Introduction. Robot surgery is one of the most high-demand and dynamic developing realms of medicine. It is widely used in urology, proctology, thoracic, cardiovascular surgery and gynecology. In February 2018 a robot surgery centre opened in Volga Federal District of the Russian Federation based on the clinic of the Bashkir State Medical University (city of Ufa).

Materials and methods. The present paper demonstrates the first successful robot-assisted vascular operations within a master-class called "Aorto-Femoral Shunting with the use of robot-assisted surgical system Da Vinci".

Results. Exemplified with three operations: two linear aorto-femoral shunting and lumbar sympathectomy demonstrate technical peculiarities and advantages of robot-assisted vascular surgery. The findings show positive short-term results of the performed surgical interference that combine minimal injury and blood loss which help to reduce hospital stay in an intensive therapy department and intestinal distention duration. These clinical effects enabled to provide early activization of patients and possibility to adequately correct nutritional status with enteral feeding. The above-mentioned advantages eventually resulted in reduction of post-operation stay of patients in in-patient department and of cost of treatment.

Conclusion. Robot-assisted surgical system Da Vinci being the most cutting-edge in the realm of endoscopic surgery, enables to carry out operational interference with minimal blood loss and injury of tissues which helps to reduce postoperation and recovery periods. 

Introduction. Pulmonary arterial hypertension (PAH) is a rare disease of unknown etiology, characterized by increased resistance of pulmonary vessels, which leads to right ventriculae heart failure and, eventually, death. At the same time, according to the literature, it has been established that the presence of an atrial septum defect in patients with idiopathic PAH (iPAH), is accompanied by a longer life expectancy, improves its quality and is the prevention of sudden death due to the development of a pulmonary hypertensive crisis. We decided to perform an operation to create an atrial septum communication (ASC) in patients with iPAH.

Materials and methods. Clinical cases showed efficiency in creating interatrial septum fenestration by implantation of intentionally fenestrated occluder in patients with PAH.

Results. It was in studies revealing that the advantage of this method as compared to others is close good fixation of the device on interatrial baffle which reduces possibility for the device to migrate from fixed position in the heart cavity and to reduce intra-operative complication. After implantation of fenestrated occluder the patients showed significant improvement of life quality: decrement of breathlessness, higher tolerance to physical exertion, less swelling in lower limbs, absence of syncopal condition. Such procedure perhaps prolongs life time.

Conclusion. Implantation of fenestrated occluder, modified in intra-operative conditions, can be an adequate method to help patients with iPAH, under conditions of unavailability of special devices in the market. 

Introduction. Hip arthroplasty is considered to be the most effective method providing social and household reintegration for destructive-dystrophic lesions. Goal of the study is to improve the results of surgical treatment using the technology of arthroplasty in patients with decompensated forms of destructive-dystrophic hip joint lesions. Material and methods. It was an open prospective, randomized study carried out on the base of traumatology and ortopaedics department of the Bashkir State Medical University including 710 patients with decompensated destructivedystrophic hip joint lesions. All patients (n=710, of which 6.1% were female) depending on the diacritic approach were divided into groups: the control group included (n=406) patients with hip joint trauma who were provided a conventional range of diagnostic and treatment procedures; the experimental group (n=304) included patients who had a range of diagnostics and treatment of destructive-dystrophic lesions of hip joints based on assessment of the connective tissue phase state. Results. Biometric indicators of stance and walking phase firmly improved in all groups 3 years after arthroplasty (p<0.05). Comparative analysis of arthroplasty results in the research groups showed effectiveness of the developed concept to surgically treat destructive and dystrophic lesions of hip joint on the basis of the system approach in the form of improved parameters of the components of the local and systemic level by 2.38% and 2.3% for osteoarthrosis (p<0.05), by 1.61% and 1.84% for aseptic necrosis of femoral head (p>0.05), by 5.62% and 4.37% for post-traumatic damage of hip joint (p<0.05). Conclusion. Analysis of short-term and long-term results of arthroplasty showed high efficiency of the developed concept of surgical treatment and monitoring of connective tissue phase state at destructive-dystrophic lesions of hip joints based on the system approach in the form of reduced pain syndrome, improvement of functional possibilities and patients life quality.

Introduction. Our first experience in embolization of prostatic arteries at patients with benign prostatic hyperplasia had comprised patients with the symptoms of chronic urinary retention.

