Objective: To study the results of surgical treatment of gastrointestinal stromal tumors of the stomach using minimally invasive methods of treatment.
Materials and methods: The clinical observation group consisted of 37 patients. There were 12 males (32.3%) and 25 females (67.7%). The median age was 53.4±11.2 years. In 23 (12.9%) patients, the tumor was originated from the muscle plate of the gastric mucosa, and in 14 — from the muscle layer of the gastric wall. The size of the tumor was varied from 2 to 10 cm. Submucosal tumor dissection (ESD) was performed in 10 patients, laparoscopic partial gastric resection — in 8, and robot – assisted partial gastric resection — in 19 patients.
Results: The average duration of video endoscopic operations was 135.8±15.5 minutes. In robotic interventions, the average duration of docking in 2017 was 33.2±3.4, in 2018 – 26.4±2.2, in 2019 – 21.7±1.6, and in 2020 — 19.5±1.4 minutes. Intraoperative complication in the form of perforation of the gastric wall with submucosal dissection of the tumor was noted in 1 (10%) case. Complications in the postoperative period were observed in 1 (3.2%) patient.
Conclusion: Tumors taking place from the muscle plate of the mucous membrane without involving the muscle membrane of the stomach with a size of 2 to 5 cm are subject to endoscopic removal by the method of submucosal dissection. For tumors larger than 2 cm with involvement of the gastric mucosa, the most preferred method of removal is laparoscopic or robotic partial resection.

Introduction. There are many approaches to performing adrenalectomy. laparoscopic adrenalectomy is considered the operation of choice. A uniform approach to the choice of access for adrenalectomy has not been established.
Purpose of the study: to compare the effectiveness of the laparotomic, standard laparoscopic approach, as well as the author's laparoscopic approach for the safe performance of adrenalectomy.
Materials and methods. 110 patients were operated on in the surgical hospital for the period from 2016 to 2019. Patients were divided into three groups: operated on by laparotomic access, laparoscopic and author's laparoscopic access.
Discussion. There is no uniform approach to the choice of access for an operation. Compared to laparotomy, the laparoscopic approach during adrenalectomy makes it possible to reduce the pain syndrome in the postoperative period, accelerate the medical and social rehabilitation of patients, reduce the risk of a number of complications, or completely avoid them. The principles formed proved to be effective in the prevention of intraoperative and postoperative complications in patients after laparoscopic adrenalectomy.
Conclusion. Comparative analysis showed the advantages of using the laparoscopic approach for performing adrenalectomies compared to the laparotomy approach. The developed principles of performing laparoscopic adrenalectomy make it possible to increase the efficiency and safety of laparoscopic adrenalectomy in comparison with standard laparoscopic intervention.

Relevance. Surgical treatment of acute cholecystitis (AC) remains one of the most urgent problems of emergency surgery. AC is the most frequent complication of gallstone disease, reaching 30% or more in the structure of this disease. Despite the widespread introduction of modern endoscopic surgical techniques, there are still many unresolved problems in the treatment of AC.
Material and methods. This paper summarizes the experience of treating more than 13,000 patients with GBD who underwent laparoscopic cholecystectomy. Acute cholecystitis occurred in 3140 patients. The author adheres to active surgical tactics — laparoscopic surgery in the first 2‒16 hours from admission in the absence of absolute contraindications to the pneumoperitoneum.
Results. The paper discusses the technical features of laparoscopic operations in various forms of AC, discusses the reasons for unsatisfactory results of surgical treatment of AC, such as late hospitalization and the use of ineffective conservative therapy, delaying the recovery of patients. The negative consequences of multi-stage AC treatment methods are discussed, and an algorithm for early radical surgical intervention is defined. The nature of inflammatory changes in the GB wall and nearby space tissues, as well as the presence of adhesions in the abdominal cavity, did not affect the decision on the timing of the operation and the choice of method.

Introduction. The use of parallel multistenting with plastic stents in benign strictures of the distal choledochus is a scientifically proven preferred method in comparison with monostenting, but there are almost no studies related to this method of treatment for repeated interventions in the dysfunction of a previously installed stents. Study Purpose. The purpose of the retrospective scientific study was to conduct a comparative analysis of the use of retrograde stenting using one and several plastic stents for the treatment of distal benign biliary tract strictures.
Material and methods: The study included 63 patients with benign distal choledochal strictures, previously performed retrograde stenting and stent dysfunction with the development of mechanical jaundice, who underwent retrograde restenting. The main group consisted of 20 patients with parallel multistenting, the control group сonsisted of 43 patients with monostenting.
The results of treatment. Statistically significant were better indicators of the ratio of postoperative to preoperative values of direct bilirubin, alpha-amylase and the diameter of the choledochus in the main group compared to the control group, statistically insignificant were the average ratio of postoperative to preoperative indicators of leukocytosis, as well as the average number of days before the patient's discharge from the hospital.
Conclusions: A comparative analysis of repeated retrograde stenting in benign strictures of the terminal choledochus showed the advantage of using multistenting, which is reflected in both immediate and long-term results.

