OBJECTIVE. The article presents the complex management of treatment in multiple trauma using endovideoassisted surgeries. MATERIAL AND METHODS. The authors demonstrated minimally invasive methods of treatment for victims with multiple trauma on the second stage of programmed multiple-stage surgery in order to eliminate life-threatening consequences and fix fractures of facial skeleton. These operations were performed during 12 hours after trauma. RESULTS. Programmed multiple stage treatment included the prevention or stop of asphyxia, bleeding and temporary fixation of fractures using extrafocal osteosynthesis and elements of primary plasty of soft tissues. Surgeons created conditions for intensive therapy (tracheostomy) using minimally invasive methods. CONCLUSIONS. Endovideo-assisted technique decreased trauma of surgical approach and allowed doctors to perform revision of complex anatomical structures, which were difficult to access. It expanded the volume and possibilities of surgical manipulations. Surgeons differentially removed foreign bodies and areas of necrosis. The method increased an accuracy of reconstructive surgeries and facilitated to monitoring of damaged structures.

OBJECTIVE. The authors developed a new method of assessment and planning of correction of sagittal midfoot deformity, which is based on original reference lines and angles. MATERIAL AND METHODS. X-ray lateral foot projections without deformities were analyzed in 64 adult volunteers. There was determined the angle between articular line of talus trochlea joint and the first metatarsal mechanical axis. It was estimated the ratio of segment length which was limited by distal point of the head of first metatarsal bone and distal edge of articular surface of talus trochlea joint (AC) to segment length, which was limited by edge of articular line of talus trochlea joint (AB). RESULTS. The target angle was 23,6 ± 3,2. The ratio coefficient of segment length AC to AB consisted of 4,3 ± 0,9. The method of planned foot correction was based on data obtained. It allowed doctors to determine the deformity apex and normal position of the first metatarsal head. CONCLUSIONS. The developed method facilitates to plan surgical correction of midfoot deformity in sagittal plane. It gives an opportunity to assess correction results independently from presence of equinus foot position in ankle joint and (or) hindfoot deformity.

OBJECTIVE. Minimally invasive correction of posttraumatic deformation and stabilization of damaged segment are important in treatment and prevention of complications after traumatic compression fractures of the vertebral bodies. MATERIAL AND METHODS. Retrospective study was made in 25 patients with A2-A3 fractures of the vertebral bodies at the period from 2014 to 2015. The patients underwent transcutaneous transpedicular fixation. The research was based on prospectively collected data. The authors evaluated the dynamics of kyphotic deformation of the spine (Cobb angle, sagittal index) before and after operation. RESULTS. The elimination of thoracic and lumbar spine traumatic deformation resulted in decrease of Cobb angle from 42º (39…44º) and 17º (8…24º) to 21º (20..23º) and 9º (5…14º), respectively (p < 0,01 and p < 0,03). There wasn’t noted any significant decrease of reduction angle (p =0,38 and p = 0,46). CONCLUSIONS. Percutaneous transpedicular fixation is the effective minimally invasive method of treatment for patients with A2-A3 traumatic compression fractures of the vertebral bodies.

OBJECTIVE. The aim of this research was to improve results of gloss total resections of glial tumors of the brain. MATERIAL AND METHODS. Fluorescence-guided resection was performed in 31 patients with glial tumors of different degree of malignancy. «Photoditazin» was applied during operation. The authors assessed the efficacy, sensitivity and specificity of the method and degree of radical nature of resection in relation to surgery of gliomas. RESULTS. Sensitivity of the method numbered 68,3 % and specificity was 60,1 % in cases of gliomas of grade I-II. It was 85,4 % and 76,2 %, respectively in cases of gliomas of grade III-IV. The degree of achievement of gloss total resection (GTR) was 79,3 % (gliomas of grade III-IV) and 95,6 % (gliomas of grade III-IV). CONCLUSIONS. Intraoperative fluorescent diagnostics using «Photoditazin» was highly effective, sensitive and very specific method in surgery of glial tumors of different degree of malignancy. The method allowed doctors to develop the radical nature of surgery in cases of glial tumors removal.

OBJECTIVE. The research compared efficacy and safety of application of dabigatran and rivaroxaban in prevention of venous thromboembolism after orthopedic operations. MATERIAL AND METHODS. An analysis of prophylaxis and treatment results of venous thromboembolism was made in 208 patients who underwent knee and hip arthroplasty. The patients were divided into two statistically homogeneous groups. The first group consisted of 102 patients where dabigatran etexilate therapy was used in fixed dose 220 mg/day. The second group included 106 patients who had prophylaxis by rivaroxaban in dose 10 mg/day. RESULTS. Venous thromboembolic complications were noted in 36 (17,3) patients equally in both groups. Internal bleedings of different nature were found in 18 (8,65 %) patients with deep venous thrombosis. It occurred more often against a background of therapeutic dose of anticoagulants in the second group (on 2,29 %). CONCLUSIONS. There wasn’t noted any statistically significant difference in efficacy and safety between dabigatran etexilate and rivaroxaban.

