Introduction. One of the main goals in the treatment of thrombophlebitis of saphenous veins is to separate the superficial veins from the deep ones at the sites of the most frequent transition of thrombotic masses. At the same time, the implementation of endovenous treatment methods for thrombophlebitis lacks an evidence base regulating all aspects of this procedure. Aim. This study aims to increase the effectiveness of endovenous laser coagulation for patients with varicose complicated by declined thrombophlebitis of subcutaneous veins. To that end, a modified technique of endovenous laser coagulation of the great saphenous vein was developed and implemented in clinical practice at Bashmedcenter LLC. This modified surgical intervention aims to reduce the economic costs of performing the procedure, shorten surgery duration, and improve the cosmetic result and the quality of patients’ lives. The procedure of the operation was patented, and the patent for invention No. RU 2827090 C1 was issued.

Materials and methods. From 01.01.2022 to 31.12.2022, 50 patients with varicose of the lower extremities and moderate-risk thrombophlebitis of the great saphenous vein underwent endovenous laser coagulation in Bashmedcenter LLC. The examined patients were divided into a control group (34 patients) and a comparison group (16 patients). All patients underwent an assessment of the quality of life before and after surgery using a visual analog scale (VAS). A primary economic assessment of the costs for surgical intervention in patients with standard and modified endovenous laser coagulations was also performed.

Results and discussion. Before surgery, no statistically significant difference in quality of life between the two groups was observed. After surgery, positive clinical and aesthetic results were obtained in the group of modified endovenous laser coagulation. An economic evaluation of the costs for surgical treatment and measurement of the laser-coagulation duration were performed, which showed the advantage of the modified technique. According to statistics, patients who underwent a modified technique of endovenous laser coagulation of the great saphenous vein showed a significantly better quality of life at follow-up examinations on days 7, 30, and 90 after surgery.

Conclusion. The data obtained during the comparative analysis of treatment results showed the effectiveness of a modified technique of endovenous laser coagulation of the great saphenous vein in patients with varicose and declined moderate-risk thrombophlebitis, which is proved by a higher quality of life, better clinical outcome, and shorter surgery duration.

Introduction. The incidence of anemia in colorectal cancer patients reaches 30–67% depending on the stage and location of the tumor; the presence of anemia adversely affects the short-term and long-term results of radical treatment. One possible way of anemia correction is to parenterally administer iron preparations, specifically ferric carboxymaltose (III), prior to cancer treatment.

Materials and methods. The efficacy of anemia correction through intravenous administration of ferric carboxymaltose (III) in prehospital care was retrospectively evaluated in Stage II–III colon cancer patients who were treated at the Oncology Center No. 1 of the S.S. Yudin City Clinical Hospital (Moscow) from June 2022 to February 2023. The study group included 103 patients who underwent primary tumor removal (Group 1) and 61 patients who received chemotherapy (Group 2). The mean hemoglobin level prior to correction with parenterally administered iron preparations amounted to 92.12 ± 10.75 g/L in both groups. Mild anemia was observed in 58% of patients; moderate, in 39% of patients; severe, in 3% of patients. The average amount of ferric carboxymaltose (III) received by each patient in both groups was 982.58 ± 102.93 mg. The hemoglobin and iron levels were, on average, monitored on day 14 in both groups.

Results. In the entire sample, the hemoglobin and iron levels, on average, increased to 113.7 ± 11.0 g/L (p < 0.0001) and 20.3 ± 9.1 µmol/L (p < 0.0001), respectively. On average, the hemoglobin level increased by 21 ± 11.5 g/L (p = 0.01086), and the iron level rose by 15.7 ± 9.4 µmol/L (p = 0.038). Following correction, no severe anemia was observed; moderate and mild anemia was noted in 2% and 80% of patients, respectively; 18% of patients had no anemia (p < 0.0001).