Objective: to test the effectiveness of devices that facilitate the positioning of drainage tubes in the pleural cavity under experimental conditions.
Methods: The study was prospective, quasi-randomized, controlled. Subject of the study: 30 corpses of both sexes. Three series of installation of drains were carried out 1. without the use of positioning devices (n = 10); 2. with usage of tracheostomy tube (n = 10); 3. using the original trocar adapter (n = 10). Draining of both pleural cavities was performed with the installation of two drains in each (to the apex and pleural sinus). The positioning of the drainage and kinking were visually monitored, and the distance to the drainage zone was measured. All experiments were performed by five surgeons who had no experience in pleural cavity draining, each of whom performed two experiments from each series.
Results: 1. Draining without the use of positioning devices: translocation took place in 7 (18%) cases; kinking was recorded in 14 (35%) cases, and in 5 cases it was combined with drainage translocation. 2. Drainage using a tracheostomy tube: the success was achieved in 38 (95%) cases; in one case (2.5%) there was a drainage kinking, in one (2.5%) — translocation. 3. Drainage using a trocar adapter: success was achieved in all 40 (100%) cases, the drains were localized at the planned points, without kinks.
Conclusion: The use of positioning devices facilitates the process of drainage of the pleural cavity, avoids typical complications and surpasses the results of “routine” drainage in terms of efficiency. The technique of simultaneous drainage of the upper and lower levels of the pleural cavity using a trocar adapter is easily performed by surgeons who do not have the appropriate experience.

Abstract: to study the features of the dynamics of regional blood flow in patients with critical ischemia of the lower extremities who underwent revascularizing osteotrepanation with intraosseous laser irradiation.
Material and research methods. The study was carried out in 121 patients with critical ischemia of the lower extremities. 48 patients underwent standard surgical and conservative treatment. In 42 patients (group I) revascularizing osteotrepanation was performed, in 31 patients (group II) — revascularizing osteotrepanation with intraosseous laser irradiation. In dynamics the parameters of arterial and venous blood flow were studied. The indices of regional hemodynamics were compared with the identical parameters of 48 apparently healthy individuals ("reference group").
Results. Upon admission to the clinic, patients of both groups were found to have a sharp disturbance of arterial and venous blood flow. In groups I and II, both before discharge from the hospital and 3‒4 months after discharge, significant ((p <0.05) stimulation of arterial and venous blood flow was observed. Correlation-statistical analysis showed that the mobilization of regional blood flow with moderate correlation (r = 0.3‒0.6) reliably (p <0.05‒0.001) depends on surgical indirect revascularization.
Conclusion. ROT with VCLO reliably stimulates regional circulation in patients with KINC against the background of dystal lesions of the arteries. If it is impossible to perform shunt operations in patients with CILL the stimulation of regional blood flow with a ROT with ILR is pathogenetically substantiated.

Objective. High-intensity ultrasound ablation (HIFU-therapy) of the prostate gland is a young but promising treatment method. For the most effective and safe therapy, it is necessary to determine the indications for its implementation by analyzing the available results.
Materials and methods. The experience of treating 55 patients with localized prostate cancer is presented. The average age is 67.6±13 L, preoperative total PSA level of blood 8.341, the Gleason grade of acinar adenocarcinoma is 4-6 scores, the gland volume according to MRI is 34±20.7 cm3, the PIRADSv2-4 score is used.
Results. Intraoperative complications were not recorded in any case. The number and severity of postoperative complications (acute urinary retention, stricture of the prostatic urethra, accession of lower urinary tract infections, grade I-II urinary incontinence) corresponded to the data of the world literature. The postoperative total PSA index of blood within 12 months decreased by 84.58%
Conclusion. HIFU-therapy is a promising and relatively safe method for treating prostate cancer with a minimum number of possible intraoperative complications. Given the low percentage of relapses of the disease, it can be concluded that the criteria for selecting patients are correct. For the formation of the complete characteristics of the method, indications and contraindications to it, it is necessary to carry out further studies.