Material and methods. The average age of patients (n=3) was 61.0±4 years. Among medical indications to embolization there were dysuria significantly degrading the patients’ life quality and their unwillingness to proceed to transurethral resection. Before the embolization of the prostatic artery, it is necessary to identify the place of its departure and its anastomosis by computed tomography. Successful operation was effectuated without microcatheter guides in 3 cases and with the application of microcatheter guides in 3 cases. For the purposes of embolization there were used spherical embolus HydroPearl sized 400 nm. No complications were reported neither in the operational nor in the post-operational periods.

Results. All patients admitted a decrease in dysuria as well as the improvement in life quality already in 7–15 days after the endovascular invasion. Control ultrasound dopplerography was performed 3 months after intervention. Two patients with embolization showed decrease of prostate volume by 26%, and one patient — by 35%.

Conclusions. Embolization of the prostatic arteries is a promising low-traumatic and safe method for treating patients with benign prostatic hyperplasia. It is necessary to further study its long-term results, to develop an optimized methodology — fast, simple and cheap, but not at the expense of efficiency and safety. 

Relevance. Violation of colon function in children remains an important problem in clinical gastroenterology. Until now, there are various approaches to the treatment of the etiology and pathogenesis of chronic constipation and the issue of treatment practice has not been resolved.

Purpose of the research. To study blood flow of the sigmoid and rectum wall in idiopathic megarectosigmoid in children.

Material and method of the research. The age of patients varies from 3–15 years. The girls were (79%). The results of sigmoid and rectal blood flow in 29 children with constipation and 16 healthy children were studied.

Results. Indicators showed that with this pathology, as a rule, there are changes in the intestinal hemodynamics indicating signs of venous congestion, indicating the presence of veniparesis of the vessels of the colon with constipation in children.

Conclusion. Summing up the results of the study, we can say that constipation in children is characterized by disorders of hemodynamics of the colon in the form of a decrease in the tone of the vessels, and the depth of the revealed changes in the conditions of the vascular blood flow allows, along with other diagnostic methods, to form indications for surgical intervention and conservative management of patients suffering constipation. 

Introduction. Ovarian cancer is characterized by complex diagnostics and flow forecasting, which makes it important to search for prognostic criteria. However, the prognostic significance of some factors has not yet been studied.

The purpose of the study: to identify the features of immune response in the localization of metastases in the large omentum in ovarian cancer.

Tasks: to reveal the pathomorphological features of the cellular immune response to metastases in the large omentum in patients with ovarian cancer II–III stages; to conduct histomorphometry of elements of the immune system in the area of metastases.

Material and methods. The study was carried out on the biomaterial of the large omentum of 94 women with ovarian cancer II–III stage. The measurements were carried out on paraffin sections stained with hematoxylin and eosin and included evaluation of the following parameters: the number of lymphocytes in the field of view at the border and away from the tumor, the continuity of the lymphocyte shaft at the border with the tumor, the number of neutrophils on the border with the tumor, the presence of plasmocytes on the border with tumor. The preparations were studied and photographed under a microscope with a microscope-microvision mVizo-103 and a microscope Micromed 3.

The results. Observed 94 patients with stage II–III ovarian cancer. Over the three-year follow-up period, the disease-free survival rate was 79.8%. A total of 64 patients with stage III disease were observed. A recurrence-free survival rate among patients with stage III ovarian cancer was 74.32%. Without relapse during the follow-up period, those patients were found whose lymphocytes formed a continuous shaft at the border with the tumor, their number in the field of view ×200 was 400 or more, the plasmocytes were present in the composition of the shaft, and the neutrophils were absent or few.

The conclusion. A detailed histological study to quantify and qualitatively determine the severity of lymphoid elements of the large omentum allowed an indirect assessment of the state of the immune system and the probability of an unfavorable outcome in patients with ovarian neoplasia. 

Introduction. Myoma of the uterus is the most common neoplasm of the female reproductive system. The frequency of combination of uterine fibroids and pregnancy varies from 1.6% to 10.7%, often fibroids occur in pregnant women of late reproductive age. Traditionally, myomectomy during caesarean section was not recommended because of the risk of bleeding and postoperative complications. To assess the safety and feasibility of a one-stage myomectomy in a caesarean section, this study was conducted.

Materials and methods. From 2010 to 2015, we examined 260 pregnant women with uterine myoma, who had a cesarean section with a single-stage myomectomy. The data obtained during the survey were compared with the data of 96 women from the control group. We study assessment of intraoperative blood loss, pre- and postoperative hemoglobin levels, duration of hospitalization.