Discussion. The correction of anemia through intravenous administration of ferric carboxymaltose (III) to colorectal cancer patients at the outpatient stage was found to be safe and efficacious.

Conclusion. The administration of ferric carboxymaltose (III) to colorectal cancer patients with iron deficiency anemia 14 days prior to the cancer treatment enabled a statistically significant increase in hemoglobin levels and a drastic reduction in the number of patients with moderate and severe anemia.

Introduction. Minimally invasive direct coronary artery bypass (MIDCAB) of the anterior descending artery provides a means to avoid artificial circulation and full sternotomy, reducing the risks of associated complications. Aim. To evaluate the short-term results of MIDCAB.

Materials and methods. The retrospective study included a total of 172 patients (132 men and 40 women) who underwent surgery in 2017–2022. The mean age was 60.83 ± 8.36 years, and the BMI was 28.7 (25.8–32.3) kg/m². The left ventricular ejection fraction amounted to 55 (49–59)%. Diabetes mellitus was diagnosed in 27.9% of patients, and atrial fibrillation was identified in 15.1% of patients. The medical history of patients included stroke (4.7%), percutaneous coronary intervention (PCI, 25.6%), and myocardial infarction (60.5%). The endpoints were in-hospital mortality and postoperative complications.

Results. Hybrid interventions (MIDCAB + PCI) were performed in 4.7% of patients. The surgery took 112(90–130) minutes. Perioperative myocardial infarction and acute kidney injury occurred in 1.2% of patients. No strokes were observed. Atrial fibrillation was diagnosed in 13.4% of patients; reexploration for bleeding occurred in 2.9% of cases; postoperative wound suppuration was observed in 0.6% of patients. The in-hospital mortality amounted to 0.6%. The length of ICU stay was 22 (18–24) hours, and the inpatient stay lasted 9 (8–11) days.

Discussion. MIDCAB shows good short-term results, combining the advantages of minimally invasive access and standard bypass surgery.

Conclusion. MIDCAB is an effective technique to achieve revascularization of the anterior descending artery that ensures low mortality and complication rates.

Introduction. In order to improve the efficacy of treatment for primary hyperparathyroidism, it is important to make a science-based choice of the surgical intervention method. 

Aim. To justify a new approach to the surgical treatment of primary hyperparathyroidism patients relying on the analyzed dynamics of laboratory bone turnover markers. 

Materials and methods. The dynamics of laboratory bone turnover markers were compared in primary hyperparathyroidism patients (n = 394). The patients were divided into four groups: 1) parathyroidectomy through central mini-access with bilateral exploration of the parathyroid glands and the use of confocal laser microscopy (n = 97); 2) parathyroidectomy through mini-access with unilateral exploration (n = 150); 3) parathyroidectomy through mini-access without ipsilateral exploration (local anesthesia) (n = 72); 4) parathyroidectomy through the Kocher access on the neck (n = 75). 

Results and discussion. In Group 1 patients, the target intraoperative levels of intact parathyroid hormone (iPTH) were reached in 100% of cases (n = 97): normalization in 84.6% of cases (n = 82) or a decrease of 50% or more from preoperative values in 15.4% of cases (n = 15). With the use of the other approaches (Groups 2, 3, and 4), iPTH normalization was observed in 61.3 % of cases (n = 182); a decrease of 50% or more in iPTH occurred in 25.6% of cases (n = 76); in 13.1% of cases (n = 39), the target iPTH levels of were not reached. Only in Group 1, complete normalization of ionized calcium and iPTH was observed three months after the surgery. In Groups 2, 3, and 4, ionized calcium levels of over 1.35 mmol/L were observed in several cases, and iPTH levels of over 68.3 pg/mL were noted in 30.3% of patients (n = 90).

