Alexander Anatolievich Popov

Background. Formation of adhesions after surgical interventions on the pelvic organs directly affects reproductive outcomes and quality of life in women. Adhesion prevention involves minimally invasive endoscopic techniques, systemic anti-inflammatory drugs and local corticosteroids. However, these methods are not sufficiently effective and have side effects. Therefore, efficacy and safety of promising anti-adhesion medications – barrier gels – is being actively investigated. Aim. To evaluate the safety of using a hyaluronan-based anti-adhesion gel during robot-assisted myomectomy and adenomyomectomy in patients planning a pregnancy. Materials and methods. A single-center, prospective, open-label, randomized controlled trial was conducted involving 120 female patients who underwent pre-pregnancy robot-assisted uterine reconstructive surgery. Patients were randomized into a study group which received an anti-adhesion barrier gel based on sodium hyaluronate and carboxymethylcellulose (Antiadgezin) and a control group which did not receive an anti-adhesion barrier gel. Safety of this prevention method was evaluated through rigorous monitoring of clinical and laboratory parameters during the postoperative period. Results. In both groups of patients undergoing robot-assisted myomectomy and adenomyomectomy, the use of a hyaluronan-based anti-adhesion barrier was not associated with an increased rate of postoperative complications (p >0.05 for all comparisons). Conclusion. An anti-adhesion barrier based on sodium hyaluronate and carboxymethylcellulose is safe to use during reconstructive uterine surgery in patients planning a pregnancy. These results justify further large-scale studies to confirm the efficacy and safety of the anti-adhesion barrier in various types of robot-assisted gynecological procedures.

This paper presents a literature review examining current approaches to the treatment of patients with endometrial cancer (EC) and concomitant morbid obesity. Excess body weight and associated hyperestrogenism are known to be the main risk factors for the development of the endometrioid type of EC. However, the treatment of these severely obese patients remains a pressing and controversial issue. Traditional laparoscopy, which has demonstrated high-quality and comparable oncological outcomes in patients with a body mass index 40 kg/m2, leading to an increased incidence of complications and a 33% increase in treatment costs. Robotic-assisted laparoscopic surgery creates all the necessary conditions for successful surgical treatment of such patients. Despite the high cost of robotic surgery, postoperative rehabilitation and recovery are much faster, which offsets overall costs (the difference in the cost of surgical treatment performed using laparoscopic, open, or robotic approaches was statistically insignificant). The obtained data suggest that preference should be given to robotic-assisted surgery in patients with endometriosis and concomitant morbid obesity.

Increasing life expectancy in women and maintaining social activity in older age groups necessitate improving surgical correction methods for apical pelvic organ prolapse (POP), with an emphasis on reducing the morbidity of the procedure and the incidence of specific complications. Objective. To compare the efficacy and safety of two modifications of sacrospinal fixation (SSF) using a mesh prosthesis (uni- and bilateral) for the correction of apical POP. Material and methods. A single-center, non-randomized, prospective study was conducted. It included 94 patients with apical POP stages II—IV according to the Pelvic Organ Prolapse Quantification (POP-Q) classification. They underwent unilateral (UniL) and bilateral (BiL) SSF using a Dallop NM synthetic prosthesis. Results. Forty-six patients were included in the UniL group, and 48 in the BiL group. Preoperatively, the BiL group was characterized by more severe prolapse: POP-Q stages III—IV — 85.5% versus 39.1% in the UniL group; p<0.001. When using the UniL technique, pain syndrome on the first postoperative day was less 3 [2; 4] points on the visual analog scale versus 5 [4; 5.5] points in the BiL group; (p<0.001). No differences were found between the groups in the frequency of vaginal mucosal erosion (12.5% in the BiL group versus 2.2% in the UniL group), dyspareunia, de novo pelvic pain, or any late complications (35.4% versus 17.4%), including in subgroups by POP-Q stages. The frequency of de novo stress urinary incontinence was approximately 4% in both groups. Both techniques provided comparable improvements in quality of life according to the validated PFDI-20 and PFIQ-7 questionnaires. Conclusion. UniL SSF is a less invasive alternative to BiL SSF, comparable in functional outcomes and quality of life with less pain. BiL SSF may be preferable for severe forms of prolapse. The choice of surgical correction method for apical prolapse should be individualized.

