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Objective: To evaluate the effectiveness of intraoperative visualization and risk factors of central lymph node metastases in unilateral PTC without preoperative clinical signs of central lymph node metastases.

Material and methods: There were 227 patients with preoperatively verified thyroid cancer in one lobe without lymph node metastases between January 2018 and December 2018. They underwent hemithyroidectomy and prophylactic central lymphadenectomy (CLE).

Results: The follow-up period was 47.6±10.6 months. Metastases were detected in 57 (25.1%) patients during intraoperative visualization and in 72 (31.7%) patients after morphological analysis. Sensitivity and specificity of intraoperative visualization were 76.4% and 98.7%, respectively. Extrathyroidal invasion was significantly associated with higher risk of central lymph node metastases (p=0.006, p<0.001; and p<0.001, respectively). Oncological outcomes did not differ significantly between true- and false-negative results of intraoperative visualization.

Conclusion: Intraoperative imaging is valuable to obtain accurate information about status of disease and extent of surgery. Further long-term studies are needed to evaluate clinical benefits of intraoperative visualization.

Duodenal injury in blunt abdominal trauma is a rare and often requires complex repair. We present a case of duodenal injury successfully managed with primary repair and jejunostomy. Additionally, we reviewed the literature devoted to the management of duodenal injuries, particularly D4 duodenal injuries. A 34-year-old male patient came to the emergency department with severe abdominal pain caused by a workplace accident. The patient's condition on arrival was stable. Abdominal examination: severe epigastric pain, bruising and skin scratches in epigastric area, positive signs of abdominal rigidity, and inaudible peristaltic movements. Computed Tomography (CT) of the abdomen revealed free air in abdominal cavity and retroperitoneal space. The patient underwent emergency surgery 4 hours after the accident. Intraoperatively, we found rupture of the fourth part of duodenum and stomach. These injuries were chosen for primary repair combined with jejunostomy. The patient recovered after surgery, and there were no complications. Rupture of D4 duodenum can result from falling and hitting the back on a hard surface, while gastric rupture may occur due to direct impact on abdominal wall. Free retroperitoneal air adjacent to D4 segment is indicative of duodenal injury. Extensive suturing of surrounding tissues and two-layer suture repair at the injury site are necessary. Additionally, jejunostomy was imposed to prevent complications such as duodenal leaks. Due to anatomical characteristics of D4, primary repair can be effective for duodenal injuries up to grade III. Extensive abdominal drainage and jejunostomy are essential for fast recovery and minimal risk of complications related to duodenal leaks.

Objective: To determine prognostic factors in resectable common bile duct (CBD) cancer and feasibility of adjuvant therapy.

Material and methods: We retrospectively studied the results of pancreatoduodenectomy for CBD cancer in 1999-2023.

Results: There were 89 patients, mortality rate was 5.6% (n=5), complications developed in 66 patients (74.2%), complications ≥ grade III - in 37 (41.7%) cases. Postoperative pancreatic fistula (POPF) grade B/C was detected in 29 (32.6%) cases. Postoperative chemotherapy was administered to 43 patients (gemcitabine-based therapy - 27, capecitabine alone - 15, capecitabine/oxaliplatin combination - 1). The median overall survival was 33 months, disease-free survival - 19 months. Among patients selected for assessment of long-term results (n=79), the median OS was 37 months, DFS - 30 months. Retroperitoneal invasion (RPI), pancreatic invasion (PI), perineural invasion (PNI), moderate/poor differentiation, R1 resection, retroperitoneal lymph node (LN) involvement worsened long-term results in multivariate analysis, regional LN involvement and elevated CA 19-9 - in univariate analysis. Accumulation of factors worsened prognosis. Postoperative chemotherapy improved OS (median OS 35 months vs. 16.5, p=0.035) in patients with two or more negative prognostic factors. Chemotherapy mode did not affect prognosis.

Conclusion: Retroperitoneal, pancreatic and perineural invasion, R1 resection, moderate/poor tumor differentiation, lymph node involvement and elevated CA 19-9 are negative prognostic factors in CBD cancer. Postoperative capecitabine monotherapy is justified in patients with two or more negative factors.

Despite low prevalence compared to other thermal injuries, severe electrical trauma with large area of injury and deep burns is associated with extremely high risk of death. Severity of pathological process depends on many factors: electric current itself, body status. Treatment of these injuries is a labor-intensive process, including numerous surgical interventions. Surgical treatment should be started as early as possible after admission. The authors describe electric injury from high-voltage power transmission network. This example demonstrates how early intensive care and surgical treatment affect the outcome.