Conclusion. A new approach is proposed for the surgical treatment of primary hyperparathyroidism patients with the use of confocal laser microscopy, which provides a means to increase treatment efficacy, allows target iPTH levels to be reached in 100% of cases, and achieves normalization of ionized calcium. This approach also justifies the permissibility of omitting the mandatory intraoperative iPTH testing, ensuring a decrease in the length of the surgical procedure without reducing its radicality.

Introduction. Biliary complications are serious and life-threatening complications after major liver resections. Prevention of these conditions is important for successful treatment. Aim. This study aims to evaluate the method for intraoperative drainage of the extrahepatic biliary tract as a way to prevent post-resection biliary complications.

Materials and methods. The results of surgical treatment of patients with liver diseases for the period of 2020–2024 were analyzed; patients were given treatment in the surgical department of the BSMU Clinic. The results of 61 patients who underwent extensive liver resections are presented. The experimental group included 31 (50.8%) patients who underwent intraoperative biliary drainage, and the control group included 30 (49.2%) patients who had no drainage. Perioperative criteria were compared between the two groups. Statistical data processing was performed using Statistica 10.0 program; the level of statistical significance was analyzed at p < 0.05.

Results. Statistically significant differences were observed between the groups in terms of operative intervention time and duration of hospitalization. In the experimental group, surgical interventions lasted longer (p < 0.05), while the duration of hospitalization was shorter (p < 0.05). At the same time, no differences were found in terms of intraoperative blood loss, volume of blood transfusions, and time to restore normal intestinal function (p > 0.05). According to statistics, the level of total bilirubin was significantly lower in the experimental group on the third day after surgery (p < 0.05). The control group demonstrated a total of more post-resection biliary complications compared with the experimental group (7 (23.3%) and 3 (9.7%), respectively, p < 0.05). 

Discussion. The data from world literature sources demonstrate the advantages of intraoperative biliary drainage. Prognostic scales are being developed to predict biliary complications.

Conclusion. The presented method significantly reduces the risk of biliary complications after extensive liver resections.

Vulvar cancer is one of the rare malignant neoplasms treated in gynecologic oncology. This type of cancer ranks nineteenth among the most common types of malignant neoplasms in European women. The main method for treating localized vulvar cancer is surgery. Starting from the stage TIb and with the lateral location of the tumor, surgical treatment is indicated (vulvectomy and inguinofemoral lymphadenectomy). The classical Ducuing surgical procedure, which was developed in 1934, is accompanied, in most cases, by such postoperative complications as lymphorrhea, delayed healing of surgical wounds, and suppurative septic complications. One way to minimize them is to use videoendoscopic technologies. The provided review of studies on the subject presents the results of using videoendoscopic technologies (e.g., a significant reduction in the number of postoperative complications). Noteworthy is that the operative time decreases with experience in performing such interventions. Randomized studies are needed to evaluate the long-term results when using videoendoscopic technologies to perform an inguinofemoral lymphadenectomy.

Crosslinking is a method of linking together high-molecular compounds by forming new chemical cross linkages inside and between macrochains. At the same time, various agents can act as cross linkers, i.e., chemical compounds, ultraviolet radiation, etc. Crosslinking of biotissues is known for improving their mechanical strength, increasing structural density, and reducing bioscaffold permeability. This review aims to characterize possible applications of cross-linking technology in various branches of medicine, i.e., ophthalmology, traumatology, urology, gastroenterology, oncology, bioengineering, and others. A review of domestic and foreign publications was carried out using the database and resources of search systems of scientific electronic libraries such as PubMed, elibrary.ru, Google Scholar, Science Direct, and the library stock of Bashkir State Medical University for the period from 1994 to 2023. The study of available literature sources makes it possible to conclude that the method of ultraviolet crosslinking is currently widely used in ophthalmology, while various modifications of crosslinking have prospects in medicine and related industries and can become the basis for the creation of bioengineered products and original medical technologies aimed at improving the effectiveness of treatment of various human diseases.

