K. R. Musakaeva

Introduction. A hiatal hernia (HH) is a condition of weakened diaphragmatic ligaments, resulting in stretching and enlargement of the hiatal opening and protrusion of abdominal organs into the pleural cavity. In the pathogenesis of HH, one of the leading roles is played by the structural degradation of connective tissue fibers of the esophageal-diaphragmatic membrane and weakening of the ligamentous apparatus of the stomach. A common method of HH surgical treatment involves laparoscopic Nissen fundoplication combined with anterior or posterior cruroraphy. An alternative method is the use of robot-assisted surgery. Materials and methods. During the period from April 2022 to January 2024, 113 robot-assisted laparoscopic fundoplications were performed in the thoracic surgery unit at the Hospital of Bashkir State Medical University (Ufa, Russian Federation). The patients were divided into two groups. A research group ( n = 65) underwent robot-assisted laparoscopic Nissen fundoplication with modified cruroraphy and cuff fixation with Z-shaped sutures according to patent 2813330C1. A control group ( n = 48) had standard laparoscopic Nissen fundoplication with anterior cruroraphy using interrupted sutures. The age of operated patients ranged from 35 to 65 years, including 72 and 28% of women and men, respectively. All surgical interventions were performed using the Da Vinci Si robotic system. Results and discussion. The use of an advanced technique (patent 2813330C1) in robot-assisted interventions for type III HHs prevents cuff migration and slippage, including into the pleural cavity, as well as the occurrence of the “telescope” symptom. It helps achieve symmetry and prevent cuff deformation and slippage, as well as ensures early patient activation and initiation of enteral nutrition through the use of laparoscopic techniques and Z-shaped suture with nonabsorbable suture material. Conclusion. The positive results of surgical interventions performed for type III HHs using the developed technique (patent 2813330C1) demonstrate the proposed method promising for videoendoscopic surgery.

Introduction. Prostate cancer (PCa) is one of the most common oncological diseases, the tactics of its treatment directly depends on the stage. According to statistics, prostate cancer (prostate cancer) accounts for more than 1.4 million new cases annually. The «gold» standard at the moment for localized prostate cancer is surgical intervention in the volume of radical robot-assisted prostatectomy. The aim was to development technologies for calculating the trajectory of movements of the traveled path of surgical instruments during robot-assisted radical prostatectomy; devalopment and implementation of an «active» robot system into the learning process, and later into the workflow; devalopment of a self-monitoring system for a surgeon in self-study. Materials and methods. On the basis of the Bashkir State Medical University clinic, 30 surgical robot-assisted radical prostatectomies performed by two surgeons were analyzed, of which surgeon 1 performed 14 surgical interventions and surgeon 2 performed 16 surgical interventions. Results. During the analysis, data were obtained on the average duration of the operation of robot-assisted radical prostatectomies, the movement time of robotic instruments. Conclusion. The study of the analysis of the time of movement of instruments is an important step towards optimizing resources and improving the efficiency of the medical process.

Introduction. Esophageal pathology constitutes a small share in general morbidity, however, it remains highly relevant due to its social and clinical significance. Corrosive strictures account for a large proportion among benign esophageal diseases. Treatment of the disease starts with intraluminal surgery. However, it provides only short-term effect due to the tendency of esophageal strictures to restenosis. In case of treatment failure, esophagoplasty is performed. The esophagoplasty according to Ivor Lewis with the formation of manual intrapleural anastomosis was performed in the BSMU Clinic. The abdominal and thoracic phases were performed using Da Vinci Si robotic surgical system. By the time of publication of this paper, the authors have gained experience of 15 successfully performed surgeries of this kind.Materials and methods. The paper presents a clinical case of robot-assisted esophagoplasty according to Ivor Lewis performed on patient Y., born in 1978, with the clinical diagnosis: corrosive strictures of the lower third of the esophagus with dysphagia of III–IV degree. The pathology developed as a result of surrogate alcohol consumption in September 2017. Since October 2017, the patient has been regularly treated in the Thoracic Surgery Unit of the BSMU Clinic, where she underwent a number of endoscopic surgeries, which appeared to provide a little effect. The patient underwent a subsequent surgical treatment including esophagoplasty according to Ivor Lewis with the formation of manual intrapleural anastomosis using Da Vinci Si robotic system.Results and discussion. First three days of the postoperative period, the patient remained in the Anaesthesiology and Intensive Care Unit. She received step-by-step parenteral and enteral nutrition. Control fl uoroscopic examinations revealed timely, disturbances-free evacuation and no contrast leakage from the formed anastomosis. The patient was discharged on day 11 in satisfactory condition.Conclusion. Using Da Vinci robot-assisted system in Lewis esophageal plastic surgery has a number of specific features. It provides more precise tissue extraction with preservation of stomach and esophageal vessels, moreover, mobility of the instruments enables the key phase to be performed, namely — manual suturing in the esophagoanastomosis. As a result, the risk of postoperative complications is reduced.