Objective. To analyze the possibilities of using lipofilling for the treatment of post-radiation damage to the rectum.
Material and methods. The object of the study is female patients aged 28 to 83 years, inclusive, with complications of radiation therapy (rectovaginal fistulas, radiation proctitis, radiation ulcers). Methods used: analysis of literary sources, publications, review of used treatment methods, analysis of statistical data, analysis of history and results of treatment, generalization, systematization, classification of literature data.
Results. Due to lipofilling, it is possible to normalize the structure of soft tissues, achieve healing of wound surfaces, eliminate scar deformities, and also by assessing the quality of life of patients. The healing process was assessed by clinical and histological methods. The clinical picture included a gradual decrease in the size of the fistula, a decrease in inflammation, and restoration of the vaginal and rectal mucosa.
The residual hole closed spontaneously. The results also indicate a significant increase in the quality of life of patients after treatment. We have evaluated the effectiveness of the lipofilling method based on the introduction of mesenchymal stem cells of adipose tissue into damaged tissues. The healing process was assessed by clinical and histological methods. As a result of treatment, there is a tendency to improve the quality of life of patients. Improvement is noted for all the studied indicators. Conclusion. Our data indicate the effectiveness of the developed by us technique of microinjection autotransplantation of adipose tissues.

Introduction. Predictive analysis of clinical and demographic factors, geographic factors and the psychological status of patients in particular the eating behavior model, separately and in common, is promising from the standpoint of a personified approach to the choice of bariatric procedure and the prediction of results.
The aim of this study is to assess the influence of clinical and demographic factors and eating behavior models on the effectiveness of bariatric procedures in patients with morbid obesity.
Material and methods. A retrospective cohort study included 230 patients with restrictive (68.3%) and bypass (31.7%) bariatric surgeries. From the Central region of Russia were 74.8% of patients, from the Northern region were 13% and from Southern — 12.2%. The age groups of patients were different, men were 29.1%, females — 70.9%. Class I obesity at the time of the operation had 12.2% of patients, class II had 25.2%, class III — 62.6% of patients. The universal criterion of effectiveness was %EWL after 12 months. The Dutch Eating Behavior Questionnaire (DEBQ) was used to assess eating behavior. Statistical analysis was carried out on the StatTech v. 1.2.0. Results. The Effectiveness of Bariatric Surgeries in patients living in the Southern region was significantly higher than in Patients living in the Central and Northern regions (% EWL — 73.9%, 62.3% and 46% respectively). More favorable results were achieved in "thinner" and younger patients. In the correlation analysis of the relationship between % EWL 12 months after surgery and the eating behavior model it was found that a decrease in % EWL by 1.141% should be expected with an increase in BMI of 1. The increase in the index of the restrictive eating behavior scale by one leads to decrease in % EWL by 3.943%. The increase in the index of the emotional scale by one leads to decrease in % EWL by 6.043% 12 months after surgery.
Conclusions. The best results of the operation should be expected in people with an external type of eating behavior, although this dependence was poorly expressed and did not reach statistical significance. At the same time, significantly worse results were obtained in patients with an emotional type of eating disorders, which requires the participation of a psychologist in the treatment of such patients.

Introduction. The purpose of the study. To evaluate the state of the immune system in patients with complicated forms of SDS on the basis of a hemogram.
Materials and methods: A retrospective analysis of the results of the case histories of 332 patients with type 2 diabetes mellitus complicated by SDS. According to the detailed blood test, the types of immune system reactions were determined using the computer program "CANCERS". Statistical processing of the results was carried out by the method of variation statistics.
Results. It was found that the areactivity of the immune system is determined only in patients with long-term diabetes mellitus. A statistically significant correlation between the types of immune system response and their characteristics and the gender of the patients was found. In patients with the neuropathic form of SDS, the inertia of immune activation, combined with insufficient activation of lymphopoiesis, was revealed. A statistically significant increase in patients with this type of immunity was in the group of patients with neuroishemic form of SDS.
Conclusion. The proposed method for determining the state of the immune system based on a clinical blood test in this group of patients is available for surgical and therapeutic hospitals of a wide profile. The computer program "CANCERS" is easy to understand and can be used to predict the course of the disease and a personalized approach to planning methods for both conservative and surgical treatment of patients with type II diabetes.

Introduction. Objective: analysis of the major problems of surgical correction of pressure ulcers.
Material and methods. Searching of data was carried out by keywords in the database PubMed.gov, as well as in the Russian scientific system – on last 20 years. More than 50 publications have been studied. underlying disease.
Conclusion. The problem of providing high-quality surgical care to patients with grade III-IV pressure ulcers is still far from being resolved. Plasty with displaced multilayer flaps is the method of choice that allows to adequately fill the tissue deficit, prevent the recurrence of extensive and deep decubital ulcers, and improve the quality of life of these patients. However, the final results are highly dependent on the quality of the pressure ulcer preparation, the choice of the optimal technique and postoperative care. A comprehensive assessment of chronic pressure ulcers and a personalized approach to treatment, based on an understanding of the deep pathophysiological mechanisms of the development of DU, their specificity, taking into account anatomical localization, length and depth of the lesion, will make it possible to optimize the results of corrective interventions in the future. Careful adherence to the aid technique and competent postoperative care are no less important. Nevertheless, this area of clinical practice remains the area of the highest risk of postoperative complications. This fact is the leading reason for the low surgical activity in DU.

