Experience of application of 3D-visualization in laparoscopic operations

Objective. Studying of first results of application of 3D visualization in various laparoscopic interventions. Materials and methods. There were performed 169 operations: 27 transabdominal preperitoneal plasties of inguinal hernias, 19 intraperitoneal alloplasties of umbilical and postoperative ventral hernias with suturing of hernia defect, 1 retromuscular alloplasty of umbilical hernia, 6 reconstructions of anterior abdominal wall for dyastasis of rectal abdominal muscles, 103 plasties of hiatal hernias with fundoplications, 7 Heller’s cardiomyotomies and Dor’s fundoplication, 1 subtotal, 3 atypical gastric resections and 2 sleeve gastric resections for obesity. Results. 3D laparoscopy have simplified and accelerated the parietal peritoneum suturing in conduction of transabdominal preperitoneal plasties of inguinal hernias, as well as while performance of intraperitoneal alloplasties of umbilical and postoperative ventral hernias – the hernia defect suturing. While doing the hiatal hernia plasty, fundoplication with crurorrhaphy 3D laparoscopy have provided the additional advantages of manipulations improvement in special anatomic zones. Analogous advantages were shown in gastric operations, using 3D visualization. Intra- and postoperative complications were absent, as well as the hernias recurrence in the 6 mo-1.5 yr follow-up. Conclusion. The 3D visualization guarantees a rapid and highly-precision performance of complex manipulations in technically hard anatomical zones. Further accumulation of the material and comparison of results of 3D and 2D laparoscopy in prospective investigations, using objective parameters, as well as studying of expediency for 3D visualization selective application, for instance while performance of the most complicated operative stages are necessary

The evolution ways for laparoscopic surgery

The evolution ways for laparoscopic surger

A new method of laparoscopic repair of giant hiatal hernias: long-term results of 40 consecutive patients

Catedra de chirurgie nr.1, Universitatea Naţională de Medicină, Odessa, Ucraina, Al XII-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” din Republica Moldova cu participare internațională 23-25 septembrie 2015Introducere: Tehnicile curente de reparare laparoscopică cu meșă a herniilor hiatale gigante – adică cu suprafeţe hiatale (SH) mai mari de 20 cm2 – nu sunt efective, deoarece rata de recurenţă este de 40%. Astfel, este necesară utilizarea unei metode fundamental noi de reparare protetică. De asemenea, această metodă trebuie să excludă complicaţiile referitoare la protezare. Scopul a fost de a testa pe termen lung rezultatele reparării laparoscopice fără tensiune a herniilor hiatale gigante cu proteze fundamental noi. Material și metode: Din 2010 până în 2013 au fost efectuate 44 reparări laparoscopice a herniilor hiatale gigante. Dintre acestea, 41 pacienţi au fost evaluaţi cu o medie de monitorizare de 35,9±8,0 luni (interval, 24-49 luni). SH medie a fost de 37,5±15,6 cm2 (interval, 21,7-75,4 cm2). Reparaţiile laparoscopice posterioare fără tensiunea herniilor hiatale au fost efectuate cu o proteză nouă – “Rebound HRD-Hiatus hernia” (Minnesota Medical Development, SUA) care a fost fixată la crură cu 3-5 suturi separate. Această proteză este o meșă ușoară în formă de inimă din politetrafluoretilenă (PTFE) cu margine din nitinol. Rezultate: Toate procedurile au fost efectuate cu succes. Timpul mediu de fixare a protezei a fost de 24,8±5,6 min (interval, 15- 35 min). Nu au survenit complicaţii intraoperatorii asociate cu repararea. Durata medie de spitalizare a fost de 6,0±1,7 zile (interval, 2-11 zile). Monitorizarea pe termen lung a prezentat lipsa recurenţelor anatomice și a complicaţiilor esofagiene (adică disfagia persistentă, stricturi sau eroziuni). Au fost înregistrate doar 2 (4,8 %) recurenţe de reflux simptomatic. Concluzii: Această metodă nouă de reparare laparoscopică a herniilor hiatale gigante este sigură și permite evitarea recurenţelor anatomice pe perioade lungi de monitorizare. Tehnica necesită o evaluare temeinică pe perioade mai lungi de urmărire.Introduction: Current techniques of laparoscopic mesh repair of giant hiatal hernias – i.e. with hiatal surface area (HSA) exceeding 20 cm2 – are not effective as rate of recurrence reach 40%. Thus, usage of fundamentally new method of prosthetic repair is needed. Also, this method must exclude prosthesis-related complications. The aim was to assess long-term results of laparoscopic tension-free repair of giant hiatal hernias with a fundamentally new prosthesis. Material and methods: From 2010 to 2013, 44 laparoscopic repairs of giant hiatal hernias were performed. From them, 41 patients were evaluated with a mean follow-up period of 35.9±8.0 months (range, 24-49 months). Mean HSA was 37.5±15.6 cm2 (range, 21.7-75.4 cm2). The posterior tension-free hiatal repair was performed with a new prosthesis – Rebound HRDHiatus hernia (Minnesota Medical Development, USA) which was fixed to the crura with 3-5 separated sutures. This prosthesis is heart-shaped lightweight polytetrafluorethylene (PTFE) mesh with peripheral nitinol frame. Results: All procedures were successfully completed. Mean time of fixation of the prosthesis was 24.8±5.6 min (range, 15-35 min). There were no intra-operative complications associated with the repair. Mean postoperative hospital stay was 6.0±1.7 days (range, 2-11 days). Long-term follow-up showed absence of anatomical recurrences, and oesophageal complications (i.e., persisting dysphagia, strictures, and erosions). There were only 2 (4.8 %) symptomatic reflux recurrences. Conclusion: This new method of laparoscopic repair of giant hiatal hernias is safe and provides absence of anatomical recurrences in long-term follow-up period. It requires thorough assessment in more delayed long-term follow-up period

