Timur Alekseevich Glebov

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.

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.

Introduction. Sacrocolpopexy (SCP) is a well-established technique that over the past decades has become the “gold standard” for the correction of apical pelvic organ prolapse (POP) due to its high efficacy. The widespread adoption of robotic surgery allowed to make this labor-intensive intervention more ergonomic. Aim. To evaluate long-term efficacy of robot-assisted SCP in patients with POP. Materials and methods. The single-center cohort prospective study included 309 patients with isolated or combined stage III–IV apical POP according to the Pelvic Organ Prolapse Quantification system (POP-Q). All patients underwent robot-assisted POP repair at the V.I. Krasnopolsky Moscow Regional Research Institute of Obstetrics and Gynecology between 2013 and 2024. Subjective outcomes were assessed using the internationally validated questionnaires: Pelvic Organ Prolapse Distress Inventory-20, Pelvic Floor Impact Questionnaire-7, and Pelvic Organ Prolapse Incontinence Sexual Questionnaire-12. Results. Median postoperative follow-up period for patients was 74.6 (44.5–110.2) months. The most common phenotype of recurrent disease was anterior vaginal wall prolapse, accounting for 5.8 % (n = 18) of observations. Recurrence of the sensation of a foreign body in the vagina occurred in 3.9 % (n = 12). Despite this, the reoperation rate was 1.6 % (n = 5). Intraoperative complications occurred in 2.3 % (n = 7) of patients, and there were no cases of conversion. Vaginal erosions were observed in 0.3 % (n = 3) of operated women. Conclusion. The obtained data reflect the long-term efficacy of robot-assisted SCP, highlighting its viability as a surgical treatment for apical POP. It is most relevant to consider this intervention for patients after previous reconstructive plastic surgery or hysterectomy. The target patients for the robot-assisted approach are women with complex surgical history, severe somatic diseases, and obesity.

The article provides a review of the literature on the problem of endometriosis of the diaphragm. Endometriosis of the diaphragm is a rare disease characterized by the presence of functional endometrial tissue on the diaphragm. Almost 80% of patients with endometriosis of the diaphragm have concomitant endometriosis of the pelvic organs. In 70% of cases, the disease is asymptomatic, and most often the diagnosis of endometriosis of the diaphragm is made immediately during surgery for pelvic endometriosis. Objective — to analyze various approaches to the diagnosis and treatment of patients with endometriosis of the diaphragm in order to create an algorithm for managing patients with this disease.

Objective. To reduce the risk of recurrence of endometriosis of the anterior abdominal wall after surgical treatment by clarifying the pathogenesis, developing diagnostic and treatment algorithms. Materials and methods. A retro-prospective study was conducted, including 120 patients with endometriosis of the anterior abdominal wall who were treated in the Department of Operative Gynecology with Oncogynecology and Day Hospital of the V.I. Krasnopolsky” Moscow Regional Research Institute of Obstetrics and Gynecology in the period from 2015 to 2023, in addition, 25 patients delivered by caesarean section were additionally examined. Results. Risk factors for the development of endometriosis of the anterior abdominal wall are identified. Diagnosis of endometrioid infiltrates is usually delayed, which is due to the late appearance of complaints and a late visit to the gynecologist. Ultrasound allows us to determine the size, localization and structure of the infiltrate. In the presence of multiple foci of different sizes, especially recurrent ones, magnetic resonance imaging is preferable. Treatment of patients with endometriosis of the anterior abdominal wall should be surgical. Conclusion. Endometriosis of the anterior abdominal wall after abdominal delivery is a delayed complication. However, in patients with certain risk factors, with the use of preventive measures, it is possible to reduce the likelihood of this disease. A thorough diagnosis based on instrumental research methods makes it possible to optimize surgical treatment tactics. Hormone therapy for endometrioid infiltrates of the anterior abdominal wall at the pre- and postoperative stages does not lead to a clinically significant change in the course of the disease, only compliance with the technology of surgical removal of the formations reduces the risk of recurrence of the disease.