Results. Statistically significant differences in intraoperative blood loss, changes in hemoglobin levels and in the duration of hospitalization between the examined groups of women were not revealed. A prognostic model has been developed to assess risk factors for intraoperative blood loss of more than 1000 ml.

Conclusion. The size, localization of myomatous nodes are not risk factors for high blood loss in abdominal delivery with a one-stage myomectomy. The factor of risk of hemorrhage is multiple uterine fibroids, whereas the size of myomatous nodes less than 5 cm can be regarded as a protective factor for blood loss. The study showed that a one-stage myomectomy with a caesarean section is safe and can be performed with the surgeon’s experience. 

Introduction. Pulmonary embolism (PE), being the most severe embolic complication, is characterised by low predictability, high mortality and incapacitation rates as well as a correspondingly high economic cost of therapy and aftercare. In this connection, the main purpose of our work is to find a warning for PE development in non-cardiosurgical patients that have undergone intensive therapy under conditions of general surgical ICU, among the indicators of the haemostasis system.

Materials and methods. Based at the anaesthesiology and emergency surgical department № 1 of the Kuvatov Republic Clinical Hospital (Russia), the researchers carried out an analysis of the haemostasis system in 430 patients hospitalised between 2010 and 2014. The functional activity of platelets was studied using a Biola 230LA laser platelet aggregation analyser (Russia). The determination of circulating aggregates was conducted using the Wu — Hoak method. Thromboelastography was carried out using a TEG 5000 Thromboelastograph (USA). A Stago STA Compact automated selective haemostasis analyser (France) was used to register indicators that characterise the state of endothelium, the haemostatic coagulation element and thrombosis and fibrinolysis markers.

Results. Univariate analysis demonstrated a connection between nosocomial episodes of thrombosis and the following factors: emergency surgery (OR 9.1, p<0.01), peripheral vessel disease (OR 13.5, p=0.01), collapse development in pre-operation period (OR 30, p<0.01), high content of D-dimers (OR 30, p<0.01) and low content of AT III (OR 13.5, p=0.01). The results of multifactor analysis show that the significant diagnostic criteria are high D-dimer content and low AT III venous blood activity.

Conclusion. A determination of high risks will enable the incidence of pulmonary embolism to be to minimised as well as provide a timely assessment of the efficiency of preventive measures carried out. 

Introduction. Atherosclerotic lesions of the branches of the aortic arch in 60% of cases is the cause of the development of ischemic stroke. As a radical means of preventing neurological disorders, carotid endarterectomy is used, since there is currently no effective drug treatment.

Material and methods. This article presents a comparative characteristic of anesthesiological support and types of surgical intervention in 710 patients with atherosclerotic lesions of brachiocephalic arteries in the period from January 2010 to December 2017 in Department of Vascular Surgery at the Clinic of the Bashkir State Medical University. To perform this comparative characteristic, the patients were divided into 2 groups, depending on the time interval. Group 1 — patients operated from 2010 to 2013 (291 patients). Group 2 — patients operated from 2014 to 2017 (491 patients). In Group 1, operations were predominantly performed under regional anesthesia and classical carotid endarterectomy predominated over an eversion. In Group 2, operations were performed under general anesthesia, and here the overthe-top carotid endarterectomy predominated over the classical one. Patients were comparable in age, sex and risk of anesthesia and surgical intervention according to the ASA classification. The overall incidence of ischemic postoperative complications was 4.22%.

Results. According to our data, the application of the eversion method of carotid endarterectomy under general anesthesia reduces the relative risk of neurological complications by 1.648 times (as in the 2nd group the technique of eversion carotid endarterectomy under general anesthesia was used). The use of general anesthesia with carotid endarterectomy allows to provide adequate gas exchange, manageability by hemodynamic parameters, absence of emotional reactions from the patient.

Conclusion. Thus, at the present moment, our experience in treating patients with atherosclerotic lesions of the brachiocephalic arteries is approaching the optimal one, allowing us to achieve good results of carotid endarterectomy. 

Introduction. Presently there is no unified tactics to treat patients with aberrantly localized coronary arteries of “muscular bridge” type. There are controversial data regarding the benefit of coronary artery stenting due to often stent breakage or perforation of tunneled vessel. There are no major randomized studies regarding this issue. In this regard the goal of this research was to assess strength characteristics of stents in the model of muscular growth that we restored.