Laparoscopic Repair of Giant Hiatal Hernias with Fundamentally New Mesh

As rates of recurrence and prosthetic strictures following laparoscopic repair of giant hiatal hernias are large, creation of fundamentally new method of hiatoplasty is essential. The aim of the study was creation and clinical application of new prosthesis and method of its fixation. From 2010 to 2013, 43 laparoscopic repairs of giant types II and III hiatal hernias were performed. From them, 27 patients were followed within mean period of 15 months (range, 6-24). Mean hiatal surface area in this cohort was 33.5 cm2 (range, 24.6-75.4). Posterior tensionfree hiatal repair was performed with a new prosthesis — Rebound HRD-Hiatus hernia which was fixed to crura with 3-5 separated sutures. The prosthesis is heart-shaped lightweight polytetrafluorethylene mesh with peripheral nitinol frame. All procedures were successfully completed. Mean time of fixation of prosthesis was 25 min (range, 15-35). Pain scores were not larger than after standard mesh repair. Mid-term results studied by questionnaires, 3D barium study, endoscopic examinations, and 24h pH testing, showed no cases of recurrence and esophageal complications. New method is safe and provides good anatomical and functional mid-term results, and requires further development and comparison with other technique

Retrospective analysis of 15 years experience of laparoscopic repair of hiatal hernias