Urinary tract endometriosis is rare, and ureteral involvement is particularly insidious due to its asymptomatic nature. The absence of symptoms can lead to ureteral stricture, hydronephrosis, chronic kidney disease up to end-stage renal failure, and irreversible loss of kidney function. Diagnosis requires imaging methods to assess the degree of obstruction, while treatment involves surgical release of the ureter from endometriotic infiltrates to preserve organ function. Our observation illustrates the difficulty of establishing the etiology of a retroperitoneal tumor-like infiltrate leading to ureteral obstruction and hydronephrosis, as well as the need for differential diagnosis of endometriosis with other infiltrative processes.

Endometrial cancer ranks 2nd after cervical cancer in the structure of oncogynecological diseases worldwide and 1st in economically developed countries. Among patients with endometrial cancer, the incidence of concomitant obesity can reach 60%. Minimally invasive techniques such as laparoscopic or robot—assisted approaches are often used in the treatment of patients with endometrial cancer, especially patients with morbid obesity. Compared to traditional open surgery, these approaches can reduce the risk of complications and accelerate recovery. Objective. Comparative assessment of surgical outcomes of laparoscopic and robot-assisted panhysterectomy in combination with or without pelvic lymphadenectomy in the surgical treatment of patients with endometrial cancer and morbid obesity. Materials and methods. A one-stage comparative study was conducted with the participation of 177 endometrial cancer patients suffering from pathological obesity who underwent surgical treatment with standard and robot-assisted laparoscopic access on the basis of the GBUZ MO MONIIAG named after academician V.I. Krasnopolsky in the period from 2015 to 2024 years. Results. Based on the medical documents of individual and group records, the medical data of 374 patients diagnosed with endometrial cancer were analyzed, among them 177 (47.3%) women had morbid obesity (median body mass index — BMI 46.6 kg/m2). These patients were divided into 2 groups depending on operative access: group 1 consisted of women operated with standard laparoscopic access (n=98), group 2 (n=79) — with robot-assisted laparoscopic access. There were no statistically significant differences in the volume of blood loss, the number of lymph nodes removed, and the number of intra- and postoperative complications. There was one case of laparoconversion in the robotic access group due to bleeding in a patient with an extremely high BMI >53 kg/m2. Pelvic lymphadenectomy was performed in 22 (22.9%) patients from group 1 and 15 (19.0%) patients from group 2. The BMI of patients in group 1 who underwent lymphadenectomy was lower than in group 2 (median 40.5 and 47.9 kg/m2, respectively). Conclusion. Robot-assisted laparoscopy is safe in the treatment of patients with endometrial cancer and morbid obesity: the results obtained are comparable with the results of standard laparoscopy. Nevertheless, given the statistically significant differences in BMI in the groups of patients who underwent pelvic lymphadenectomy along with panhysterectomy, the robotic system makes it more likely to carry out full surgical treatment in conditions of pathological obesity.

Objective. Evaluation of the results of simultaneous laparoscopic and robot-assisted pectopexy combined with hysterectomy in patients with apical pelvic organ prolapse (APOP). Materials and methods. A single-center observational prospective study that included patients who underwent minimally invasive hysterectomy in combination with POP correction in the period from 2023 to 2024. The criteria for inclusion in the study were the presence of grade I-IV apical POP according to the standardized classification Pelvic Organ Prolapse Quantification system (POP—Q), as well as the presence of diseases that serve as indications for hysterectomy. A total of 34 patients underwent surgery using this method during the follow-up period. The anatomical and functional results were evaluated 12 months after the intervention according to the POP-Q classification and internationally validated questionnaires. Results. Laparoscopic hysterectomy with simultaneous correction of apical POP took an average of 136±37 minutes. There was no recurrence of apical POP during the follow-up period, however, 3% (n=1) and 6% (n=2) of women had prolapse of the posterior and anterior vaginal walls, respectively. The patient satisfaction rate with surgical treatment was 97% (n=33). Conclusion. The technique of simultaneous fixation of the vaginal dome to the comb ligaments with obliteration of the Douglas space makes it possible to effectively surgically arrest apical POP in patients during hysterectomy, which makes it possible to surgically cover several gynecological diseases at once. This method is most justified in elderly women with overweight, burdened with somatic diseases, making it possible to reduce the risk of repeated interventions for POP.