Materials and methods. The originally developed model enabled to determine the strength limit of coronary stents under conditions that are maximum close to the physiological ones. The stents were placed into a polytetrafluoroethylene tube, the bridge-imitating oscillation frequency was configured to 250 beats per minute. The results of the experiment were recorded on USB-camera each 30 minutes in order to register mechanical defects of the stent.

Results and discussion. The stent consisting of cells that are joined with V-shaped connections, showed first signs of strut deformity on the 10th day. Complete breakage happened on the 17th day after implantation. After 2 months observation the stent preserved mechanical firmness without V-shaped connections.

Conclusion. Thus, it is not quite correct to support the hypothesis on infeasibility of stent implantation into the coronary artery with a muscular bridge. Taking into consideration the findings it is possible to suppose that the structure, design, form and content of stents predetermine the possibility to implant it into coronary artery with muscular bridge, but require individual approach to every particular patient. 

Introduction. One of the worst complication of different surgical diseases of abdominal cavity organs and of performed, on that regard, operational interventions, are intestinal festulas including without limitation deodenum fistulas. Longterm experience of surgical treatment of patients with unformed duodenal and high enteric fistulas show that it is feasible to have a clear surgical tactics with account of location level and type of fistulas, their quantity, volume of sarcous reduction, peritonitis and multi-organ failure syndrome. In this regard, the objective of this research is to find optimal surgical tactics and to determine the most effective method of treating duodenum fistulas of various causation.

Materials and methods. Experimental work was carried out under conditions of experimentally formed intestinal fistula in rabbits of “Shinshilla” breed. After formation of fistula the animals were divided into 3 groups based on the method of removing artificially installed duodenal fistula: sealing through Albert — Schmieden — Lembert suture without fastening of suture line; sealing through fastening of intestinal suture with biological surgical glue; sealing through fastening with swine dermal collagen. Mechanical constancy of the sutures was measured with pneumocompression of sealed intestinal tract areas as well as with morphological study of surgical wound edges.

Results. The results of histological study show that experiments with application of bio-implant demonstrated less vascular congestion and interstitial swelling. Phologistic infiltration also responded more efficiently both quantitatively (manifestation rate) and qualitatively (quick change of cell elements) in the group that used bio-implant.

Conclusion. Results of morphological studies and pneumocompression data under modelling of duodenal fistulas in experimental animals show that application of bio-implant helps to earlier restore microcirculatory abnormality. 

Introduction. Acute renal failure is considered a functional, progressive, oliguric, but reversible kidney disease that occurs due to severe liver disease with hepatic insufficiency. In the development of the syndrome, the leading role is played by the “classical hypothesis of peripheral vasodilation”. Important differentiation in verification of diagnosis is primarily with pseudo hepatorenal syndrome. In the type I (of hepatorenal syndrome) mortality in the first 10 days without an adequate management in intensive care unit is extremely high. The chronic, type II, is a slow process, but requires adequate therapy for up to six months. In general, all clinical manifestations of hepatorenal syndrome are combined into three groups: cardiac insufficiency, systemic vasodilation, and vasoconstriction of renal vessels. The goals of the therapy include restoration of blood flow through the vessels, management of inflammatory processes, prevention of further hepatic tissue destruction, and stabilization of arterial blood pressure in kidney vessels. The core in medical management is adequate albumin infusion and minimal crystalloid support of blood volume, vasopressors, adequate antidote and antibacterial therapy. Additional methods include extracorporeal albumin dialysis to bridge patient to liver transplantation. The orthotopic liver transplantation is the established surgical treatment, as well as transjugular intrahepatic portosystemic shunt (TIPS) or peritoneovenous shunt. Survival rate of patients with hepatorenal syndrome type I on terlipressin in patients with hypoalbuminemia correction is close to 60–75%; survival of with hepatorenal syndrome type II is more favorable in most cases.

Methods. The literature review examines diagnostics possibilities of hepatorenal syndrome, importance of timely relevant differential diagnoses and adequate intensive care management.

Conclusion. The differential diagnosis between hepatorenal syndrome and pseudo hepatorenal syndrome remains a challenge in routine diagnostic examinations. Intensive care management of such patients requires immediate treatment, which may not be always the most appropriate option. The refore new strategies are needed to improve management of this medical condition.