating patients with cholangiolithiasis and obstructive jaundice, which is impossible to perform “traditional” interventions or is associated with a high risk.

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1 ФГБОУ ВО «Московский государственный медико-стоматологический университет им. А.И. Евдокимова» Минздрава России, Москва, Россия; 2 ГБУЗ «Городская клиническая больница им. братьев Бахрушиных» ДЗ Москвы, Москва, Россия В последние годы отмечается неуклонный рост числа заболеваний, сопровождающихся развитием синдрома механи-ческой желтухи и требующих экстренного хирургического вмешательства. С целью разрешения механической желтухи выполняются операции наружного желчеотведения, при которых частота развития осложнений составляет 2,4-32,7%, а летальность -0,4-13,8%. Благодаря совершенствованию методик антеградных вмешательств, инструментального обе-спечения, детальному изучению топографо-анатомических особенностей строения печени и сосудистой системы печени повышается безопасность выполнения оперативной техники -антеградные чрескожные чреспеченочные вмешательства. Цель исследования -определить оптимальную оперативную технику декомпрессии билиарного тракта у больных с забо-леваниями гепатопанкреатобилиарной зоны, осложненными синдромом механической желтухи, основываясь на топо-графо-анатомических особенностях строения печени, желчевыводящих путей и сосудистой системы. Материалы и методы. Проведен ретроспективный анализ лечения 150 больных с механической желтухой в возрасте от 29 до 83 лет (средний возраст 74,3±5,4 года). С целью купирования механической желтухи больным выполнена чрескож-ная чреспеченочная наружная холангиостомия. Оптимальным при холангиостомии является использование двух мето-дов визуализации желчных протоков: на первом этапе ультразвуковая визуализация с оценкой топографо-анатомических особенностей гепатопанкреатобилиарной зоны, позволяющая выполнить канюляцию желчных протоков с последующим рентгенологическим контролем. В случае недостаточности данных для оценки топографо-анатомических особенностей, полученных в результате ультразвукового исследования (УЗИ), больным показано выполнение спиральной компьютер-ной томографии (СКТ). В нашем исследовании мы выполняли канюляции протоковой системы через левую долю печени, пунктируя второй сегментарный проток по левой парастернальной линии, отступив от края реберной дуги на 3-6 см, через правую долю выполняли канюляцию шестого сегментарного протока точкой доступа по задней подмышечной линии в восьмом-одиннадцатом межреберье. При анализе лечения 150 больных с синдромом механической желтухи оцени-вались следующие параметры: объем интраоперационной кровопотери, продолжительность пребывания в стационаре, частота развития осложнений и летальность в зависимости от выбора точки пункции билиарного тракта, основываясь на топогрофо-анатомических особенностях. Результаты. Объем интраоперационной кровопотери при пункции правых отделов протоковой системы составил 32±9 мл, при пункции левых -18±5 мл (р=0,029). Кровотечение из пункционного канала в послеоперационном периоде из правой доли отмечено у 4 больных, левой -у 2, желчеистечение с правым доступом -у 4, с левым -у 5; нагноение места стояния дренажа -у 15 (10%); гематомы паренхимы печени -у 2 (1,3%); пневмоторакс -у...

Despite of an obvious success in the management of cancer patients and in the quality of medical care for them, however there are still open questions on the effectiveness of prevention and treatment of complications after surgery, chemotherapy, and radiotherapy, as well as on the quality of comprehensive rehabilitation of such patients. One of the possible ways to solve these issues is low-level laser therapy.Laser therapy in Russia has been successfully used in many areas of modern clinical medicine for more than 50 years; it is still developing and improving. Main advantages of laser therapy are simplicity, comfort, and safety for patients, as well as low costs.The widespread use of low-level laser light has experimental and clinical justification. Awareness in principles of dosing, methodological features of laser procedures, justified prescription and strict compliance with indications and contraindications can ensure high effectiveness of the discussed therapy in oncologic patients.

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.