This paper presents a review of the state-of-the-art in skin melanoma treatment with a particular focus on immunotherapy and checkpoint inhibitors. Melanoma as a malignant neoplasm presents a serious threat given its high mortality rate, which emphasizes the need for further research and development of effective treatment strategies. Immune checkpoint inhibitors have shown a significant increase in the survival rate for skin melanoma patients. Nevertheless, the problem of drug resistance remains unresolved as a reaction to treatment differs from one patient to another even with high mutational burden. Obviously, immunotherapy may be accompanied by complications, which also emphasizes the need for an individualized approach to therapy. In order to predict treatment efficacy and understand possible resistance, mutation burden, T-cell receptor diversity, and specific antigens should be taken into account. All the above confirms the importance of a systematic approach to melanoma treatment including the use of modern drugs as well as a deep understanding of the patient’s immune status. Thus, this paper outlines the need for further research in the mechanisms of action of immunotherapeutic drugs as well as for the identification of biomarkers that may serve as predictors of response to therapy. This may lead to the development of more effective treatment strategies given the available advances in molecular biology and genetics. Addressing issues related to individualization of therapy based on immune status should become an important part of clinical practice.

Introduction. Urinary incontinence is an urgent problem in urogynecology and the number of patients with this pathology is steadily increasing. The main treatment method of urinary incontinence in women includes synthetic suburethral slings. Currently, more than 200 operations for stress urinary incontinence are carried out. One of the methods of surgical treatment of this pathology implies Burch colposuspension, which has been considered the gold standard treatment of stress urinary incontinence for recent decades. Aim. This study aims to describe a clinical case of using an alloplant in a robotic-assisted Burch operation for urinary incontinence.

Materials and methods. A 48-year-old patient was admitted to the BSMU Clinic in a planned manner with complaints of urinary incontinence during coughing, sneezing, and physical exertions as well as of a feeling of a foreign body in the vagina. The examination results confirmed a diagnosis of stress urinary incontinence. Comorbidities: Pelvic floor weakness. 2–3 degrees omission of the anterior vaginal wall. Cystocele. POP-Q 2. It was decided to perform a robotic-assisted Burch operation using an alloplant.

Results and discussion. The postoperative period proceeded without complications. A Foley’s catheter was removed on the first day. After its removal, natural urination was restored. The stitches were removed on the fifth day. The wound healed by primary intention healing. Urine was retained well during functional tests. On the 7th and 30th days, magnetic resonance imaging (MRI) revealed no inflammatory processes at the fixation site of the allograft. The allograft was retained, its integrity was preserved, and no pathology was detected. Patient examination at a distant time after surgery (2, 4, and 12 months) revealed that the function of the bladder to hold urine was preserved.

Conclusion. Robotic colposuspension using an alloplant is safe and can significantly improve quality of life indicators. The main advantages of this operation include the absence of allograft deformation and disease recurrence during patient examination as well as slighter injuries to the paraurethral tissues assisting the bladder in holding urine.

Introduction. Primary mature retroperitoneal dermoid cysts constitute a fairly rare pathology that is uncommon in men aged 50 years and older. In this article, we describe a case of a 68-year-old man with a large mature paravesical dermoid cyst extending into the rectovesical pouch and its successful surgical treatment using a da Vinci Xi robotic surgical system. Aim. To discuss the advantages of robotic access in the removal of large pelvic masses to achieve a speedy, successful outcome.

Materials and methods. An oval-shaped mass in the right side of the lesser pelvis measuring 66×85×62 mm was detected during a pelvic MRI exam performed as a follow-up after an adenomectomy. The attempted ultrasoundguided puncture was unsuccessful. A diagnostic laparoscopy was indicated to collect biopsy samples of the mass, with its subsequent removal if possible. Histology results verified the presence of a retroperitoneal dermoid cyst. In order to ascertain its localization and relationship with surrounding tissues, as well as to determine the structural parameters, a PET CT scan was performed. The planned robot-assisted laparoscopic excision of the retroperitoneal pelvic mass was performed.

