Paragangliomas represent 15 to 20% of all chromaffin tissue tumors. Most often, paragangliomas are located in the abdominal cavity along the large vessels — in the para-aortic region from the diaphragm to the aortic bifurcation. One of the most common extra-adrenal pheochromocytomas is the Zuckerkandl tumor, originating from the para-aortic accumulation of sympathetic tissue located in the area of the inferior mesenteric artery’s origine or in the zone of the aortic bifurcation itself. Due to the technical difficulty in performing laparoscopic removal of paragangliomas, conversion to laparotomy is frequent and reaches 80%. The article describes a clinical case of a patient suffering from this type of neoplasm, with diagnosis details and treatment by a successful radical laparoscopic intervention with a large chromaffinnoma located in a difficult anatomical zone removal.

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The aim of the study is to investigate changes in the renal topography in the supine and lateral position of the patient in order to further improve the preoperative planning of laparoscopic operations in kidney masses.Material and methods. The study included 35 patients with a simple renal cyst, who underwent computed tomography in the supine position and on the healthy side (operating position). To assess the topography, the authors have proposed the following coordinate system: on axial computed tomograms performed with the patient in the supine and lateral position, the OY axis was drawn across the spinous process and the middle of the vertebral body, the OX axis was perpendicular, and went across the most posterior point of the spinal foramen. CT-grams were assessed using RadiAnt DICOM Viewer program. Results. The study defined morphometric features of the renal displacement medially and anteriorly, as well as cranially or caudally. There was a greater mobility of the left kidney compared with the right kidney. The least mobile was the upper third of the kidney on each side, the middle third of the kidney was more mobile at the level of the hilum, and the greatest displacement was noted in the lower third of the kidney. When patients being in the lateral position, the left kidney was more often displaced downward (caudally) – in 83% of cases, the right kidney was equally often displaced cranially (53% of cases) and caudally - 47%. In all cases of the patient's lateral position, the displacement of the kidney was accompanied by deformation of its vascular pedicle. Conclusion. The data obtained must be taken into account in preoperative planning, when performing laparoscopic kidney surgery.

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Aim - to evaluate the effectiveness of minilaparotomic access under intraoperative ultrasound navigation in the surgical treatment of liquid formations in the abdominal cavity and retroperitoneal space in comparison with the puncture-draining interventions under ultrasound guidance. Material and methods. The analysis covered the treatment of 77 patients with interventions for liquid formations of the abdominal cavity and retroperitoneal space using minimally invasive ultrasound-controlled technologies. Among them, 33 patients underwent puncture-draining interventions under ultrasound navigation (I group). Group II consisted of 44 patients with minilaparotomic surgery under intraoperative ultrasound guidance. Results. It is shown that minilaparotomic access under intraoperative ultrasound navigation allows performing one-step sanitation and drainage of abdominal structures of the abdominal cavity and retroperitoneal space, containing in the lumen not only liquid, but also dense necrotic tissues. Conclusion. The process is technically feasible in any surgical hospital, economically relevant, since it does not require the purchase of additional equipment. Application of this method can significantly reduce postoperative mortality.