MINIINVASIVE NAVIGATION TECHNOLOGIES IN MULTI-FIELD MEDICAL INSTITUTION: THE MODERN STATE AND PROSPECTS

Aim. To generalize an experience of minimally invasive navigation technologies in multi-field hospital. Material and Methods. For seven years 2117 US- and X-ray-assisted operations were performed in the department of ultrasonic and X-ray diagnosis and treatment including 1110 interventions for hepatopancreatobiliary diseases, 443 for postoperative complications, 624 for defeat of other organs. 33% of operations were diagnostic, 67% – curative. An amount and quality of drainage, general state of patient, laboratory and instrumental data were assessed in postoperative period to determine an efficiency of minimally invasive interventions. Results. Navigation technologies are the most valuable for obstructive jaundice, acute destructive pancreatitis, parasitogenic liver diseases, postoperative complications. Two-stage approach including percutaneous or endoscopic obligatory biliary decompression followed by subsequent decision about either surgery or stenting is preferable in case of tumoral obstructive jaundice regardless further tactics of treatment. Possibilities of multi-field hospital allow to apply minimally invasive technologies for either local accumulations and complicated forms of acute pancreatitis. Timely use of these methods is associated with 3-fold decrease of mortality in these patients. The main role in treatment of parasitogenic lesion of abdominal organs is belonged to conventional surgery. Percutaneous minimally invasive interventions have the best results for mono-vesicular cysts without fibrous capsule calcification. Dimensions of cysts have no fundamental significance as a rule. Removal of all germinal cystic elements is obligatory. Minimally invasive intervention is the method of choice in postoperative complications management. Conclusion. Modern navigation technologies are dynamically developing and improving. They occupy more deserving place in clinical practice and are very perspective according to Russian and foreign data. Their further development and introduction into clinical practice require multidisciplinary approach, active and wide scientific discussion.

minimally invasive interventions, hepatopancreatobiliary disease, percutaneous navigation technologies, acute destructive pancreatitis, abdominal echinococcosis

1. Huard P., Do-Xuan-Hop. La ponction transhepatique des canaux biliares. Bull. Soc. Med. Chir. Indochine. 1937; 15: 1090.

2. Carter F., Saypol G. Transabdominal cholangiography. JAMA. 1952; 148 (4): 253–255.

3. Menghini G. One-second needle biopsy of the liver. Gastroenterology. 1958; 35 (2): 190–199.

4. Glenn F., Evans J.A., Mujahed Z., Thorbjarnarson B. Percutaneous transhepatic cholangiography. Ann. Surg. 1962; 156: 451.

5. Burcharth F.A. New endoprostesis for nonoperative intubation of the biliary tract in malignant obstructive jaundice. Surg. Gynec. Obstet. 1978; 146 (1): 76–78.

6. Hanke S., Edersen J.F. Percutaneus puncture of pancreatic cysts guided by ultrasound. Surg. Gunecol. Obstet. 1976; 142 (3): 551–552.

7. Vetshev P.S., Ippolitov L.I., Vetshev S.P., Kovalenko E.I. Controversial issues and negative tendencies in diagnostics and surgical treatment of incidentally revealed adrenal glands tumors. Khirurgiya. 2005; 6: 11–14. (In Russian)

8. Vetshev P.S., Musaev G.Kh., Bruslik S.V. Mini-invasive percutaneous technologies: history, traditions, negative tendencies and prospects. Аnnaly khirurgicheskoy gepatologii. 2014; 19 (1): 12–16. (In Russian)

9. Rukovodstvo po khirurgii zhelchnykh putej (rukovodstvo dlya vrachej) [Guidelines for biliary surgery (a management for doctors)]. 2-e izd. Ed. Galperin E.I., Vetshev P.S. Moscow: Vidar-M, 2009. 568 р. (In Russian)

10. Shevchenko Yu.L., Vetshev P.S., Stoyko Yu.M., Levchuk А.L., Bardakov V.G., Stepanyuk I.V. Surgical tactics for mechanical jaundice syndrome. Vestnik Natsional'nogo mediko-khirurgicheskogo tsentra im. N.I. Pirogova. 2009; 4 (1): 10–13. (In Russian)

11. Gal'perin E.I., Аkhaladze G.G., Kotovskiy А.E., Glebov K.G., Chevokin А.Yu., Momunova O.N. Pathogenesis and treatment of acute suppurative cholangitis. Аnnaly khirurgicheskoy gepatologii. 2009; 14 (4): 13–21. (In Russian)

12. Gal'perin E.I., Kotovskiy А.E., Momunova O.N. Rate of biliary decompression in tumoral mechanical jaundice. Khirurgiya. 2011; 8: 33–40. (In Russian)

13. Karpov O.E., Vetshev P.S., Bruslik S.V., Maady А.S. The combined application of retrograde and antegrade accesses for difficult choledocholithiasis. Аnnaly khirurgicheskoy gepatologii. 2013; 18 (1): 59–62. (In Russian)

14. Zhang Y.G., Li T.W., Peng W.J., Li G.D., He X.H., Xu L.C. Clinical outcomus and prediction of survival following percutaneous biliary drainage for malignant obstructive jaundice. Oncol. Letts. 2014; 7 (4): 1185–1190.

