Aim. To analyze own experience of laparoscopic liver resection in living donors and to compare our results with the experience of world leading centers.

Material and Methods. In our center 32 laparoscopic liver resections for transplantation to pediatric patients have been performed since May 2016 to October 2017. Left lateral sector resection was performed in 31 cases, left-sided hemihepatectomy – in one case.

Results. Mean age of donors was 28.61 (±5.84) years, mean intraoperative blood loss – 93.87 (± 50) ml, time of surgery – 276 (±44) min, length of hospital-stay – 4 (± 1.12) days. There were no complications Clavien–Dindo grade II and over.

Conclusion. Laparoscopic liver resection in adult donors for transplantation to pediatric patients is followed by qualitative graft and facilitates rapid rehabilitation of living donor.

Aim. To improve the outcomes in patients with pancreatic tumors by using of robot-assisted techniques.

Material and Methods. For the period 2009–2017 in the abdominal department №1 of Vishnevsky Institute of Surgery 93 patients with  pancreatic tumors have undergone robot-assisted surgery. There  were 17 pancreaticoduodenectomies, 49 distal pancreatectomies, 19  tumor enucleations, 6 median pancreatectomies and 2 total  duodenopancreatectomies.

Results. Time of procedures depended on their types: 400 (360; 505) min for pancreaticoduodenectomy and 210 (178; 250) min for  distal pancreatectomy. Mean blood loss for the same surgeries was  200 (150; 500) and 100 (50; 300) ml respectively. In case of tumor  enucleations and median pancreatectomies blood loss was minimal.  Conversion to laparotomy was performed in 4 cases: 2 in  pancreaticoduodenectomy, 1 in distal pancreatectomy and 1 in tumor enucleation. Postoperative complications occurred in 38 cases:  there were 35 pancreatic fistulas which were followed by hemorrhage in 6 patients.

Conclusion. Robot-assisted procedures are indicated for malignant and borderline malignant pancreatic T1–T2 staged tumors as well as  benign tumors with diameter less than 5–6 cm. Robot-assisted  technologies are not associated with significantly decreased  postoperative morbidity. Indications for robot-assisted pancreatic  surgery may be extended along learning curve.

Aim. To analyze the outcomes of robot-assisted and laparoscopic distal pancreatectomies.

Material and Methods. 42 patients were enrolled: 27 patients underwent laparoscopic distal pancreatectomy, 15 – robot-assisted distal pancreatectomy.

Results. Both groups were statistically homogeneous and comparable. Time of laparoscopic and robot-assisted distal  pancreatectomy was 184 ± 21.4 and 236 ± 31.6 min (p = 0.0384),  respectively; intraoperative blood loss – 310 ± 54 ml and 240 ± 86  ml (p = 0.0564), respectively. There were 6 (66.7%) spleen-sparing  laparoscopic distal pancreatectomies and 6 (85.7%) robotic  procedures in the same fashion. The length of hospital-stay after  laparoscopy was 5.4 ± 1.8 days, after robot-assisted operation – 6.1 ± 1.6 days (p = 0.073). The number of hemorrhagic complications  and pancreatic fistulas ISGPS 2016 was similar in both groups. There were 16 Clavien–Dindo complications after laparoscopic pancreatectomy and 8 after robot-assisted surgery.

Conclusion. It was established that laparoscopic pancreatectomy is associated with reduced time of surgery and lower percentage of  spleen-sparing interventions. Intraoperative blood loss, hospital-stay and postoperative morbidity do not depend on the type of surgery.

Aim. To analyze early outcomes of laparoscopic surgery and to show their advisability in surgical treatment of liver and pancreatic neoplasms.

Material and Methods. There were 60 patients with liver tumors and 44 patients with pancreatic neoplasms who underwent  laparoscopic surgery. Prospective control groups consisted of patients after conventional procedures.

Results. Overall incidence of postoperative complications was 8.3% after laparoscopic liver interventions that was significantly less than  in open procedures. Incidence of post-resection liver failure and  biliary complications (ISGLS, 2011) was similar after laparoscopic  and open liver interventions. Overall complication rate after  laparoscopic pancreatic surgery was 6.8% that was significantly lower compared with standard interventions. Incidence of postoperative fistula (ISGPF, 2005) was 4.5% (Grade A – 2.3%,  Grade B – 2.3%), that was significantly less than in open surgery 29.5% (Grade A – 15.9%, Grade B – 16.5%). The length of hospital-stay after laparoscopic interventions was less than after open procedures in both groups of patients. There was no in-hospital mortality.