OBJECTIVE. The authors determined criteria for reasonable selection of patients for application of optimal minimally invasive interventions in cases of thyroid gland diseases. MATERIAL AND METHODS. The treatment results of 322 patients with thyroid gland diseases were analyzed. There were used a conventional method and variety of minimally invasive methods. RESULTS. It was stated that the main criteria that verified a choice of optimal minimally invasive surgery were the nodule size and thyroid gland volume, autoimmune inflammation of thyroid tissues against a background of toxic and diffuse toxic goiter, retrosternal goiter position and necessity of central lymphodissection in case of metastatic thyroid gland. CONCLUSIONS. The authors applied the determined criteria based on modern diagnostic methods in patients with surgical thyroid gland diseases. This study allowed doctors to justify the choice of optimal minimally invasive surgeries and avoid unreasonable operations, improve treatment results.

OBJECTIVE. The authors developed a low invasive method of bimammary coronary artery bypass grafting (CABG) of minimum two arteries through left-sided thoracotomy. MATERIAL AND METHODS. The left internal thoracic artery was used for bypass grafting of anterior interventricular artery according to V.I. Kolesov method. Anastomosis of the right interventricular artery with conduit (from autoartery or autovein) was performed by using extrapleural way in the second intercostal space from the right of the breast. Conduit was lengthened behind the sternum to pericardium cavity in order to create the second distal anastomosis with branch of coronary artery. RESULTS. The operations (10 cases) were conducted at the period from October 2015 to December 2016. The second distal anastomosis between conduit and coronary artery was performed with diagonal artery in 1 case, with branch of blunt edge in 5 cases and with posterior interventricular branch in 4 cases. Tolerance of operation and early postoperative period were satisfactory. CONCLUSIONS. New method of bimammary coronary artery bypass allowed doctors to perform revascularization minimum of two coronary vessels on working heart by avoiding manipulations on aorta and the sternum.

OBJECTIVE. The study summarized personal surgical experience of uniportal video-assisted thoracoscopic (VATS) lobectomies for patients with stage I-II non-small cell lung cancer. MATERIAL AND METHODS. The authors have performed 72 VATS lobectomies for patients with stage I-II non-small lung cancer using modified minimally invasive single incision above anterior part of musculus latissimus dorsi. RESULTS. During the implementation period, there were carried out 2 (2,8 %) conversions to open thoracotomy. There weren’t observed lethal postoperative complications of VATS lobectomies. Other complications had 5 (6,9 %) patients. Postoperative pneumonia was in 1 (1,4 %) patient. Arrhytmia was noted in 4 (5,6 %) patients. The average operation time consisted of 227,4 min (from 60 to 460 min). Learning curve demonstrated a significant decrease of operation time with every following VATS lobectomy from 227,4 to 90,3 min (p=0,03). The quantity of removed regional lymph nodes estimated 14,2 ± 0,7 during uniportal VATS lobectomy. The median blood loss was 98,3 ml (from 10 to 300 ml). The average duration of air leak was 2,3 ± 0,65 days after uniportal VATS lobectomy. The mean term of drainage was 4,6 ± 0,53 days. CONCLUSIONS. The data obtained justified the feasibility, efficacy and safety of VATS lobectomies in patients with I-II stage of lung cancer.

OBJECTIVE. The research evaluated efficacy of combined treatment of initially nonresectable and inoperable cases of non-small cell lung cancer. The treatment consisted of preoperative endobronchial and intraoperave photodynamic therapies. MATERIAL AND METHODS. The prospective investigation included patients with central non-small cell lung cancer. These cases were initially considered as nonresectable (the trachea was involved in tumor) or inoperable (functional intolerance of pneumoectomy/ bilobectomy). Neoadjuvant chemotherapy (2-6 courses) and endobronchial photodynamic therapy (PDT) were conducted for these patients in preoperative period. PDT of resection edge was carried out during the operation and it was straight away after specimen removal and ipsilateral lymphodissection. RESULTS. The research was made on 38 patients. Lung resections underwent 30 (79 %) patients. Surgeries included 20 pneumoectomies and 10 lobectomies. Bronchial resection was performed by crossing an initially affected zone. It was noted that 5-year survival consisted of 68 %. CONCLUSIONS. Photodynamic therapy was important in combination with chemotherapy and surgical treatment of central non-small cell lung cancer. These measures allowed doctors to decrease the resection volume in part of inoperable patients or patients with initially nonresectable tumors.