Питання вибору методики пластики стравохідного отвору діафрагми до сьогодні залишається спірним. Метою даної роботи є вивчення результатів 1500 лапароскопічних пластик за різними методиками. У I групі (крурорафія) рецидиви відмічені в 10,2 % випадків, дисфагія – в 5,3 % випадків. У II групі (пластика сітчастим трансплантатом) рецидиви відмічені в 5 % випадків, дисфагія – в 7,1 % випадків. При цьому в підгрупі, де використовувалася оригінальна методика пластики полегшеним композитним сітчастим трансплантатом, частота рецидивів та реоперацій була нижчою, ніж у підгрупі, де використовувалися поліпропіленові сітки.The choice of method of hiatal hernia repair is still controversial. The aim of the study was to analyse long-term results of 1500 laparoscopic repairs. In the I group (cruroraphy) recurrence rate was in 10,2 %, dysphagia rate – in 5,3 %. In the II group (mesh repair) recurrence rate was in 5 %, of cases, dysphagia – in 7,1 %. The rates of dysphagia and reoperations were lower in lightweight composite mesh subgroup (original technique) than in polypropylene mesh subgroup

Reasons of failures after laparoscopic repair of hiatal hernias: analysis of 2500 procedures

В работе представлен тщательный анализ неудовлетворительных результатов различных методик лапароскопической пластики грыж пищеводного отверстия диафрагмы по данным отдаленных исходов и повторных лапароскопических операций, выполненных у 2 % прооперированных пациентов. Повторные операции проведены без конверсий и обеспечили полную ликвидацию имеющихся расстройств. При этом основным показанием к операции служили анатомические рецидивы (86,6 %), из которых в 85 % случаев анатомический рецидив был в сочетании с функциональным. Описана классификация неудовлетворительных результатов, позволяющая унифицировать понятия и определять тактику лечения. Даны рекомендации по диагностике неудовлетворительных результатов и особенностям повторных лапароскопических операцийFailures occur in approximately 25% of laparoscopic procedures. Aim of the study was to perform comprehensive analysis of failures of laparoscopic repairs of hiatal hernias, based on long-term outcomes and laparoscopic redo procedures. Laparoscopic redo procedures were necessary in 2% of operated patients. The main reasons for redo procedures were anatomical recurrences (86.6%). 85% of them were in combination with reflux recurrences. Pure reflux recurrences were reasons for redo procedures in 6.7% of cases, and oesophageal strictures — in 6.7% of cases. A new classification of failures was created and discribed. This classification system unifies definitions and indications for distinct treatment of each variant of failures. Recommendations about diagnostics and tips of laparoscopic redo procedures were also given

Inclusive library service for users with special needs and formation of multimedia library collections based on nosology

Обґрунтовано принципи побудови інформаційних технологій на основі методів математичного програмування для вирішення проблеми вибору програмної платформи системи дистанційного бібліотечного обслуговування осіб з особливими потребами, базуючись на розподілі ваг альтернативних платформ. Cформульовано концептуальні засади розвитку бібліотечних технологій для осіб з особливими потребами, що базуються на застосуванні сучасних мультимедійних інформаційних технологій та методології створення консолідованого інформаційного ресурсу, орієнтованого на обслуговування таких користувачів. Окреслено роль електронних бібліотек, зорієнтованих на обслуговування осіб з вадами здоров’я, як елементів системи соціальних комунікацій.The principles of construction of information technology on the basis of mathematical programming methods for solving the problem of choosing the software platform of the remote library services for people with disabilities basing on the distribution of weights of alternative platforms have been analysed. The concept of the use of benchmarking tools for the research of libraries was developed. The conceptual foundations of library technologies for people with disabilities, which are based on the use of modern multimedia information technology and creation methodology of consolidated informational resource, which is designed to serve for users with special needs were formulated. The multimedia information resource of means, methods and forms of service for users with special needs in libraries is consolidated systematically and comprehensively. The role of digital libraries, which are service-oriented for individuals with disabilities, as part of social communication has been stressed. The integrated study of the service processes for users with special needs is implemented and a verbal model of multimedia information and library services in this category of users is formed. The conceptual basis of the creation of a multimedia library and information service for users with special needs is formulated. System analysis as an integrated system whose properties are determined by the gross properties of its individual elements or subsystems, has been presented as well as the characteristics of its structure, system-specific, integrative connections. The technology of multimedia library and information services for people with special needs is proposed, which allows to make differentiated providing of library and information services for users and to improve the available forms of service in all libraries on the basis of real inclusion of people with disabilities in an active social life (inclusion)