Conclusion. Laparoscopic surgery for liver and pancreatic neoplasms is associated with significantly reduced overall morbidity  and postoperative hospital-stay, accelerated rehabilitation.  Laparoscopic pancreatectomy decreases incidence of postoperative pancreatic fistulae Grade A and, especially, Grade B.

Aim. To compare early and long-term outcomes of laparoscopic and robot-assisted liver resections with open procedures.

Material and Methods. Retrospective case-control study was performed. Pseudo-randomization was used to compare homogeneous data. We have assessed survival in patients  with various forms of cholangiocellular carcinoma and colorectal cancer metastases after minimally invasive liver resections.

Results. For the period 2013–2017 two hundred and fifteen minimally invasive liver resections were performed including 49  robot-assisted and 166 laparoscopic ones. Malignant tumors were in  45% of cases, benign tumors – in 42%, parasitic neoplasms – in  13%. Early results of minimally invasive resections and 70  comparable open liver resections were compared. All procedures  were carried out within the same period at one institution.  Immediate results were significantly better after minimally invasive  liver resections both before pseudo-randomization and after that.  There were 60 pairs of patients after pseudo-randomization. In  groups of minimally invasive and open resections blood loss was 396 (0–3400) and 853 (20–6000) ml respectively, time of surgery – 319  (85–580) and 376 (180–775) min, incidence of severe (Clavien–Dindo II and over) complications – 10% (n = 6) and 23% (n = 14), length of postoperative hospital-stay – 9 (3–90) and 12 (2–39) days, respectively. 3-year survival after mini-invasive liver resections for  colorectal cancer metastases was 70%, various forms of  cholangiocellular carcinoma – 40%.

Conclusion. Conventional liver resections can be successfully performed in laparoscopic or robot-assisted fashion in certain  patients at specialized center of surgical hepatology with sufficient  experience in open and laparoscopic liver surgery.

Aim. To evaluate the outcomes of laparoscopic pancreatoduodenectomy (LPDE) along with experience accumulation.

Material and methods. Laparoscopic pancreatoduodenectomy was performed in 215 patients. There were hepatopancreatoduodenal  malignant tumors in 187 (87%) cases and benign diseases in 28  (13%) patients. Pylorussparing LPDE was performed in 55 (26%)  cases, gastropancreatoduodenectomy – in 160 (74%) patients. In 13 cases procedure was followed by segmental superior mesenteric vein/portal vein resection.

Results. Mean blood loss and time of surgery were 400 ml and 427 min, respectively. There was decrease of median operative time from 450 min in the first 50 operations to 320 min in the last 65 cases.  Pancreatic fistula occurred in 32 (14.8%) patients. There was  decrease of pancreatic fistula incidence from 21% in the first 100  patients to 9.6% in the last 115 cases. Delayed gastric emptying  occurred in 7% of patients, overall morbidity was 35.5% and mortality – 6%. In 70 patients with pancreatic adenocarcinoma  3-year overall survival rate (OSR) was 35.5%, 5-year – 25.2%,  median survival time – 22.5 months. In 11 patients with distal  cholangiocarcinoma 3-year OSR was 57%, 5-year survival was absent. In 31 patients with ampullary carcinoma 3-year and 5-year OSR were the same – 67%.

Conclusion. Laparoscopic pancreatoduodenectomy is safe and effective procedure. There was a tendency to improved outcomes along with experience accumulation.

Aim. To compare the effects of “nonequilibrium plasma” and cryodestruction on liver abscesses in experiment.

Material and Methods. 60 experimental animals (rats, males) with liver abscess were enrolled. There were 3 groups by 20 animals.  Placebo group – abscess cavity lavage with sterile 0.9% NaCl  solution, control group – cryodestruction of abscess wall (liquid  nitrogen, temperature of −196 °C), experimental group – abscess  wall management with “nonequilibrium plasma”. Animals were  eliminated from the experiment in 1, 5, 15 and 30 days after  surgery. We examined bacterial inoculation of the abscess cavity  after exposure, performed biopsy of abscess wall and surrounding liver parenchyma specimens and biochemical analysis of blood.

