Extracorporeal partial nephrectomy under pharmaco-cold ischemia without ureter intersection with orthotopic replantation of renal vessels for RCC is a relatively safe organ-sparing treatment. It provides resection of large tumors with any location under prolonged cold ischemia without ureter intersection.

Aim. To improve quality and duration of life in patients with locally advanced pancreatic cancer. Material and methods. Cryosurgery through laparotomy has been performed in 36 patients with locally advanced pancreatic cancer since 2012. There were 14 (38.9%) men and 22 (61.1%) women (mean age 58 ± 6.8 years). Dimensions of pancreatic tumors were from 4 to 10 cm. Domestic devices “CRYO-MT”, “CRYO-01”, “ELAMED” and cryoapplicators with a diameter 2–5 cm were applied. Target temperature was about 186 °С, time of exposure – 3–5 min. There were 1–5 sessions of cryoablation (mean 2.4) and their number depended on tumor dimensions. Local cryodestruction was supplemented by bypass anastomoses in 18 patients (50%). All patients subsequently underwent adjuvant chemotherapy with additional regional chemoembolization in 10 of them. Results. There were no lethal outcomes during cryodestruction and in postoperative period. Early postoperative complications occurred in 14 (38.8%) patients, severe complications – in 13.6%. Cryodestruction was followed by complete regression (39.2%) or significant improvement (41.6%) of pain syndrome. 6-, 12-, 24- and 36-month survival was 92%, 84%, 48% and 14%, respectively. Median survival was 18.2 months. Conclusion. Cryodestruction is able to improve patients’ quality of life due to reduced pain syndrome in case of locally advanced pancreatic cancer. Certain increase of survival was observed in additional chemotherapy.

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Background: Laparoscopic distal pancreatic resection has gained acceptance and being practised in major HPB units. Laparoscopic pancreatico-duodenal resections are technically demanding and benefit of this approach has been a matter of debate over the past decade. We aim to analyse our early experience in laparoscopic pancreatico -duodenal resections. Methods: From November 2012 to August 2015, we have performed 8 pancreatico-duodenal resections. There were 2 total pancreatectomies and 6 Whipple's resections. The laparoscopic approach was using 5 ports with patient in supine position. We describe the patient characteristics, techniques and short-term outcomes. Results: The median age was 56 years (39e75) and M:F was 2:1. The Median BMI was 21 (17.5e23.5). The major indication was ampullary carcinoma. Two of the Whipple's resections had early conversion during dissection because of adjacent visceral invasion requiring extended resections. One Whipple's resection was totally laparoscopic and rest of them required a small incision to complete the anastomosis. The mean operating time was 598 min (425e689). One patient had grade A pancreatic leak that was managed conservatively. The median length of stay was 11 days (6e 22). The median tumour size was 19.3 mm (9e30).The mean lymph node yield was 20 (10e24). There was one case of R1 resection margin because of tumour within 1 mm SMV margin. There were no postoperative mortality. Conclusion: Laparoscopic pancreaticoduodenectomy is feasible and safe in selected group of patients performed by experienced surgeons. The oncological and the short term outcomes are similar to open resections.

The incidence of focal lesions in the spleen is 3.2–4.2% per 100,000 population. Spleen cysts are rare (incidence 0.75 per 100,000). These are single or multiple, thin- and smooth-walled cavities filled with a transparent liquid. Distinguish between primary (or true) cysts, lined with epithelium, and secondary (or false), devoid of epithelial lining. Among the primary cysts, there are congenital cysts formed in the embryonic period due to the migration of peritoneal cells into the spleen tissue, dermoid and epidermoid cysts. A special group of primary cysts are parasitic cysts. Cystic tumors of the spleen include lymphangioma and lymphoma.The main difficulties in the diagnosis and differential diagnosis of cysts and cystic tumors of the spleen are associated with the rarity of this pathology and, as a consequence, a small number of works, including a significant number of the cases. However, in those works where a large number of the cases are described, most often this is one morphological form and an analysis of its various characteristics.Purpose. Based on the analysis of our own examination data of a significant number of patients with cysts and cystic tumors of the spleen, to assess the possibility of differential diagnosis of individual morphological forms according to ultrasound data.Materials and methods. 323 patients with cysts and cystic tumors of the spleen from 15 to 77 years old (men – 105 (32.5%); women – 218 (67.5%) were treated at A.V. Vishnevsky National Medical Research Center of Surgery for the period from 1980 to 2020. All patients underwent ultrasound during examination. Surgical treatment was carried out in various ways – (85.1%), when making a preoperative diagnosis of an uncomplicated spleen cyst of small size, dynamic observation was carried out (verification by puncture biopsy data).Results. Morphological verification of cysts and cystic tumors of the spleen was presented as follows (taking into account possible difficulties in identifying the epithelial lining): true cyst – 182 (56.4%); dermoid cyst – 3 (0.9%) (malignant – in 1 case); pseudocyst – 16 (5.0%); pancreatogenic – 34 (10.5%); echinococcus – 52 (16.1%); lymphangioma – 24 (7.4%); lymphoma – 10 (3.1%); ovarian cancer metastasis – 2 (0.6%). The article describes the ultrasound signs of the above forms of the lesions with an emphasis on the complexity of diagnosis.Conclusions. Primary and parasitic spleen cysts are well differentiated according to ultrasound; false cysts of the spleen, depending on the cause of their occurrence, can create difficulties in their identification and differentiation (they require careful dynamic control); cystic tumors of the spleen should be differentiated from malignant tumors and metastases of a cystic structure, as a result of which such vigilance should always be present when they are detected.