OBJECTIVE. The study assessed an efficacy of laparoscopic gastric bypass (LRGB) in correction of main components of metabolic syndrome (MS). The authors revealed the possible reasons of insufficient efficacy of operation. MATERIAL AND METHODS. Results of LRGB were estimated in 228 patients who underwent operation during 5 years. Index of body mass, % EBMIL, lipid spectrum, level of glycemia, content of leptin and ghrelin were considered. RESULTS. The high efficacy of operation influence on MS was found in young age groups. Other groups had lower efficacy of operation. The reason was in gastrointestinal tract reconstruction that resulted in decrease of body mass, regress of associated diseases, change of key hormones which regulated energy metabolism, homeostasis of glucose and lipids. The ghrelin level didn’t have a determining value and didn’t influence on decrease of MT after operation. CONCLUSIONS. The operation effectively influenced on all possible components of MS, but the ghrelin content wasn’t determinative for long-term regulation of body mass loss and reduced the efficacy of operation.

OBJECTIVE. The study revealed clinical, endocrine and genetical predictors of safety of spermatogenic epithelium in patients with nonobstructive azoospermia. MATERIAL AND METHODS. The open testicular biopsy was performed in 38 patients with secretory azoospermia. The wide range of instrumental, laboratory studies were conducted before biopsy. RESULTS. Two prognostic models were developed by taking into account the revealed predictors of damage of germinogenic epithelium. CONCLUSIONS. The age, concentration of follicle-stimulating hormone, presence or absence of microdeletion AZFc are independent prognostic predictors of germinal epithelium condition.

OBJECTIVE. The study considered the rate and clinical features of recurrent intussusception in children. MATERIAL AND METHODS. Retrospective analysis was made in all patients with intussusception at the period from 2006 to 2016. RESULTS. There were observed 45 cases of intussusception recurrence in 39 (14,5 %) children out of 268. Relapse of intussusception was three times more frequent in boys compared with girls (29 (74,4 %) vs 10 (25,5 %) and it was four times more frequent in children older than one year. The majority of patients (28 (71,8 %) have been admitted to hospital at the first 12 hours since onset of disease. Recurrence of intussusception was more frequent after conservative disinvagination compared with surgery (17,8 % vs 2,5 %; p = 0,026). Pathological formation of the intestine (Meckel’s diverticulum, doubling of the small intestine) were detected in 3 (7,7 %) out of 39 patients with relapse intussusception compared with 3 (1,3 %) out of 229 patients without recurrence (p = 0,05). Conservative treatment was conducted in 23 (59 %) patients and 16 (41,0 %) patients underwent surgery. There weren’t noted severe complications of lethal outcomes. CONCLUSIONS. The authors observed the tendency of frequent recurrence of intussusception in children, especially after conservative treatment.

OBJECTIVE. The study identified peculiarities of clinical manifestations of opisthorchosis papillitis depending on the stage of disease. MATERIAL AND METHODS. Features of diagnostics were based on analysis of medical data of 384 patients with opisthorchosis papillitis. There were investigated and statistically processed 23 clinical signs, 9 laboratory indices and data of 9 methods of instrumental diagnostics. RESULTS. Generalized and isolated analyses of signs allowed doctors to determine their diagnostic significance. The instrumental methods of diagnostics gave an opportunity to reveal this pathology in contrast to data of clinical manifestations. The inner diameter of major duodenum papilla was used in order to determine the stage of opisthorchosis papillitis. CONCLUSIONS. Specific clinic-laboratory signs for papillitis indication weren’t found. The most preferable instrumental method of diagnostics appeared to be the endo-ultrasound investigation, which gave a possibility to visualize lumen and walls of papilla and perform a needle biopsy of its deep structures.

OBJECTIVE. The authors identified independent risk factors of postoperative prolonged ileus after colorectal cancer surgery. MATERIAL AND METHODS. Multivariate logit regression analysis was made in order to reveal independent risk factors of prolonged ileus. RESULTS. The frequency of prolonged ileus cases consisted of 13 %. The authors detected three independent risk factors such as body mass index higher than 25 kg/m² (p=0,033), taking of opioid analgetics (p=0,022) and left colon flexure mobilization (p=0,047) in multivariate statistical analysis. CONCLUSIONS. Postoperative prolonged ileus was the frequent complication in colorectal cancer surgery. There is a possibility to identify the group of patients who exposed to risk of occurrence of prolonged postoperative ileus due to application of revealed risk factors.