Results. Bacterial growth in abscess cavity was absent in control and experimental groups. Biochemical analysis revealed only  insignificant fluctuations of the majority of indicators in all groups.  There were less significant inflammatory infiltration and edema of  the abscess capsule, as well as inflammatory infiltration of liver  parenchyma in 5 and 15 days in experimental vs. control group.

Conclusion. Cryodestruction and effect of “nonequilibrium plasma” on the internal wall of rats’ liver abscess lead to death of pyogenic  bacteria. “Nonequilibrium plasma” is associated with less severe  injury of liver parenchyma compared with cryodestruction.

Esophageal and stomach varicose veins is one of the most frequent and serious complications of portal hypertension with incidence  about 80–90% among liver cirrhosis patients. In developing  countries hemorrhage-related mortality is up to 60%, in countries  with well-established hepatology services – 20%. This value is near  24.4% among liver cirrhosis patients waiting for transplantation. In  multiple clinical recommendations and protocols for prevention and  treatment of bleeding transjugular intrahepatic portosystemic  shunting is posed as preferable treatment, however it is associated  with early encephalopathy and the risk of TIPS thrombosis. The  possibilities of TIPS are significantly limited in case of spleno-portal  pool thrombosis. In view of disadvantages of conventional bypass procedures azigoportal dissociation is under close attention.

Aim. To evaluate surgical outcomes in patients with liver alveococcosis.

Material and Methods. 581 patients have been included for the period 2000–2016. There were 366 (62.9%) women and 215  (37.1%) men. Mean age was 35.0 ± 1.5 years. Right liver lobe  lesion was observed in 380 (65.4%) cases, left lobe involvement – in 140 (24.1%) cases, both lobes lesion – in 61 (10.5%) patients. 8  patients had lungs metastases, 3 – brain metastases, 1 –  metastases in right ventricle and lungs. One patient had a rare  coinfection of alveococcosis with echinococcosis. 570 patients underwent surgery.

Results. Radical surgery was performed in 424 (74.3%) cases, palliative procedures – in 146 (25.5%) patients. 163 (28.1%)  patients underwent right-sided hemihepatectomy including  tangential inferior vena cava resection in 3 patients. Advanced right- sided hemihepatectomy was carried out in 36 (6.2%) cases including 2 cases of concomitant tangential resection of inferior vena cava and 4 cases of common bile duct resection followed by  hepaticojejunostomy.  Left-sided hemihepatectomy was made in 95  (16.4%) patients, 2 of them underwent concomitant tangential  resection of inferior vena cava. Advanced left-sided hemihepatectomy was performed in 22 (3.6%) cases including tangential resection of portal vein in 1 patient and common bile duct  resection followed by hepaticojejunostomy in 1 patient. Atypical or  anatomic liver resection (segmentectomy, double segmentectomy,  triple segmentectomy) was made in 64 (11.1%) patients. Hemihepatectomy followed by resection of the other lobe was carried out in 44 (7.5%) cases. Percutaneous transhepatic cholangiostomy  was made in 28 (4,8%) cases, explorative laparotomy – in 25  (4.3%) patients. Transhepatic drainage of bile ducts was performed  in 42 (7.2%) cases, cytoreductive procedures – in 51 (8.8%) cases. Postoperative morbidity rate was 9.8% (n = 56), mortality – 2.1% (n = 12).

Conclusion. Radical surgery for liver alveococcosis is difficult but provides positive results in timely diagnosis. Proportion of radical  procedures is much greater in case of early diagnosis of the disease.  Palliative surgery combined with chemotherapy with albendazole is justified to improve quality of life.

Aim. To improve the outcomes in patients with colorectal cancer liver metastases.

Material and Methods. 326 patients with colorectal cancer liver metastases were enrolled. In 185 cases liver resection was  performed including advanced resection in 73 patients and minor  procedures in 112 cases. Radiofrequency ablation of metastases was performed in 141 patients: open in 7 cases, transdermal – in 134 patients.

Results. The most frequent complications after liver resection were hepatic insufficiency (8.6%), hematoma (abscess) within liver stump (4.9%), pleuritis (4.9%), subdiaphragmatic abscess (3.8%).  Mortality after advanced liver resection was 1.6%. 1-year survival  after liver resection was 74.8%, 3-year survival – 46.7%, 5-year  survival – 26.7%. Complications after radiofrequency ablation were  detected in 11 (7.8%) observations: pleuritic in 7, hematoma within  puncture channel in 3, liver abscess – in 1 case. Overall 1-year  survival was 88.2 ± 7.9%, 2-year – 68.0 ± 14.1%, 3-year – 30.5 ± 13.2%.

