Introduction. Bladder cancer dominates among global health problems. Radical cystectomy is the recognized standard of care for muscle-invasive bladder cancer with bilateral pelvic lymphadenectomy as a mandatory step in the surgical procedure. The concept of sentinel lymph nodes, acting as a barrier to the spread of malignant process, can be beneficial in terms of reducing the extent of pelvic lymphadenectomy. Intraoperative imaging using indocyanine green now appears to be a contemporary and relevant method for intraoperative imaging of sentinel lymph nodes. Materials and methods. A study involving 28 patients diagnosed with bladder cancer was carried out at the clinic of the Bashkir State Medical University. All patients underwent robot-assisted radical cystectomy with intracorporeal formation of a heterotopic neobladder using Bricker technique. At the stage of pelvic lymphadenectomy, the isolated lymph nodes were evaluated and intraoperative ICG-fluorescence was performed. All lymph nodes obtained were examined microscopically and the results were interpreted taking into account the intraoperative diagnosis. Results and discussion. Intraoperative ICG fluorescence identified sentinel lymph nodes in 7 of 9 patients (77.8%, p < 0.05), with sensitivity equal to 77.8%, p < 0.05 and specificity — 87.5%, p < 0.05. Conclusion. The results proved a high reliability of the method of intraoperative lymph nodes imaging with indocyanine green in patients with muscle-invasive bladder cancer. Fluorescence navigation in cancer surgery opens up new opportunities for improving perioperative outcomes and reducing complications.

Introduction. The key treatment for high-risk non-invasive bladder tumor or invasive urothelial cancer remains radical cystectomy (RCE), which provides the best survival rates. At the same time, the incidence of infectious complications in a number of studies reaches 33%, which in most cases causes repeated hospitalizations and disrupts the Enhanced Recovery After Surgery (ERAS) guidelines. Therefore, research into effective alternations of antibiotic prophylaxis remains relevant.

Materials and methods. The MACS trial is a Russian Phase 3 study with a prospective randomized set of participants to assess the incidence of infectious complications after RCE in the context of the ERAS guidelines (intermediate data snapshot after including 39% of the data). Detailed inclusion and exclusion criteria are published on ClinicalTrials. gov, ID – NCT05392634. The study has been approved by the Local Ethics Committee, No. 1/129 of April 28, 2022. Statistical data processing was performed with StatPlus:Mac LE.

Results and discussion. 36 patients were included in the study (39% of the expected sample). For the period from May 30, 2022 to February 01, 2023. A heterotopic Bricker reservoir was formed intracorporeally in 83.3% of cases (30/36), an orthotopic J-pouch reservoir was created in 13.8% of cases (5/36) and in 2.9% of cases (1/36) the urodereating stage was completed with ureteral clipping. No significant differences were revealed in urine bacterial contamination before surgery. However, in group A, the incidence of positive bacterial cultures, when the ureteric intubators were removed, was 2-fold higher than in the prolonged antibiotic therapy group: 7/14 cases (50.0%) and 3/12 cases (25.0%), respectively. In group B, the risk of complications in the prolonged antibiotic therapy group reduced by 47% within 30 days after RCE (HR 0.53 (95CI %: 0.21-1.32).

Conclusion. An intermediate data snapshot in MACS study revealed that RCE was associated with a high risk of early postoperative infectious complications. The prognostic significance of systemic inflammation indices as predictors of infectious complications subject to further evaluation in the remaining 61% of cases.

Introduction. The incidence of postoperative ureteral strictures induced by iatrogenic injuries tends to increase. Reconstructive surgery involves open or laparoscopic intervention to repair strictures. However, both methods have their drawbacks. Surgical treating strictures of the lower third of the ureter can be effectively performed by means of robotic surgery.

Aim. To determine outcomes of robot-assisted reconstructive surgery in treating postoperative strictures of the lower third of the ureter.

Materials and methods. Five female patients with postoperative strictures of the lower third of the ureter underwent robot-assisted reconstructive surgery. Clinical and radiological outcomes in the long-term postoperative period were determined.

Results and discussion. Two patients underwent simultaneous robot-assisted reconstructive surgery, namely, robot-assisted uretero-cysto-neoanastomosis on the right side and Boari operation on the left; robot-assisted Boari operation and isolation of post-traumatic uretero-vaginal fistula. In the remaining three cases, robot-assisted Boari operation and uretero-cysto-neoanastomosis with psoas-hitch were performed. No evidence of ureteral stricture in all cases was detected via multislice spiral CT (MSCT) urography in 3 months after surgery.

