Robot-assisted surgery is not advisable for colon diseases according to price-effectiveness ratio due to available laparoscopic approach. Preventive intestinal stoma in endoscopic low and ultra-low anterior rectal resection allows you to avoid clinically significant inconsistency of colorectal anastomosis. Laparoscopic procedure should be performed with Contour stitching-cutting device in low and ultra-low anterior rectal resection if there is technical complexity of one-stage rectum intersection below the tumor. Robot-assisted operations for rectal cancer have advantages due to three-dimensional imaging and better orientation, greater freedom of manipulation in confined spaces, and simplicity of lymphadenectomy.
The analysis of short-term results of 117 laparoscopic and 16 robotic-assistant colon surgeries, performed in NMSC N.I.Pirogov between January 2011 and May 2015 was undertaken. There were 90 resections for colon cancer, 31 for diverticular disease and one for megacolon. Also results of 11 reconstructive operation after Hartmann procedure was investigated. In 74 cases of cancer operation were performed with mesocolonectomy and central vessels ligature. In 16 patients sceletization of inferior mesenteric artery and paraortal lymphadenectomy was performed. Morbidity rate was 11,3 % among all patients. The use of robotic technology in colon surgery is not an optimal option due to low cost effectiveness and prolonged operating time comparing to those after routine laparoscopic procedures.
The authors analyzed their 25-year experience in organizing obstetric and gynecological care in outpatient settings of the branch clinical and diagnostic center of PJSC Gazprom using inpatient replacement technologies. Effective use of modern clinical, laboratory and instrumental methods of examination allows at the stage of primary treatment in the shortest possible time to establish a clinical diagnosis and determine the plan of invasive diagnostic and therapeutic measures. Cost-effectiveness of hospital-replacing forms of care delivery involves a significantly lower cost of services in day hospital, as well as a shorter average length of treatment in comparison with a day and night facility. Social efficiency is determined by the fact that treatment in a day hospital has a significant “deontological” advantage, most of the time the patient is at home, in a familiar comfortable environment, surrounded by the family which increases satisfaction with health care. Medical effectiveness of hospital-replacing forms of care delivery is determined by continuity of inpatient and outpatient care, ensuring continuity of the entire treatment process. Reduction of temporary disability in the patient, reduction of postoperative complications, nosocominal infections are high efficiency of the developed model of organization. The experience accumulated over 25 years in the organization of surgical gynecological care allowed us to reach the level when the patient’s age, the presence of several concomitant chronic diseases, compensated diabetes mellitus type 2, obesity of any degree, cicatricial adhesion of any prevalence have ceased to be absolute and relative contraindications for laparoscopic benefits under general anesthesia and sling operations for genital prolapse under general or regional anesthesia in the surgical day care center of the clinic of high medical technologies of the clinical diagnostic center.
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