Abdominoplasty performed for aesthetic or medical reasons aims to restore physiological ratios of anatomical formations of the anterior abdominal wall and to obtain a good aesthetic result for the patient. At the same time, the main task is to maximize the number of local and systemic postoperative complications, for this the surgeon must clearly know the anatomical, physiological features of the anterior abdominal wall, be able to use information about the mechanisms and pathogenesis of anterior abdominal wall deformation. The review describes the types of deformation of the anterior abdominal wall that require strengthening of its frame during abdominoplasty. Data are given on the methods of strengthening the anterior abdominal wall frame during abdominoplasty. The disadvantages and advantages of the methods used are indicated. Based on the literature data, it has been proved that the problem of choosing a material to eliminate defects of the anterior abdominal wall and choosing an effective method for correcting it has not yet been solved.
A significant number of operations carried out in modeling the anterior abdominal wall framework using both synthetic and biological materials and methods of their use indicate that the problem has not yet been solved. This forces surgeons to carefully choose the endoprosthesis, taking into account its size, biocompatibility and plastic technique according to the detected defect of the anterior abdominal wall frame.

Aim: To determine the current aspects in use of the telemedical technologies (TT) in surgery during the COVID-19 pandemic, to consider the availability of innovative devices for remote interaction of the systems doctor-patient, doctor-doctor, compare the effectiveness of using the usual approach in the treatment of a surgical patient with modern remote techniques using TT.
Materials and methods: An analysis was carried out of various domestic and foreign medical literary sources that have information and data from their own and third-party research on modern aspects in the use of TT in surgical practice during the COVID-19 pandemic.
Results: After an analysis medical literature sources, it was found that at all three stages of the management of a modern surgical patient during the COVID-19 pandemic, innovative TT allow to achieve satisfying results in most cases of use. Moreover, at some specific stages, the use of online systems helps to achieve a better result than the usual “face-to-face” interaction between doctor/patiet. The main disadvantages of telemedicine relate to the problem of technical problems and the inability to achieve a stable online connection.
Conclusion: Based on the above, it was concluded that TT in the surgeon-practice during the COVID-19 pandemic play an important role, allowing to achieve optimal results in some stages of patient management. Given the insignificant percentage of ineffective use, it is safe to say that TT have already established as the "golden standard" of surgical patient management in modern epidemiological conditions.

Introduction. The aim of this study was to assess the possibilities and results of distance learning technologies in the system of professional training of students of a medical university during the period of coronavirus infection (COVID-19) pandemic.
Materials and methods. The article describes the experience of distance teaching in total, more than 2,500 students during the period of pandemic restrictions and full Lock Down at the Sechenov University. We use on-line lessons, video lectures, lecture presentations, methodical guidance, control tests in Russian and English, which were posted on the unified educational portal (UEP) of the University.
Results. The average number of students who attended lectures increased by 45.6%, and for practical lessons- by 16.6%, 96.9% of them positively assessed the distance learning form for knowledge, skills and abilities.
Conclusion. The use of remote learning showed the possibility for the development of theoretical knowledge without prejudice to the volume and depth of the information provided. Distance learning for medical education cannot completely replace full-time one, but it will serve as the basis for the further technologies in medical universities.

The paper analyzes the main milestones in the life and work of Professor A.A. Troyanov. Little-known facts from the life of the scientist are given. It is noted that in 1882 he defended his doctoral dissertation on the topic: «Оn the influence of extensive body burns on the animal body», which brought A.A. Troyanov wide fame. In 1883-1886, he was an assistant in the surgical clinic of Professor S.P. Kolomnin at the VMA. It is emphasized that in 1886, at the invitation of S.P. Botkin, he headed the surgical Department of the largest Obukhov hospital in St. Petersburg, which he permanently managed until 1905. The author analyzes the fact that the main scientific works of A.A. Troyanov are devoted to the problems of surgery. It is noted that in 1890, he proposed an operative method for treating varicose veins of the lower extremities — ligation and resection of a section of the large saphenous vein at its mouth (Troyanov‒ Trendelenburg method); described the symptom of venous valve insufficiency, defended the idea of the feasibility and safety of ligating large veins in their wounds; also, he was the first in Russia to perform cholecystectomy for acute perforation of the gallbladder (1896); described the original method of opening the subdiaphragmal space through a pre-isolated costal-diaphragmatic sinus (Troyanov's method); proposed a method of cystectomy. It is shown that they were offered operations for the inversion of the sigmoid colon (operation Troyanov‒Vinivarter) and two-moiety resection of the sigmoid colon (operation Troyanov‒Vinivarter‒Grekov); an original needle holder was developed. A.A. Troyanov founded the brilliant St. Petersburg surgical school, whose prominent representatives were I.I. Grekov, A.A. Kadyan, B.N. Holtsov, and others.