Conclusion. At present, robot-assisted reconstructive surgery, being suitable for simultaneous surgery, is safe and effective when
treating postoperative strictures of the lower third of the ureter.

Introduction. Minimally invasive surgical techniques, including robot-assisted ones, on the one hand, allowed indications for surgery to be expanded, but on the other hand, generated a number of specific problems associated with technical aspects of minimally invasive treatment. The latter has led to a new consideration of the influence of surgical aggression on patients and showed a clear need for adequate anaesthetic support in order to correct homeostasis changes and ensure safety of patients. Aim. To improve the patient safety in mammary coronary bypass surgery using the Da Vinci robotic surgical system. Materials and methods. The study enrolled 12 patients who underwent robot-assisted endoscopic isolation of the left internal mammary artery, followed by an anastomosis of the anterior descending branch via a mini-thoracotomy in the fifth intercostal space under single lung sevoflurane inhalation anesthesia with continuous ESP analgesia. Results and discussion. No lethal outcomes or serious complications such as myocardial infarction and acute cerebrovascular accident were reported. Discharge or transfer to the rehabilitation unit was carried out on the 5th–7th day. Conclusion. Minimally invasive techniques, including robot-assisted ones, require that the intensivists and cardiac surgeons be aware of the pathophysiological factors that affect the cardiovascular and respiratory systems, and have the ability to predict the course of events and take actions to prevent complications.

Introduction. Acute appendicitis (AA) is one of the most common acute abdominal surgical diseases. The current incidence, according to various authors, is 22.8 per 10,000 inhabitants. Annually, 50 to 70 thousand people die from AA and its complications around the world. Laparoscopy is generally accepted as the most effective method of differential diagnosis of AA. It is fundamentally significant to move from the diagnostic stage to the therapeutic one, i.e. to perform the elimination of the disease, including cases with other surgery-requiring pathology detected. Aim. To evaluate the role of video-endoscopic surgical methods in the surgical management of acute appendicitis complicated by peritonitis. Materials and methods. The analysis of recent publications and personal clinical experience revealed that diagnostic laparoscopy, unless contraindicated, should be performed as the initial step in suspected acute abdominal pathology. When the surgery is technically performable, laparoscopy also causes curative effect. Results and discussion. The use of laparoscopy in surgical treatment of acute appendicitis complicated by peritonitis has proven advantages for the patient over open surgery. An adequate appendectomy as a reliable method for elimination of the source of peritonitis is the key to successful treatment of patients. Laparoscopic lavage in the early postoperative period against the postoperative peritonitis with developing complications, is considered to be an alternative method to non-surgical treatment or delayed intervention and to have better ultimate results than percutaneous drainage or relaparotomy. Conclusion. The success of video-endoscopic technologies application depends not only on the technical aspects, but also on the correct choice of indications for such an intervention and their appropriate combination with open surgeries.

Introduction. According to the statistics of Plastic Surgery Unit, Mother and Child Clinical Hospital, Ufa (Russia), for 2019–2022, surgical interventions on the anterior abdominal wall rank third in popularity. The complexity of the approach to the treatment of patients with concomitant pathology of the anterior abdominal wall implies the need to replace isolated techniques with simultaneous surgical intervention in this area.

Aim. To analyze the experience of surgical treatment and postoperative management of patients with aesthetic and physiological pathology of the anterior abdominal wall, based on the clinical data of Plastic Surgery Unit, Mother and Child Clinical Hospital.

Materials and methods. The study enrolled 54 women who were undergoing inpatient and outpatient treatment in Plastic Surgery Unit, Mother and Child Clinical Hospital from 2019 to 2022. 31 of them made up group 1 (persons with aesthetic and functional deformity of the anterior abdominal wall but without a hernial defect), and 23 made up group 2 (persons with aesthetic and functional deformity of the anterior abdominal wall and with a midline ventral hernia). Abdominoplasty was performed in group 1, and hernio-abdominoplasty was performed in group 2. 