Results and discussion. A general visual examination showed the removed specimen to be a cyst filled with a mushy mass of dirty white color, having an unpleasant odor and a large number of follicles. The histological study revealed an inflamed, ruptured retroperitoneal dermoid cyst.

Conclusion. The clinical case shows that old age mature dermoid cysts are found in the elderly; however, with timely diagnosis, they can be fully treated.

Introduction. Abdominal mesothelial cyst (AMC) is a type of mesenteric cysts of mesothelial origin. In patients with AMC and a history of diverticular disease, differential diagnosis is extremely difficult and requires the use of a correct diagnostic algorithm.

Materials and methods. A case of a 39-year-old patient with a cystic mass of the greater omentum is presented. The preliminary diagnosis was made on the basis of an ultrasound examination and an abdominal CT scan with intravenous contrast.

Results. The patient underwent a laparoscopic removal of the cystic mass of the greater omentum. The intraoperative findings confirmed the presence of a clearly defined cystic tumor originating from the greater omentum. The histologic study yielded the following macroscopic description: a thin-walled mass of gelatinous consistency, round in shape, and 8.5 cm in diameter. The outer surface was shiny and translucent, with a vascular pattern, a small amount of fatty tissue, and reddish-brown hemorrhages. The contents of the cyst were yellowish in color. The inner surface was translucent with white strands and a vascular pattern. The wall thickness varied from 0.1 to 0.3 cm. The microscopic description was as follows: fragments of adipose tissue with layers of fibrous tissue, that are lined with mesothelium in some areas. The morphology does not contradict the diagnosis of a cyst of the greater omentum.

Discussion. The described clinical case demonstrated that in patients with AMC and a history of diverticular disease, differential diagnosis is extremely difficult and requires the use of a correct diagnostic algorithm. A thorough preoperative preparation and surgical risk assessment allowed a laparoscopic surgical procedure to be performed.

Conclusion. The clinical case demonstrates that for such neoplasms, surgeons should give preference to laparoscopic access. It is also necessary to conduct a thorough differential diagnosis prior to surgery.

Introduction. Rectal cancer ranks second among the causes of mortality from oncological diseases, which determines the relevance of improving the diagnosis and treatment of this pathology. Augmented reality (AR) technology makes it possible to visualize complex anatomical structures and, therefore, improves preoperative planning and intraoperative navigation as well as reduces complication risks and increases the efficiency of surgical procedures.

Materials and Methods. A 58-year-old patient with a locally advanced recurrence of rectal cancer was clinically observed. The diagnostic process included pelvic CT and MRI, the data from which were used to create a 3D model of the tumor. The use of AR (Microsoft HoloLens 2 glasses) ensured precise tumor localization and minimized the risk of damage to vital structures during ultrasound-guided needle biopsy.

Results. Preoperative planning using the 3D model allowed the surgeon to determine the optimal approach for the biopsy. The obtained gross specimens confirmed the diagnosis of intestinal adenocarcinoma. The application of AR technology facilitated precise tumor localization, reduced the operation time, and prevented damage to vessels and adjacent anatomical structures. The postoperative period was unremarkable, and the patient was discharged on the seventh day. Discussion. The treatment of recurrent pelvic tumors is complicated by altered anatomy following primary interventions and radiotherapy. Standard biopsy methods carry a high risk of vascular and nerve damage. The use of AR in such cases ensures accurate navigation and reduces the risk of complications. In the presented clinical case, AR technology helped successfully perform a biopsy in a challenging anatomical situation.

Conclusion. The application of AR in oncology opens new opportunities for the diagnosis and treatment of recurrent pelvic tumors. This case demonstrates that AR improves diagnostic accuracy, enhances intervention planning, and minimizes surgical risks. Thus, AR can become a key tool in oncological surgery, particularly in complex clinical scenarios.