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.

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To perform quantitative assessment of intraoperative blood loss volume and severity during stages of idiopathic scoliosis surgical correction. Material and Methods. Data of intraoperative blood loss during stages of surgical correction of idiopathic scoliosis were analyzed in 1241 operated patients. Multi-stage surgical interventions were performed in 581 (46.8 %) patients, posterior fusion-in 660 (53.2 %), and multilevel corrective vertebrectomy-in 72 (12.4 %) patients. Two methods of general anesthesia were used: TIVA with propofol, fentanyl, tracrium, and with inhaled sevoflurane, fentanyl, and tracrium. Volumes of intraoperative blood loss were assessed at main stages of surgery. Results. Total intraoperative blood loss during multistage surgical treatment with segmental hook instrumentation was 967.4 ± 43.6 ml, and with hybrid instrumentation-1135.9 ± 139.5 ml. Blood loss during posterior only fusion procedure was 865.5 ± 40.1 ml with segmental hook instrumentation, and 1049.9 ± 75.5 ml with hybrid instrumentation. Multilevel vertebrectomy was associated with maximum intraoperative blood loss of 1242.9 ± 121.8 ml. Conclusion. Intraoperative blood loss during surgical correction of idiopathic scoliosis varies considerably and averages from 20.0 to 40.0 % of the circulatory blood volume. The duration of surgical intervention is the main proved factor influencing the volume of blood loss.

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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.