The OBJECTIVE of this work was to study the possibility of preoperative color 3D-modeling and intraoperative navigation through the use of the system «Avtoplan» in the surgical treatment of patients with pathology of the liver.MATERIAL AND METHODS. System «Avtoplan» was used in 32 patients with different surgical diseases of the liver: hemangioma, hydatid cyst, alveococcosis and metastatic colorectal cancer to assess the feasibility of the operation – resection of the liver of a particular volume.RESULTS. The performed 3D-modeling of the liver in the preoperative stage were used in 3 cases (10.3%) of 32 to abandon the planned surgical treatment in favor of conservative therapy due to local spread of the pathological process (in 2 cases – metastatic bilobate and in 1 case – alveococcosis organ damage). Of the 29 operated patients, in 6 (20.7%) at the stage of preoperative modeling, the planned volume of liver resection was changed: in 4 patients, in the direction of its increase in connection with the identified topographic and anatomic location of tumors, and in 2 patients, in the direction of its reduction due to the peculiarities of the blood supply to the zone of surgical interest.CONCLUSION. Preoperative 3D-modeling allowed the surgeon to better prepare for surgical intervention according to individual anatomical characteristics of the patient and to choose the optimal extent of surgery. Knowledge of 3D topography of liver lesions allowed reducing intraoperative blood loss and the likelihood of damage to intrahepatic structures (vessels, bile ducts). Postoperative 3D modeling allowed to assess the adequacy of the volume of surgery performed and could serve as an objective criterion in assessing the quality of medical care.The authors declare no conflict of interest.The authors confirm that they respect the rights of the people participated in the study, including obtaining informed consent when it is necessary, and the rules of treatment of animals when they are used in the study. Author Guidelines contains the detailed information.

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Aim. To assess overall survival and recurrence-free period in patients with locally advanced pancreatic cancer who underwent irreversible electroporation of the tumor in combination with chemotherapy. Matherials and methods. It was performed a prospective analysis of overall survival in 23 patients who underwent irreversible electroporation of unresectable pancreatic cancer for the period from May 2012 to March 2017. Control group consisted of 35 patients with pancreatic cancer stage III who received standard chemotherapy alone. Results. Mean age of patients was 61 years (range 45–80). All procedures were successful. Fifteen patients had pancreatic head cancer, 8 – cancer of pancreatic body. Preoperative chemotherapy has been applied in 20 (86.9%) patients for 4 months prior to surgery on the average. Seventeen (73%) patients underwent chemotherapy after electroporation procedure. 90-day mortality was 4.3% (n = 1) in electroporation group. Surgery was followed by improved local recurrence-free survival (12 and 6 months, respectively, p = 0.01) and distant recurrence-free survival (15 and 8 months, respectively, p = 0.03). Overall survival was 18 and 11 months, respectively (p = 0.03). Conclusion. Irreversible electroporation of locally advanced pancreatic cancer is safe. Four-month chemotherapy followed by surgical procedure is associated with good local response and better overall survival compared with chemotherapy alone. These data will be validated in further multicenter study.

Background: The need for simultaneous cholecystectomy for asymptomatic cholelithiasis in patients undergoing bariatric intervention has not been proven. The experience of managing patients with obesity and concomitant disease cholelithiasis is presented. Aim: to determine the indications for simultaneous cholecystectomy and bariatric surgery in the combination of morbid obesity and a asymptomatic cholelithiasis. Methods: The results of observation of 37 patients with initially asymptomatic cholelithiasis were analyzed: 27 patients underwent bariatric surgery and simultaneous cholecystectomy, and 10 patients underwent only bariatric surgery. The immediate and long-term results of the treatment, the quality of life of patients and the cost of the treatment were assessed. Results: During 12 months of the follow-up, none of the patients who underwent simultaneous cholecystectomy developed any complications. Of the 10 patients in the observation group, 3 were operated on. Two patients underwent laparoscopic cholecystectomy for acute cholecystitis and one patient was operated on for choledocholithiasis with obstructive jaundice. The greatest improvement in the quality of life was observed in the gastric bypass group with simultaneous cholecystectomy. The treatment cost per patient was lower in that group, too. Conclusion: In the presence of asymptomatic cholelithiasis in a patient with morbid obesity, bariatric intervention and simultaneous cholecystectomy prevents the development of complications of cholelithiasis and thereby potentially improves the quality of life and reduces the cost of medical care.