[Transoral endoscopic thyroid surgery]

OBJECTIVE

To analyze own initial experience of transoral thyroid surgery.

MATERIAL AND METHODS

There were 7 patients thyroid nodules who underwent surgery for the period from March 2018 to May 2019. All patients signed an informed consent to be included in the study. Surgical approach was performed through three incisions in the lower arch of the vestibule of the mouth with deployment of 10 mm endoscope and two 5 mm tools. Gas insufflation was used. All patients were females aged 43.3±11.8 years. Thyroidectomy was performed in 2 cases, hemithyroidectomy - in 5 patients. Dimensions of nodules varied from 10 to 42 mm.

RESULTS

Mean time of hemithyroidectomy and thyroidectomy was 206.4±63.8 and 232±37.5 min, respectively. Papillary carcinoma was histologically verified in 1 case. Injuries of recurrent laryngeal nerve, postoperative hypocalcemia and local complications were absent. Drainage was not applied. Postoperative hospital-stay was 3.7±1.1 days.

CONCLUSION

Transoral approach to the thyroid gland is technically feasible with standard endoscopic instruments, safe for important anatomical structures and more precise due to the optical capabilities of endoscopic equipment. Any types of procedures are possible. Undoubtedly, aesthetic outcome is also favorable.

[Early ileostomy closure in patients with rectal cancer. Primary results of the randomized controlled multicenter trial]

AIM

To evaluate safety of early closure of ileostomy in patients with rectal cancer after primary surgery.

MATERIAL AND METHODS

The trial included patients from several medical centers without signs of anastomotic leakage. CT-proctography or rectoscopy were performed in 8 days after primary surgery to confirm integrity of the anastomoses. Exclusion criteria were factors affecting normal tissue regeneration (diabetes mellitus, steroid drugs prescription, etc.). Patients with intact anastomoses and no exclusion criteria were randomized into 2 groups: group 1 (n=31) with early closure of ileostomy (in 8-13 days after surgery) and group 2 (n=34) with delayed closure (after 12 weeks). All data were analyzed.

RESULTS

Postoperative morbidity was similar in both groups (6.45% vs. 5.88%, p=0.08). However, less duration of reconstructive surgery was noted in group 1 (50 (27-126) min vs. 71 min (31-134). This value was 1.42 times less in the main group (95% CI 1.30-1.52; p=0.02).

CONCLUSION

Early closure of ileostomy in patients after surgery for rectal cancer is feasible and does not result increased postoperative morbidity. This approach may be considered as an alternative to delayed closure. However, further researches devoted to analysis of ileostomy-associated complications and quality of life are necessary.

[Redo laparoscopic surgery for recurrent gastroesophageal reflux disease and hiatal hernia]

AIM

To assess mechanisms of recurrent gastroesophageal reflux disease and the ability to perform adequate surgical correction after previous surgery.

MATERIAL AND METHODS

The authors from various surgical centers have operated 2678 patients with gastroesophageal reflux disease and hiatal hernia for the period 1993-2018. 127 (4.74%) patients underwent redo surgery for recurrent disease, 46 of them were previously operated in other clinics.

RESULTS

Median follow-up after redo surgery was 63 months (12-139). Satisfactory functional result was achieved in 76.4% of patients.

Instrumental palpation in endoscopic renal surgery: case reports and analysis

Palpation is one of the classic examination methods in open surgeries. In minimally invasive surgery, intra-operational manual palpation is impossible to use for assessing tactile characteristics of tissues. In Russia, the only available instrument for intra-operational assessment and objective registration of tissue visco-elastic properties is the Medical Tactile Endosurgical Complex (MTEC). The aim of this work was to study the performance of MTEC in renal surgery. The study was performed during nine elective laparoscopic surgeries for clear cell renal carcinoma and simple renal cysts. We have found several differences in the use of MTEC in renal surgery, as compared to its use in gastrointestinal or lung surgeries. The key factor determining these differences was the inverse relations between tissue visco-elastic properties: the studied tumors were softer than the surrounding tissue. Detection of intraparenchymal tumors by tactile methods was impossible. For surface tumors, in one case out of nine it was possible to strictly locate the border of the tumor by tactile examination. We were able to quantitatively assess and determine the difference in hardness of tumors and intact tissue using MTEC. This allows studying the prognostic value of objectively registered tactile characteristics of renal tumors.

[The wound healing stimulation]

The aim of the study is to work out the method of stimulation of postoperative wound healing after emergency abdominal surgery. Morphologic and morphometric studies showed that serotonin and/or NO-therapy use in the treatment of surgical laparotomic wounds furthers its healing by decreasing distrophic and inflammatory processes and favouring fibroblast proliferation, neoagiogenesis, collagen production etc. Results of 763 patients with laparotomic wounds treated with serotonin, mexidole and NO postoperatively demonstrate faster wound healing and absence of infectious suppurative complications.

[Photodynamic therapy and exogenous nitric oxide in combined treatment of purulent wounds of the soft tissues]

Results of treatment of 160 patients with purulent wounds of the soft tissues treated with photodynamic therapy and exogenous nitric oxide were analyzed. High efficacy of this method is demonstrated: clinical course of the disease improves, period of wounds healing and hospitalization reduces. Photodynamic therapy in combination with exogenous nitric oxide results in rapid repair of microcirculation, stimulation of phagocytosis, accelerates cleaning of wounds, activates macrophagal reaction, fibroblast proliferation and epithelium regeneration that is in stimulation of reparation.

[Antioxidant properties of 3-oxypyridine analogues: mexidol, emoxipin, proxipin]

Using three chemiluminescent model systems of oxidation (suspension of phospholipid liposomes, a geous solution of haemoglobin-hydrogen peroxide-luminol and a geous solution 2,2'-azo-bis-(2-methylpropionamidine)dihydrochloride-luminol) the antioxidant activity and mechanism of antioxidant action of three 3-oxypyridine analogues: (mexidol, emoxipin and proxipin) were studied. These compounds were shown: a) to interact with catalitically active two valency iron ions (Fe2+), that causes elimination of ions from the model system; b) to scavenge reactive oxygen species and/or luminol radicals produced in the model systems. Their activity reduced in the following order: mexidol > emoxipin > proxipin. The antioxidant activity of 3-oxypyridines may underline known clinical effects of these compounds.

[Experimental study of photodynamic effect on bacterial wound microflora]

The in vitro study of the influence of photodynamic action (with the use of photosensitizer "Photosens", laser and non-laser irradiation) on the strains of the main representatives purulent wound microflora was carried out. Staphylococcus aureus, S. epidermidis, Pseudomonas aeruginosa, Escherichia coli, Proteus mirabilis cultures have been isolated from wound secretions and identified. The photosensitizer was shown to produce no bactericidal effect by itself. Irradiation with laser and non-laser light sources induced a sharp decrease in the number of viable cells in the cultures under study. The irradiation of the photosensitizer led to its activation, manifested in bactericidal action. The results thus obtained confirm good prospect of using photodynamic therapy for the treatment of purulent wounds.