[Results of video-assisted technologies in colorectal surgery]

AIM

To analyze immediate outcomes of 286 laparoscopic and robot-assisted interventions on the colon and rectum.

MATERIAL AND METHODS

There were 256 (89.51%) laparoscopic and 30 (10.49%) robot-assisted procedures. 233 (81.46%) operations were performed for rectum and colon cancer. Postoperative complications after colon cancer surgery were revealed in 11.11%, including anastomosis failure in 2.08% of cases. Postoperative complications after rectal cancer surgery occurred in 32.58% of cases including anastomosis failure after anterior rectectomy in 11.67%.

CONCLUSION

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.

[Endovascular interventions in true and false aneurysms of hepatic, splenic and renal arteries]

A false aneurysm of visceral arteries is a life-threatening pathology sufficiently difficult to treat. Open operations are characterised by a large scope, considerable surgical injury and accompanied by a high rate of serious complications. The development of the technology of superselective catheterization of blood vessels, creation of specialized microcatheters, glue composites and various types of spirals made it possible to treat this severe pathology without resorting to open operations. The work deals with a brief literature review concerning epidemiology, methods of diagnosis and treatment of pseudoaneurysms of visceral arteries, followed by presenting three clinical case reports concerning successful treatment of posttraumatic false aneurysms of the right hepatic and splenic arteries, as well as an aneurysm of the renal artery. Both immediate and remote results of endovascular interventions in these patients are followed up, demonstrably showing possibilities of endovascular technologies in treatment of the pathology involved.

SP-D-dependent regulation of NO metabolism in lipopolysaccharide-stimulated peritoneal macrophages

This work was designed to study the role of surfactant protein D in the regulation of NO synthesis by "non-alveolar" microphages. We evaluated whether the effects of surfactant protein D depend on the phenotype of macrophages. In the absence of surfactant protein D, the LPS-induced iNOS response was shown to decrease in macrophages of native and proinflammatory phenotypes by 30%, and in macrophages of the antiinflammatory phenotype (by 63%). Under the influence of lipopolysaccharide in high doses (500 ng/ml), NO(2)*- production by mouse macrophages without surfactant protein D was reduced in native cells (by 25%), but increased in proinflammatory (by 40%) and antiinflammatory phenotypes (by 12% compared to mouse macrophages with surfactant protein D). Our results suggest that surfactant protein D is involved in the immune response in the whole organism, but not only in the lungs. The effect of surfactant protein D depends on the phenotype of macrophages.

Inversion of stress response reprogramming phenomenon in lipopolysaccharide-stimulated alveolar macrophages

The stress response and NO production in reprogrammed proinflammatory or antiinflammatory alveolar macrophages were studied after lipopolysaccharide treatment. Experiments with macrophages not containing HSP70 showed that lipopolysaccharide in a dose of 500 ng/ml induced stress response in cells with the proinflammatory phenotype (as distinct from an antiinflammatory phenotype). The stress response was not observed in HSP70-containing lipopolysaccharide-stimulated proinflammatory macrophages, but occurred in cells with antiinflammatory phenotype. Hence, the presence of HSP70 in alveolar macrophages results in the inversion of the phenomenon of reprogramming of the stress response. Independently on the phenotype, stimulation with lipopolysaccharide was accompanied by a 60-70% increase in NO production by macrophages not containing HSP70. However, NO production by HSP70-containing macrophages did not increase in response to lipopolysaccharide treatment. Our results indicate that reprogramming of the cell response in macrophages does not concern the system for NO synthesis. HSP70 prevents the lipopolysaccharide-induced activation of NO synthesis in alveolar macrophages.

[Anesthesia in the early postoperative period in patients who had undergone extensive surgical interventions on the colon with plastic repair]

Reconstructive plastic (n = 24) and repair operations (n = 23) on the colon were performed in 47 patients at Coloproctology Research Center (Moscow). The patients were divided into 2 groups administered different anesthesias and postoperative analgesias: total intravenous anesthesia (TIA) and combined epidural anesthesia (CEA). Adequate analgesia by CEA and early activation of patients after the operation promoted earlier (by 2 days) recovery of the motor function of the intestine than after TIA and traditional intramuscular analgesia with a narcotic analgetic. CEA ensured complete blocking of nociceptive pulsation and neurovegetative protection a with lower doses of narcotics during the postoperative period and can be used in this type of operations and postoperative management. CEA prevented gastrointestinal pareses, improved microcirculation and metabolic processes at the zone of intervention, and decreased the incidence of postoperative complications.