Десятилетний опыт пневматической баллонной дилатации пищеводно-желудочного перехода

Цель. Выбор оптимального режима пневматической баллонной дилатации (ПБД) пищеводно-желудочного перехода под рентгенологическим контролем при ахалазии (АП) и стенозе (СП) пищевода после пластики пищеводного отверстия диафрагмы (ПОД) и фундопликации. Материалы и методы. С 2007 по 2017 г. ПБД выполнена 34 пациентам: 7 пациентам с I-II стадией АП; 13 – с рецидивом после лапароскопической кардиомиотомии (ЛКМТ); 14 – с функциональной дисфагией или СП после пластики ПОД и фундопликации. Результаты. Осложнений ПБД не было. У всех пациентов достигнута ремиссия на протяжении разных сроков, зависевших от причины дисфагии. Возникшие рецидивы проанализированы и соотнесены с результатами повторных операций. Выводы. ПБД высокоэффективна и не сопровождается осложнениями при тщательном соблюдении методики. Оптимальный режим ПБД предполагает постепенное повышение давления от 20 до 26,7 кПа (от 150 до 200 мм рт. ст.), экспозицию от 30 до 60 с, которые соизмеряют со степенью расправления баллона и болевой реакцией пациента. ПБД помогает установить уровень и причину как стеноза при рецидивах АП после ЛКМТ, так и стеноза после пластики ПОД и фундопликации, и таким образом определить показания к повторной операции и ее объем

The role of proximal vagotomy at laparoscopic fundoplication according to Toupet

Залишається актуальним питання про спосіб фундоплікації при лапароскопічних антирефлюксних операціях. Метою даного дослідження є порівняння віддалених результатів фундоплікації за Тупе в чистому вигляді і доповненої селективною проксимальною ваготомією (СПВ). Із 1994 до 2010 року 203 пацієнтам були виконані лапароскопічні фундоплікації за Тупе. Хворих поділили на 3 зіставних групи залежно від клінічних характеристик пацієнтів. У пацієнтів, які мали явища шлункової гіперсекреції та індекс DeMeester >80, фундоплікація за Тупе доповнювалася СПВ (основна група). Віддалені результати, вивчені в середньому через 6 років після операції, показали, що частота симптомів гастроезофагеальної рефлюксної хвороби (ГЕРХ) була достовірно меншою в основній групі, якість життя за шкалою GERD-HRQL достовірно поліпшилась в основній групі більшою мірою, ніж у групах порівняння. Індекс DeMeester після операції також був достовірно меншим в основній групі, ніж у групах порівняння. При тяжкому перебігу ГЕРХ і поєднанні її зі шлунковою гіперсекрецією, якщо виконується фундоплікація за Тупе (при ризику розвитку дисфагії на тлі дискінезій стравоходу і при анатомічних особливостях дна шлунка та шлунково-селезінкової зв’язки, коли неможлива широка мобілізація дна шлунка для накладення циркулярної манжети), її доцільно доповнювати СПВ.The choice of method of fundoplication in laparoscopic antireflux surgery is still controversial. The aim of this prospective randomized study was to compare long-term results of laparoscopical classical Toupet fundoplication and Toupet fundoplication with highly selective vagotomy. From 1994 till 2010, 203 patients were operated using Toupet technique of fundoplication; 3 groups were compared. Basic group contained 71 patients which were operated using Toupet technique with HSV. Long-term results were studied with a mean follow-up period of 6 years. The Touped fundoplication with HSV were superior in terms of incidence of symptoms of GERD, quality of life by GERD-HRQL score, degree of esophagitis and DeMeested score. Combination of Toupet fundoplication with HSV is recommended for GERD patients with hypersecretion of stomach and heavy gastroesophageal reflux