Results and discussion. Both abdominoplasty and simultaneous hernio-abdominoplasty enable the lost shape and contours of the anterior abdominal wall to be restored. Simultaneous hernio-abdominoplasty increases the time of surgical intervention, but reduces the multiplicity of necessary operations and anaesthetic support, the duration of the rehabilitation period, and financial costs. Abdominoplasty provides convenient access to perform tension-free hernioplasty. The simultaneous approach to the treatment of the anterior abdominal wall did not cause an increase in the incidence of complications.

Conclusion. Simultaneous hernio-abdominoplasty is a justified surgical intervention with a concomitant pathology of the anterior abdominal wall. An integrated approach improves immediate and long-term surgical out-comes.

Introduction. Determining the most optimal tactics for the diagnosis and treatment of primary malignant retroperitoneal tumors is highly relevant today. This can be attributed to a number of reasons, including: lack of versatile approach to the treatment of primary malignant retroperitoneal tumors, lack of effective ways to prevent the disease progression, small number of publications on this issue. All this motivates oncologists engaged in the treatment of patients with this pathology to accumulate and analyze the results of treatment of each patient. Materials and methods. The study was based on data analysis of 32 patients with primary retroperitoneal tumors, 26 of which were treated at the Yaroslavl Clinical Oncological Hospital from 2016 to 2021 with the diagnosis of primary malignant retroperitoneal tumors. Results and discussion. 13 patients out of 26 (50%) had T4N0M0. Stage 3B was detected in 73.08% of patients. Histologically verified: liposarcoma — 19.23%, leiomyosarcoma and myxoid liposarcoma — 15.38% each, the remaining formations comprised 3.8% each and consisted to different types of sarcomas from mesodermal rudiments. 22 patients (84.62%) had high-grade tumors, 4 patients (15.38%) had low-grade tumors. 22 patients underwent radical surgical treatment. Isolated resection of the tumor was performed in 11 patients (50%), and 11 operations (50%) were accompanied by combined or concurrent tumor resection. No postoperative complications were reported. Histologically confirmed tumor invasion was detected in 50% of operated patients. The most frequently involved organ was the kidney. Conclusion. The obtained data indicate high resectability rates for tumors of this localization. Analysis of the excised tumor volume revealed direct correlation with the degree of tumor malignancy. High rates of one-, three- and five-year survival of patients testify to the effectiveness of radical surgical resection both in case of isolated resection and combined or concurrent resection. However, frequent recurrences and, therefore, repeated surgical interventions lead to a regressive reduction in survival.

Introduction. Osteoporosis is a multifactorial metabolic disease that increases the risk of bone fracture because of reduced bone mineral density. The International Osteoporosis Foundation estimates that about 200 million people are affected by osteoporosis. Therefore, it is relevant to develop clinical and diagnostic methods that would make it possible to effectively predict fracture risks in different parts of the skeleton and, based on population studies, to accurately predict the course of the disease. Aim. To study the levels of body mass index and bone mineral density in men and women with fractures of different localizations. Materials and methods. 828 postmenopausal women (61.94 ± 7.98 years) and 496 men over 50 years (62.03 ± 10.83 years) were examined. Bone mineral density (BMD) was measured by means of two-phase Dual-energy X-ray absorptiometry (DEXA) using QDR 4500A (Hologic, USA) in standard locations. Body mass index (BMI) was also assessed. Results and discussion. The study has revealed associations between BMI and peripheral bone fractures, BMD of the lumbar vertebrae and fractures of the peripheral bones and spine, BMD of the femoral neck and fractures of this localization in women. In men, associations were revealed between BMI, BMD of the lumbar spine and fractures of all localizations, as well as between BMD of the femoral neck and spinal fractures and concomitant fractures. Conclusion. In women, a decrease in BMD of the femoral neck enhances the risk of fractures in general, BMD of the lumbar spine — only the risk of fractures of this localization. In men, a decline in BMD of both the lumbar spine and the femoral neck increases the risk of fractures of various localizations. Reduced BMI enhances the risk of fractures in general in both men and women.

