Operations without incisions, a reference point on the monitor, an organ for replacement. Doctors about the era of the latest technologies in modern medicine

12 Августа 2021 20923

The Grodno University Clinic is keeping pace with world surgery.

Eduard Mogilevets, chief freelance specialist in surgery of the main health department of the regional executive committee, head of the 1st Department of Surgical Diseases of the Grodno State Medical University, Candidate of Medical Sciences:

– In the Grodno region a successive three-level system of medical care for diseases of a surgical profile has been created. At the initial stage, patients who applied on their own or were delivered by ambulance are provided in polyclinics and surgical hospitals of central regional hospitals. There is a list of indications, for example, planned laparoscopic intervention for cholelithiasis, according to which patients from the region's districts are sent to interdistrict surgical centers, Grodno residents - to the city clinical hospital No. 4 and the clinical emergency hospital. Complex, high-tech and minimally invasive planned interventions, as well as operations for complicated acute surgical pathology, are carried out at the Grodno University Clinic.

It is very important for the development of Grodno surgery to organize and equip interdistrict surgical centers on the basis of the Lida, Ostrovets and Volkovysk central regional hospitals. In addition to directly modern surgical equipment, there are modern high-level ultrasound machines, computed tomographs, which greatly simplifies and speeds up the diagnosis in emergency and planned cases.

The surgeons of the interdistrict centers underwent practical on-the-job training in the vascular department of the Grodno University Clinic, and the centers themselves purchased vascular instruments. In particular, Fogarty catheters, which are used to remove blood clots from arteries. The opening of the angiographic office in Ostrovets was a landmark event. Now the surgeons of this center have the opportunity, without incisions, to stop bleeding of various localizations, to restore blood circulation in various basins in case of atherosclerotic lesions.

The development of surgery in interdistrict centers is facilitated by conducting offsite master classes on their basis with the involvement of leading specialists of the region. For example, in April of this year, the first laparoscopic splenectomy was performed in the surgical department of the Volkovysk central district hospital; in June, in Ostrovets, laparoscopic hernioplasty was performed on a patient with a hernia of the anterior abdominal wall. These are modern surgical interventions, which until now have been the prerogative of the university clinic.

It should be noted that in surgery, including in Grodno, today, figuratively speaking, the time of prosperity. The unique equipment radically changed the technology of operations, which became less traumatic, safer and, importantly, more "comfortable" for patients. More and more are becoming reconstructive, aimed at restoring or replacing the affected organ: vascular prostheses, artificial heart valves, reinforcement of hernial gates with synthetic mesh, etc. are used. Minimally invasive techniques are being developed that make it possible to minimize the area of ​​intervention in the body: mini-approaches, laparoscopic techniques, X-ray endovascular surgery.

Know-how of the main clinic

The Grodno University Clinic is keeping pace with world surgery. Even the difficult time of the pandemic did not stop the entry of innovations into the operating room.

"Quality mark" with a laparoscope

The main clinic of the region was the first to master many laparoscopic operations. Today they occupy the prevailing part in the structure of surgical interventions and are performed on the gallbladder, adrenal glands, stomach, kidneys, ureters, prostate gland, spleen. In a number of cases, Grodno surgeons become pioneers even on a national scale. The latest innovation is laparoscopic operations on the stomach and esophagus as a kind of magic wand for patients with recurrent bleeding from dilated veins of the esophagus. They began to be performed in the department of surgical pancreatology, hepatology, organ and tissue transplantation. Here, for the first time in the country, they mastered laparoscopic resection operations on the pancreas with laparoscopic restoration of the integrity of the vessels.

I must say that the pancreas and liver are especially sensitive to any surgical manipulation. To carry out them, you need the highest professional training of surgeons and modern technical equipment. In the university clinic, such operations are successfully performed, and it is the laparoscopic ones that are considered a kind of "quality mark" of surgical work.

Laparoscopic techniques are used, when several problems can be solved during one operation. For example, to carry out simultaneous removal of the spleen and gallbladder and a number of other operations.

One puncture

In April of this year, a French citizen, an Airbus pilot, was hospitalized at the university clinic. It is interesting that one of the foreign surgeons who had contact with them and knew about their successful use of such know-how as SILS operations recommended him to contact the Grodno specialists. As a result, the operation for an inguinal hernia went off, as they say, without a hitch, the foreign patient was satisfied and grateful to the Grodno surgeons.

The so-called single-access surgery - SILS-operations - was mastered in the main clinic of Grodno region last year. As the initiator of the innovation, Head of the 1st Department of Surgical Diseases of the Grodno State Medical University Eduard Mogilevets, notes, this is the next stage in the evolution of low-traumatic surgery - a cosmetic version of laparoscopic surgery. Its peculiarity is that all trocars and instruments are inserted through one puncture, usually in the navel. After such an intervention, only one barely noticeable scar remains on the patient's body. SILS is used for cholelithiasis, inguinal hernias and other diseases.

With a new kidney!

But even in the presence of ultramodern suture material and instrumentation, surgical treatment of some diseases is impossible without replacing the affected organs. In Grodno clinics, surgeries are successfully performed to replace worn joints, and an artificial lens is implanted. Seven years ago, the first kidney transplant operation was performed at the regional hospital. Today, surgeons of the Department of Surgical Pancreatology, Hepatology, Organ and Tissue Transplantation have experience in more than 250 transplants of this organ, together with nephrologists they observe patients in the postoperative period.