Transjugular intrahepatic portosystemic shunt (TIPS) is a minimally invasive and effective treatment for gastrointestinal variceal bleeding and refractory ascites associated with portal hypertension. However, TIPS dysfunction occurs for various reasons and can lead to recurrent complications. In such cases, repeated endovascular intervention can be performed for portal hypertension. This article presents one of the methods of endovascular correction (Y-stenting) for TIPS thrombosis.

Knowledge of extrahepatic biliary anatomy is important for surgeons involved in the diagnosis and treatment of biliary tract diseases. The use of new diagnostic methods allows for the development of optimal surgical treatment regimens and the prevention of postoperative complications. The presented clinical case illustrates the effectiveness of using 3D modeling in diagnosing biliary system anomalies to plan and adjust surgical treatment. In addition, the method allows for the monitoring of the postoperative formation of new duct-to-duct anastomoses and the adjustment of subsequent non-surgical treatment regimens. The use of a 1.5% meglumine sodium succinate solution in the postoperative treatment, due to its antioxidant/antihypoxant mechanism of action, contributed to reduction of inflammatory reactions, normalization of biochemical parameters, and improvement of subjective indicators of the patient's quality of life.

The authors discuss treatment of 11 patients with extremely rare hereditary von Hippel-Lindau syndrome, who were observed for 2 years. Two cases are presented with discussion of modern approaches to diagnosis and surgical tactics for damage to the pancreas and kidneys.

The problem of giant intrathoracic tumors is still relevant. These tumors occupy more than two parts of the mediastinum and penetrated pleural cavities. The same group includes large hemithorax tumors with spread into mediastinum and compression of adjacent anatomical structures. Many authors all over the world published different aspects of this issue (diagnostic, oncologic, surgical and anesthetic). We discuss some questions concerning the choice of surgical access and surgical techniques. In 1982-2024, there were 40 patients with giant intrathoracic tumors (20 teratomas, 12 solitary fibrous tumors, 4 thymomas, 2 sarcomas, 1 neurinoma and 1 chemodectoma). Transthoracic needle core biopsy was performed in 21 patients. Eight patients had previous attempts of tumor resection. Surgical accesses for giant intrathoracic tumor resection were sternotomy in 25 cases, lateral thoracotomy in 7 cases, hemiclamshell in 2 cases and combined access in 6 cases. Postoperative morbidity was 17.5% (7 patients had different complications after surgery). Of these, 3 ones died (mortality rate 7.5%). Thirty-three (82.5%) patients recovered after surgery well.

Intraoperative left ventricular rupture is a rare but extremely dangerous complication in cardiac surgery. This event can lead to massive bleeding and/or cardiac tamponade, as well as critical hemodynamic disturbances. In some cases, mortality can reach 100% that emphasizes the need for timely correct diagnosis and effective treatment of this complication.

Objective: To analyze the role of intraoperative ultrasound in assessment of collateral liver arterial blood supply after acute blockade of hepatic blood flow.

Material and methods: Intraoperative analysis of hemodynamic changes in liver blood supply after temporary arterial blockade of hepatic blood flow was carried out in 135 patients who underwent total resection of pancreatic, liver, and gastric cancers. In addition to analysis of ischemic complications, we studied arterial architecture, pulsation of hepatoduodenal ligament, linear arterial blood flow velocity in liver parenchyma and hepatoduodenal ligament before and after hepatic blood flow blockade, as well as diameters of the main celiac-mesenteric arteries before surgery. These parameters were compared in groups of DP CAR and other interventions.

Results: There were no ischemic liver events after DP CAR and hepatic blood flow blockade. After hepatic blood flow blockade in the overall group, hepatoduodenal ligament pulsation disappeared in 8% of cases, while linear arterial blood flow velocity decreased by more than 50%. Pulsatile blood flow was preserved in 77% of cases. Despite significant decrease in linear arterial blood flow velocity and even disappearance of hepatoduodenal ligament pulsation, arterial blood flow in liver parenchyma never ceased. None patient had arterial blood flow in liver parenchyma< 20 cm/s. When dividing the groups into DP CAR and non-DP CAR, we found no significant differences in age- and gender-adjusted distribution, Michels vascular architecture and linear arterial blood flow velocity decrease. Pulse disappearance significantly depended on diameter of gastroduodenal artery (GDA) and largely on the ratio of its diameter to the diameter of the common hepatic artery (CHA). IF CHA/GDA diameter ≈ 2, the probability of hepatoduodenal ligament pulse disappearance increased by more than 5 times.

Conclusion: High adaptive capacity of collateral arterial blood supply to the liver is revealed after CHA or celiac artery blockade. Intraoperative ultrasound is a highly reliable method for analysis of blood supply. Linear blood flow velocity in parenchymal arteries ≥20 cm/s is sufficient to prevent ischemic liver damage.