percutaneous therapeutic interventions under X-ray control were performed in patients with exudative complications. Results: Sensitivity, specificity and diagnostic accuracy of ultrasound imaging were respectively 84.7%, 73.4% and 78.8%. Sensitivity, specificity and diagnostic efficiency of cytological and microbiological examination of our data were, respectively, 86.9%, 95.2% and 91.6%. 737 miniinvasive percutaneous interventions were hold totaly. The implementation of miniinvasive percutaneous interventions helped to stop the disease process and to avoid open surgical procedures in 91.7% of cases. Conclusion: Fine-needle diagnostic puncture is a highly informative method for diagnosis of the nature and details of tissue damage and pathological process phase. The timely refining ultrasound diagnosis of various clinical and morphological forms of acute pancreatitis combined with diagnostic fine-needle puncture conducting allows to approach differentiately to the implementation of miniinvasive percutaneous interventions and to justify a strategic position in the surgical treatment of destructive pancreatitis.

This worldwide survey showed that most participating HPB surgeons value MIPR as a useful development, especially for MIDP, but the role and implementation of MIPD requires further assessment. Most HPB surgeons would welcome specific training in MIPR and the establishment of an international registry.

Background: The introduction of minimally invasive pancreatic resection (MIPR) into surgical practice has been slow and the worldwide utilization and attitudes towards MIPR remain unknown. Methods: We developed an anonymous online survey (61 questions) in order to gain knowledge on opinions and use of both, laparoscopic and robot-assisted pancreatic resections. The survey was sent to all surgeon members of the 6 largest hepato-pancreato-biliary associations. Results: In total, 435 surgeons from 50 countries completed the survey. Responders performed a median of 22(IQR:0-450) pancreatic resections as primary surgeon

Background: Distal pancreatectomy with celiac artery resection (DPCAR) is in use for borderline-resectable pancreatic cancer. It is believed that considerable reduction of the liver arterial supply after DPCAR may cause severe liver ischemia. Although the artery reconstruction is not a problem anymore the decision to reconstruct artery has to be justified. To study liver collateral arterial supply after temporary CHA, right gastroepiploic and accessory/ replaced left hepatic arteries (a/rLHA). Methods: Arterial anatomy, diameters of CHA, proper hepatic (PHA), gastroduodenal(GDA) and pancreatoduodenal arteries(PDA) were registered before surgery in 110 consecutive patients with pancreatic body/tail cancer(n35), gastric cancer with pancreatic involvementn30) and liver tumors(n45)by CT. For DPCAR(n20) these data were obtained after surgery as well. Diameters of peripancreatic arteries and mean systolic blood velocity in hepatic arteries before and after CHA clamping were measured intraoperatively by Doppler ultrasound. Results: Pulse disappeared in 19 (17 %) cases after clamping of CHA,RGEA and aLHA/rLPA. Collateral arterial blood flow in the liver parenchyma was revealed in all cases. DPCAR led to increase of GDA, rRHA, PDA and RGEA blood flow in 0,9-12 times. Conclusion: Doppler ultrasound is a reliable modality for intraoperative assessment of liver arterial blood supply after DPCAR; Hepatic artery reconstruction may be necessary after DPCAR in case of disappearance of arterial US signal upon the liver parenchyma.

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