Conventional laparoscopic segmental bowel resection with mini-laparotomy specimen extraction compared with Natural Orifice Specimen Extraction (NOSE) procedures in patients with colorectal endometriosis - Facts, Views and Vision in ObGyn

Background. Natural orifice specimen extraction (NOSE) is an innovative technique of endoscopic surgery in which with specimen extraction through the natural orifice. The relevance of studying robot-assisted colorectal NOSE resection is driven by the need for an objective assessment of its advantages and safety. Aim. To evaluate the safety and short-term clinical outcomes of robotic-assisted bowel resections with specimen extraction through the anal canal in patients with colorectal endometriosis. Materials and methods. A retrospective cross-sectional study was conducted based on the analysis of data from 66 patients with confirmed deep infiltrative colorectal endometriosis. All patients underwent robot-assisted colorectal NOSE resection. Results . The mean age of the patients was 35.4 years (range 23 to 49 years). The mean body mass index was 23.36 kg/m2 (range 16.65 to 33.12 kg/m2). The mean operative time for robotic-assisted colorectal resection using the NOSE technique was 144.6 ± 50.1 min. The mean intraoperative blood loss was 124.6 ± 90.8 mL. On postoperative day 2, 13 patients presented with a body temperature elevation up to 38°C. Conclusion. Robotic-assisted laparoscopy combined with the NOSE technique is a technically feasible, safe, and effective approach in the comprehensive surgical management of colorectal endometriosis. The technique offers several advantages: reduction in the consumption of disposable instruments, absence of a laparotomic incision, accelerated postoperative rehabilitation.

Introduction. The use of anti-adhesion barriers in intestinal anastomoses, regardless of surgical approach, remains controversial in terms of their safety. Aim. To evaluate the safety of a hyaluronic acid-containing anti-adhesion gel in intestinal anastomosis during robot-assisted procedures for deep infiltrating endometriosis. Materials and methods. A single-center, prospective, controlled trial was conducted in 76 patients with deep infiltrating endometriosis and bowel lesions. Randomization to the control and study intervention groups was based on the use of a hyaluronic acid-containing gel anti-adhesion barrier (Antiadhesin). The evaluation protocol included careful monitoring of clinical parameters (the incidence of postoperative complications: anastomotic leakage, peritonitis, abdominal abscesses, sepsis), as well as laboratory markers of inflammation in the postoperative period. Results. The use of a hyaluronic acid-containing anti-adhesion barrier was not associated with an increased incidence of postoperative complications, including anastomotic leakage (p > 0.05 for all comparisons). Conclusion. An anti-adhesion barrier composed of carboxymethylcellulose and hyaluronic acid demonstrates a favorable safety profile when used in intestinal anastomoses. The obtained results support the need for further large-scale studies to confirm the efficacy and safety of this barrier in various types of laparoscopic procedures.

Aim. To evaluate safety of robot-assisted access compared to laparoscopic, abdominal, and vaginal accesses during sacrocolpopexy for pelvic organ prolapse. Materials and methods. Randomized and non-randomized trials involving women suffering from pelvic organ prolapse were included in the analysis. A search for studies published prior to January of 2026 was performed in the PubMed, Medline and Cochrane Library databases. The following key words were used: robotic, sacrocolpopexy, and pelvic organ prolapse. Articles describing other types of interventions and articles without comparative analysis were not included in this review. Results. In total, 36 studies were selected for the systematic review. The rate of postoperative complications in robot-assisted sacrocolpopexy was comparable to the rates in surgeries without the use of robotic devices. The volume of intraoperative blood loss did not differ from the volume during standard intervention through laparoscopic or abdominal access, but in vaginal access blood loss volume was significantly higher. Additionally, conversion rate for robot-assisted access was lower than for laparoscopic access. However, laparoscopic and vaginal accesses were characterized by shorter operative time compared to robot-assisted sacrocolpopexy. In-hospital time was shorter for robot-assisted access but compared to vaginal surgeries, no significant differences were observed. Conclusion. Robot-assisted sacrocolpopexy might be associated with the following benefits: lower blood loss compared to vaginal access and shorter hospitalization time compared to laparoscopic sacrocolpopexy. However, more accurate and objective confirmation of safety of robot-assisted sacrocolpopexy requires further high-quality prospective randomized trials.