Conclusion. Surgical treatment of colorectal cancer liver metastases remains the main radical method to achieve satisfactory results.  Radiofrequency ablation is effective for colorectal cancer liver  metastases and may be applied repeatedly. Maximum effectiveness  of ablation is noted for destruction of metastases up to 3 cm.  Radiofrequency ablation may be used as an independent method of  treatment, however combined treatment is preferred in patients with colorectal cancer metastases.

Aim. To analyze the effect of growing liver biological set on viability and proliferative activity of various cellular cultures in vitro.

Material and Methods. The biological combination is an extract from the growing liver obtained by using of original technique. We  have assessed extract’s effect on the following cellular lines: hepatic  carcinoma Huh7, L-fibroblasts of mice, murine bone marrow  mesenchymal stem cells. Viability and proliferative activity were  assessed by staining the cells with trypan blue and visual counting of cells under phase contrast microscopy.

Result. Biological combination from neonatal piglet’s growing liver dose-dependently protects hepatocyte-like cells from deprivation of  fetal serum and stimulates cellular growth in presence of serum.  High concentrations of HRS do not lead to growth arrest of the Huh7  cells. At the same time, it is a cytostatic (or cytotoxic) for murine L- fibroblasts. Limited protective effect of the combination on the  deprivation of serum when exposed to bone marrow stem cells was revealed.

Conclusion. Our data show that the extract may be considered as an important regulator of reparative regeneration of liver with  protective and/or stimulating effect on mesenchymal stem and  hepatic-like cells and cytostatic effect on fibroblasts. So, further trials are necessary.

Aim. To determine the possibility, feasibility and safety of intraperitoneal approach to gallbladder for percutaneous microcholecystostomy.

Material and Methods. There were 384 high risk patients with acute obstructive calculous cholecystitis who underwent percutaneous microcholecystostomy within 2012–2016.  In 287 (74.7%) patients cholecystostomy was deployed via percutaneous intraperitoneal approach, in 97 (25.3%) –  extraperitoneal percutaneous transhepatic access through gallbladder bed. Percutaneous intraperitoneal  microcholecystostomy in 55 patients and percutaneous transhepatic (extraperitoneal) microcholecystostomy in 97 patients  became compelled final treatment of acute obstructive cholecystitis. 

Results. In 1 case of percutaneous transhepatic microcholecystostomy intravesical bleeding occurred, which was stopped with medication. Drainage tube displacement was  observed in 16 (16.5%) cases. There were no hemorrhagic complications after percutaneous microcholecystostomy with intraperitoneal access, drainage tube displacement within the  first 3 days occurred in 52 (18.1%) cases. In 22 (32.4%) patients  drainage tube displacement was followed by focal bile accumulation under gallbladder or diaphragm that required additional drainage.

Conclusion. Intra- and extraperitoneal accesses to the gallbladder for microcholecystostomy have equivalent effectiveness and safety for obstructive acute cholecystitis management in high risk patients.

Aim. To develop and evaluate efficacy of new method of subtotal cholecystectomy in surgical treatment of patients for pancreatic head and periampullary zone masses.

Material and Methods. For the period 2004–2014 subtotal cholecystectomy has been used in 23 cases of diffuse intraoperative  bleeding, portal hypertension and extensive fibrosis of gallbladder  caused by chronic inflammation. In the second group (n = 236)  standard cholecystectomy was performed regardless surgical  conditions. In both groups cholecystectomy was a stage of  pancreatoduodenectomy or billiary bypass. Comparative analysis  was made regarding intra- and postoperative bleeding.

Results. Subtotal cholecystectomy was not followed by intra- or postoperative bleeding required additional hemostasis. Standard  cholecystectomy was accompanied by bleeding from gallbladder bed  in 8 (3.9%) cases that required additional hemostasis. Postoperative  bleeding was observed in 4 (1.7%) patients including 2 of them after additional hemostasis. Redo interventions were performed in 3  patients. One patient died after re-laparotomy.

Conclusion. Subtotal cholecystectomy is effective measure for prevention of intra- and postoperative bleeding from gallbladder bed in case of difficult surgical conditions.