A stricture is a type of narrowing of the urethra, which can be caused by a variety of reasons. In addition, urethral strictures are associated with a wide range of symptoms and require special diagnostic examination before proceeding with any treatment. The treatment of urethral strictures has remained a challenge for many years. Stricture recurrence is still a serious problem in reconstructive urology. During the second half of the 20th century, urologists tried to find solutions for treating both simple and complex urethral strictures. Within the last few decades research has mainly focused on improving existing procedures to mitigate the negative postoperative effects. Despite considerable scientific achievements in this area, numerous studies have revealed a lack of knowledge about urethral stricture surgery among urologists and have shown that patients with urethral strictures are generally offered inadequate treatment options. Currently, many surgical interventions are available to treat this condition. However, the variety of treatment methods reflects a lack of optimal technique. This bibliographical review presents data on the effectiveness of minimally invasive (endoscopic) and various urethroplasty options in urological practice.

The paper presents the results of the bibliographic research materials on Bowen's disease over the past 15 years. The aetiopathogenesis of the disease is not yet fully understood; however, most experts designate the following trigger factors: prolonged use of drugs that suppress the immune response, human papillomavirus, light skin type, and excessive exposure to sunlight, ionizing radiation, arsenic intake. Clinical manifestations of Bowen's disease take anular, verrucous, pigmented, and acral forms. Atypical variants of the disease include “giant” Bowen's disease, and cases of localization of lesions on the face. The paper describes the clinical symptoms of each clinical form of Bowen's disease, diagnostic methods, and various treatment methods used in foreign and domestic practice. Comparative results of research on the treatment methods of Bowen's disease include such methods as surgical removal, Mohs micrographic surgery, photodynamic therapy, curettage, cryotherapy, laser ablation, radiation therapy as well as conservative treatment methods. The latter include topical application of external remedies (fluorouracil, imiquimod, diclofenac), as they can be quite effective in certain cases. The advantages of photodynamic therapy are indicated both in terms of high efficiency and in the safety spectrum of treatment of Bowen's disease.

Breast cancer is the most common cancer in women, both in the Russian Federation and in the United States. Eribulin is a new microtubule inhibitor, used in the USA, Europe and other countries around the world to treat patients with advanced or metastatic breast cancer, resistant to other lines of therapy. Eribulin mesylate is a structurally simplified, synthetic analogue of halichondrin B, a substance derived from a marine sponge Halichondria okadai. The mechanism of action: eribulin inhibits the microtubule dynamics, binds to the plus ends of microtubules and inhibits microtubule growth in interphase cells, without affecting the shortening phase and tubulin sequesters into nonproductive aggregates, leading to G2/M cell-cycle block and eventual apoptotic cell death after prolonged mitotic blockage. A wide variety of patients with a number of comorbidities and lower functional status are treated in actual clinical practice. The reported data suggest that eribulin has demonstrated comparable results to the EMBRACE study for a wider and more diverse cohort of patients. Further studies of eribulin in actual clinical practice will certainly provide new opportunities for the treatment of metastatic breast cancer.

Introduction. One of surgical methods for treatment of aortic valve (AV) pathology is Aortic Valve Neocuspidalization Ozaki procedure (AVNeo). Thus, according to the latest systematic review, freedom from reoperation within one, three, five years after AVNeo was 98%, 97% and 96%. Available references provide few descriptions of reoperations after AVNeo. Aim. To analyze the immediate results of AV reinterventions after AVNeo. Materials and methods. In the medium term, reinterventions after AVNeo were necessary for 11 patients (4.3%). The age of patients ranged from 26 to 69 years. 11 patients who underwent surgery included 6 males and 5 females. Four patients had class III-IV CHF, according to NYHA classification. Three patients had previously been operated on for infective endocarditis (IE), and five patients had bicuspid aortic valve. The duration of follow-up, from AVNeo surgery to reinterventions, ranged from 3 to 43 months. Results and discussion. All patients underwent an isolated AV intervention. The main causes of dysfunction were IE (six patients) and leaflet rupture in the commissural area (five patients). Seven patients underwent aortic valve replacement with mechanical valves, one patient — with aortic homograft valve, one patient — with tissue valve and two patients underwent valve repair. In the early postoperative period, one patient had bleeding with the development of cardiac tamponade and one patient had a haemorrhagic stroke. No patients had ARF, perioperative myocardial damage, sternal infection or permanent pacemaker implantation. Two patients died during the hospital period. Conclusions. AV reinterventions are associated with a high incidence of complications and deaths. Therefore, prevention of IE and commissure enhancement should reduce the frequency of repeated interventions, which is to be confirmed by prospective studies in large cohorts of patients.