15. Maady A.S. Miniinvazivnye tehnologii drenirovanija zhelchnyh putej pri nerezektabel'nyh opuholjah gepatopankreatobiliarnoj zony, oslozhnennyh mehanicheskoj zheltuhoj [Miniinvasive technologies of biliary drainage in unresectable hepatopancreatobiliary tumors complicated by mechanical jaundice: аvtoref. dis. … doct. of med. sci.]. Moscow, 2015. 43 p. (In Russian)

16. Shevchenko Yu.L., Karpov O.E., Vetshev P.S., Maady A.S., Alekseev K.I., Osipov A.S., Vasil'yev I.V., Tyurbeev B.Ts. The use of self-extending nitinol stents for tumoral mechanical jaundice. Vestnik Natsional'nogo mediko-khirurgicheskogo tsentra im. N.I. Pirogova. 2014; 9 (2): 30–34. (In Russian)

17. Beger H.G., Matsuno S., Cameron J.L. Diseases of the pancreas. Current surgical therapy. Springer – Berlin, Heidelberg, New York, 2008. 950 p.

18. Dyuzheva T.G., Dzhus E.V., Shefer А.V., Аkhaladze G.G., Chevokin А.Yu., Kotovskiy А.E., Platonova L.V., Gal'perin E.I. Pancreatic necrosis configuration and differentiated treatment of acute pancreatitis. Аnnaly khirurgicheskoy gepatologii. 2013; 18 (1): 92–102. (In Russian)

19. Tolstoy А.D., Bagnenko S.F., Krasnogorov V.B., Kurygin А.А., Grinev M.V., Lapshin V.N., Gol'tsov V.R. Acute pancreatitis (protocols of diagnostics and treatment). Khirurgiya. Zhurnal im. N.I. Pirogova. 2005; 7: 19–23. (In Russian)

20. Gol'tsov V.R., Savello V.E., Bakunov А.M., Dymnikov D.А., Kurochkin D.M., Batig E.V. Purulent-necrotic parapancreatitis: evolution of views for treatment tactics. Аnnaly khirurgicheskoy gepatologii. 2015; 20 (3): 75–83. (In Russian)

21. Khar'kov D.P., Fedoruk А.M., Savchenko А.V., Rummo O.O. Pancreatic pseudo-cysts: efficiency of percutaneous miniinvasive technology of pancreatocystogastrostomy on the stent. Аnnaly khirurgicheskoy gepatologii. 2015; 20 (3): 117–123. (In Russian)

22. Аndreev А.V., Ivshin V.G., Gol'tsov V.R. Treatment of infected pancreatic necrosis using mini-invasive interventions. Аnnaly khirurgicheskoy gepatologii. 2015; 20 (3): 110–116. (In Russian)

23. Vetshev P.S., Musaev G.Kh. Echinococcosis: a modern view on the problem's state. Аnnaly khirurgicheskoy gepatologii. 2006; 11 (1): 111–117. (In Russian)

24. Vetshev P.S., Musaev G.Kh., Fat'yanova А.S. Echinococcosis: diagnostics and the role of mini-invasive technologies (literature review). Аnnaly khirurgicheskoy gepatologii. 2015; 20 (3): 117–123. (In Russian)

25. Shevchenko Yu.L. Shhadjashhaja khirurgija [Sparing surgery]. Moscow: GEOTAR-media, 2005. 242 р. (In Russian)

26. Kelly K., Weber S.M. Cystic diseases of the liver and bile ducts. J. Gastrointest. Surg. 2014; 18 (3): 627–634. DOI: 10.1007/s11605-013-2426-8.

27. Rezolyutsiya XXI Mezhdunarodnogo kongressa Аssotsiatsii gepatopankreatobiliarnykh khirurgov stran SNG “Аktual'nye problemy gepatolbiliarnoj khirurgii”. 7–9 sentyabrya 2015, Tashkent, Uzbekistan. [Resolution of XXI International congress of Hepatopancreatobiliary Association of the CIS countries “Urgent problems of hepatobiliary surgery” on September 7–9, 2015, Tashkent, Uzbekistan]. Аnnaly khirurgicheskoy gepatologii. 2015; 4 (20): 128–131. (In Russian)

28. Rezolyutsiya XIV Mezhdunarodnogo kongressa khirurgovgepatologov stran SNG “Аktual'nye problemy khirurgicheskoj gepatologii”. 19–21 sentyabrya 2007, Sankt-Peterburg, Russia [The resolution of XIV International congress of surgeonshepatologists of the CIS countries “Urgent problems of surgical hepathology” on September 19–21, 2007, St. Petersburg, Russia]. Аnnaly khirurgicheskoy gepatologii. 2007; 12 (4): 110–112. (In Russian)

29. Rezolyutsiya plenuma pravleniya Mezhdunarodnoy obschestvennoy organizatcii khirurgov-gepatologov. 15–16 maya 2014, Tyumen'. [Resolution of the Plenum of board of Association of surgeonshepatologists on May 14–15 2014, Tyumen, Russia]. Аnnaly khirurgicheskoy gepatologii. 2014; 19 (3): 138–140. (In Russian)

30. Rezolyutsiya XXI Mezhdunarodnogo kongressa Assotsiatsii gepatopankreatobiliarnykh khirurgov stran SNG “Аktual'nye problemy khirurgicheskoy gepatologii”. 9–12 sentyabrya 2014, Perm', Rossiya [Resolution of XXI International congress of Hepatopancreatobiliary Association of CIS countries “Urgent problems of surgical hepathology” on September 9–12, 2014, Perm, Russia]. Аnnaly khirurgicheskoy gepatologii. 2015; 20 (3): 139–141. (In Russian)

31. Karpov O.E., Vetshev P.S., Levchuk А.L. Integration of innovative technologies and multidisciplinary approach into surgical practice. Vestnik Natsional'nogo mediko-khirurgicheskogo tsentra im. N.I. Pirogova. 2016; 11 (3): 3–7. (In Russian)