Primary tumors of the heart are a rare pathology with a frequency of occurrence of 0.0017% to 0.28% according to autopsies, while 75% of them are benign in nature, 25% are malignant. Secondary tumors of the heart occur 20–40 times more often than primary tumors. Due to the rapid development of radiology diagnostic methods, the chances of early detection of heart tumors have improved significantly at present. Recently, large cardiology centers have accumulated a lot of experience in the diagnosis and treatment of these lesions. However, early detection in primary malignant lesions of the heart is still a problem, since the clinical symptoms appear when tumors reach a large size. Modern methods of treatment of the heart malignant tumors include radical surgery, and in case of impossibility – cytoreductive surgery.We present literature review on the diagnostic methods and differential diagnosis of the heart lesions. The types of cardiac tumors are described; its morphological features, differential diagnostic imaging features and hemodynamic characteristics of the lesions are presented; the diagnostic effectiveness of modern imaging methods is analyzed.

The mitral valve prolapse is characterized by the degeneration of the valve leaflets, accompanied by their thickening, increasing surface area and flexibility. The mitral valves leaflets bulge (prolapse) beyond the plane of the atrioventricular ring into the left atrium during ventricular systole and lose the ability to close tightly, leading to the mitral regurgitation. Acute chord rupture of the mitral valve posterior leaflet is a rare but important cause of severe mitral regurgitation and the development of acute or progressive chronic heart failure. Acute mitral insufficiency, accompanied by hemodynamic disorders, requires an urgent valve plastic surgery or valve prosthetics. The mitral valve plastic surgery gives a number of undeniable advantages over prosthetics, providing the best hemodynamic parameters, saving the patient from lifelong receiving of anticoagulant drugs. Detailed qualified echocardiographic evaluation of all structures of the mitral valve (fibrous ring, MV leaflets by segments, overlapping structures, structure of the chordal apparatus, papillary muscles) provides the necessary information for the mitral valve reconstructive plastic surgery with the choice of the method that is most optimal for a certain patient at the preoperative stage. We report herein a clinical observation of the patient with a diagnosis: acquired heart disease, the mitral valve posterior leaflet prolapse with mitral insufficiency Grade 3. Chronic heart failure IIA. II FC. Atrial fibrillation. The patient underwent multicomponent mitral valve reconstruction with the creation of a neochord and the fibrous ring plastic on the duplicate of a PTFE strip (soft support ring), pairwise isolation of the pulmonary vein entrance and right cavotricuspid isthmus.

Background: Сombined treatment for patients with metastatic liver damage offers better long-term outcome, and laser ablation can increase the indications for liver resection for somatically burdened patients. Methods: The Results of treatment of 28 patients with metastatic liver damage and using laser ablation technique for the period from March 2017 to 2018, women 17, men 11, average age was 61 AE 2.7 years. All patients in the preoperative stage performed removal of the primary focus in the volume of R0 and lymphadenectomy D1, D2 and are at different stages of chemotherapy. Laser ablation of liver formations was performed percutaneously transhepatic, under the control of ultrasonic scanning in real time. For laser ablation, ECHO LASER, manufactured in Italy, was used, a 4-channel multiple source with a complex ultrasound system, using laser radiation with a wavelength of 1064 nm. Control of the effectiveness of the effect was carried out by ultrasound, MRI and CT with intravenous bolus enhancement in dynamics. Result: In the early postoperative period pain syndrome was noted, within 3 days, stopped with the use of analgesics, biochemical analyzes (ALT, AST, AP) were observed for 10 days. In the early postoperative period, formation under the capsular hematoma, in the area of "h"hthe light guide, was not required, which did not require surgical intervention. In 4 patients, at 6 months, progression of the disease was noted, followed by liver resection. Morphological examination of the ablation zone shows pathomorphosis of the fourth degree (according to Lushnikov). The average bed-day was 4 days. Conclusion:The use of laser ablation allows several nodes to act simultaneously. Due to low traumatism and