Laparoscopic radical nephrectomy. Procedure, results, and complications

Surgery is the method of choice for clear cell renal carcinoma not responding to chemotherapy, radiotherapy, or immunotherapy. The surgical procedure is used in the past 40 years, mainly because of the development and widespread use of diagnostic procedures such as ultrasonography and CT. Partial nephrectomy has been shown to be a safe and effective alternative to radical nephrectomy with tumors 4 cm. and less. [1 ] The other important milestone in development of renal cancer surgery was the revolution started in the 90s with adventage of laparoscopic renal surgery. Now this technique is standard. Laparoscopic surgery initially raised concern about oncological safety, but today there are a number of clinical studies that prove the laparoscopic approach as a reliable procedure. [2] Technical development has occurred in laparoscopic surgery and she is no longer considered the procedure of the future”, there is a real treatment for renal cancer which should be implemented in most urology departments.Учитывая малую эффективность химиотерапии, радиотерапии и иммунотерапии при лечении почечноклеточного рака, методом выбора является хирургическое вмешательство. Хирургическая техника лечения опухоли почки развивается в течении 40 лет, главным образом за счет внедрения в общую практику таких диагностических процедур как ультрасонография и компьютерная томография. Вместе с тем, парциальная нефрэктомия была доказана как безопасная и эффективная альтернатива радикальной нефрэктомии при размере опухоли до 4 см. [1]. Другая важная веха в развитии хирургии рака почки - это начатая в 90-е годы лапароскопическая хирургия почки, которая стала стандартом за последние 20 лет. Лапароскопической хирургии изначально был поставлен вопрос об онкологической безопасности, и на сегодняшний день есть ряд клинических исследований, которые доказывают, что лапароскопические вмешательства являются эффективным методом лечения онкологических больных [2]. Техническое развитие произошло в лапароскопической хирургии и она больше не считается “процедурой будущего”, а оценивается как реальный метод лечения рака почки, который должен быть сегодня внедрен в большинство урологических отделений

The first experience kidney radiofrequency ablation

Radiofrequency ablation (RFA) has been proposed as an alternative to open surgery for the treatment of small renal tumors in elderly patients with anamnesis record and a method for better hemostasis during operations on the kidney. In the article presents data on completed transactions using the system of 'Cool-tip'. The advantages of using this technique compared to traditional operations. In Sverdlovsk Regional Clinical Hospital №1, Department of Urologic Oncology from 2008. holds 11 operatsy using the RFA. Using the system for the RFA is reasonable to perform a variety of operational, conservative surgery for kidney tumor.Радиочастотная абляция (РИА) была предложена как альтернатива открытой операции для лечения небольших опухолей почек у пожилых больных с отягощенным соматическим анамнезом и как методика для обеспечения надежного гемостаза при резекции почек. В работе представлены данные о выполненных операциях с использованием системы “Cool-tip™”. Обоснованы преимущества использования данной методики в сравнении с традиционными операциями. В клинике урологии УГМА при ГУЗ «С0КБ№1» с 2008г. выполнено 11 операций с использованием аппарата для РИА. Использование системы РЧА является оправданной при выполнении различных оперативных пособий при опухолях почки

Regulatory and legal status of clinical guidelines and their role in the quality control of medical care in countries of the European Union, North America and Asia

Introduction. In 2016-2018, the approaches to the development and use of clinical guidelines in the Russian Federation underwent substantial changes. As part of this work, legal aspects of clinical guidelines were modified. The present review, conducted on behalf of the Ministry of Health, is aimed to analyze the international experience regarding the clinical guidelines standards and identify possible obstacles and risks for their implementation.Materials and methods. We reviewed documents and publications related to the development and implementation of clinical guidelines in 2016-2017 in 12 countries from Europe, Asia and North America known for their well established health care systems. The search for publications has been conducted with the help of the PubMed bibliographic database and the Google search engine, using the following requests: «clinical practice guidelines legal status», «clinical practice guidelines + name of the country». The results were updated to 2019.Results. In most of the 12 countries, the clinical guideline development process is coordinated at the national level. However, the implementation of these guidelines by medical professionals is not mandatory, although it is often supported by the regulations of the national health system.Conclusion. The development and implementation of clinical guidelines in the Russian Federation is consistent with the international experience: the development of clinical guidelines is coordinated at the federal level in agreement with the principles of evidence-based medicine; the implementation of guidelines are not mandatory, however, medical organizations and health professionals are expected to provide the medical care by considering the clinical guidelines, approved by the Scientific and Practical Council of the Ministry of Health