And other new items

X-ray endovascular surgery occupies a special niche in modern medical technologies. Through one puncture on the skin under X-ray control, surgeons get to the pathological area of ​​the blood vessel. They can expand the narrowed duct using a special metal stent, seal the damaged area, connect several ducts to each other, or glue a vessel through which blood flow supports the pathological process. The commissioning of new angiographic equipment made it possible to expand the scope of endovascular interventions.

For example, Grodno residents were the first to use the TIPS technology after the Republican Scientific and Practical Center for Organ and Tissue Transplantation. Excessive intrahepatic portosystemic bypass grafting - such a complex name bears no less complex, minimally invasive, high-tech endovascular technology to create an artificial canal in the liver, which ensures the outflow of blood from the portal vein into the inferior vena cava, bypassing the affected liver tissue.

In collaboration with the specialists of the angiography office, surgeons of the vascular department work. In practice, for example, restorative operations on the vessels of the lower extremities and vessels that provide nutrition to the brain. By the way, for the first time in the region, an aorta transplant was performed - a large vessel in the human body.

Personal stories

Vitaly Guzen, surgeon of the Grodno city clinical hospital №4: "I work alongside mentors, eminent representatives of the Grodno surgical school"

– After graduating from medical university, I was lucky to undergo an internship in the fourth hospital. That was ten years ago, and even then she was famous for her surgery. The regional gynecological center, the city center of gastroduodenal bleeding - here, figuratively speaking, there was aerobatics of surgical care, modern technology was used and medical know-how was introduced. Of course, a novice surgeon dreamed of working in just such a medical institution. The dream came true two years later, during which he worked as a surgeon in Slonim. I must say that working in a district hospital is a kind of school, especially the ability to act in emergency situations. Already on the second watch, for example, he independently performed gastric resection.

Today, in the "four" I work alongside my former university mentors, eminent representatives of the Grodno surgical school - Pyotr Vasilyevich Gorelik, Gennady Grigorievich Marmysh, Olga Ilinichna Dubrovshchik. For me, they are an example of constant professional development. It cannot be otherwise, because surgery is developing at a very fast pace. The fact that our hospital is keeping pace with the times can be judged by the introduction of new techniques and the equipment that appears in operating rooms. I know the latter for certain, since I am responsible for the operation of the operational unit. Six operating rooms with modern and laparoscopic stands and other surgical instruments should work like a clock. And to ensure that all the "stuffing" here was the last word, great attention is paid to the hospital management and personally the chief physician Alexander Nikolayevich Surov.

Vyacheslav Karpovich, head of the surgical department of the Grodno University Clinic: "The scalpel is often not needed, we work as a laparoscope"

– I have almost a quarter of a century of surgical practice in the main hospital of the region. I not only saw the progress in the operating room with my own eyes, but also worked for it, introducing the most modern methods and technologies into practice.

When I graduated from the medical institute, laparoscopy was just being mastered. I still remember how worried I was when I, a young specialist, was entrusted with such an operation. Assisted by Natalya Dmitrievna Maslakova, daughter of the then rector of our university, associate professor of the Department of Surgery. She and the head of the department, Nikolai Ivanovich Rusin, are actually pioneers in sparing surgery in our region.

Honestly, as a student, until I came to the operating room of the regional hospital, I could hardly imagine operations that require not large incisions, but only a few miniature punctures on the skin. And how does the surgeon perform actions without touching the wound or the affected organ with his hands, but only looking at the monitor screen. Already in the hospital, it was impressive that an hour or two after a seemingly difficult operation, the patient was on his feet, and after a day or two he was on discharge. Today it is a matter of course, three quarters of the operations in our department are laparoscopic and minimally invasive.

Four years ago, a regional hernia surgery center was established on the basis of the department. We have mastered all the surgical methods of treating patients with this most frequent general surgical pathology, accepted in the world practice, including laparoscopic options. They used the experience, fortunately there was an opportunity to learn it in practice from foreign specialists.

Viktor Martinovich, head of the surgical department of the Ostrovets Central Regional Hospital: "Modern technologies are coming to the regions"

– When, after graduating from a medical university, I was choosing where to go according to distribution, the Belarusian NPP was just beginning to be built. But the prospects of Ostrovets to become a city of nuclear scientists sounded rather tempting. Now I understand that I was not mistaken in my choice. My wife is also a doctor, and such specialists are needed in a young, rapidly growing city.

Nuclear plant gave impetus to the development of all spheres, including medical. Today the Ostrovets CRH is a vivid example of a supporting clinic with modern equipment and high-quality medical staff. Not only new buildings have been built, but a powerful diagnostic and therapeutic interregional medical center has been created. The clinic has an angiograph, computer and magnetic resonance tomographs, X-ray equipment and other modern equipment.

We have received the latest laparoscopic stand in the operating room and are undertaking such surgical interventions, the implementation of which until recently was possible only on the basis of large medical institutions of the regional center and the capital. For example, we perform plastic surgery for umbilical hernias, apply a gastrostomy tube for tumors of the esophagus, suture an ulcer. Ureteral stenting operations were mastered among the first in the field. Previously, our people and residents of neighboring districts traveled to Grodno for such help, now everyone turns to us. I have no doubt that the status of an interdistrict center will give a new impetus to the development of Ostrovets surgery. Acceleration is also given by the experience shared with us by regional specialists who come and conduct master classes.
Текст: Гродненская правда.Гродненская правда.