Aim. To justify the application of surgical access to thyroid and parathyroid glands by means of videoendoscopic equipment. Methods. 14 video-assisted surgeries on thyroid and parathyroid glands were performed during the period of 2011-2014 using low-invasive midline cervical access by means of videoendoscopic equipment. Results. The surgery was carried out with a skin access of less than 3 cm, the section was made 1.5-2 cm above than jugular notch. Tissue dissection was performed by means of «channel» formation with mobilization of tissues while looking for recurrent laryngeal nerve and parathyroid glands up to allocation of the superior pole of a thyroid gland lobe under the laparoscopic control. In case of parathyroidectomy due to adenoma special attention was paid to presurgical topical diagnostics which included neck organs ultrasound examination with the use of expert class equipment as well as thyroid and parathyroid glands scintigraphy. Intrasurgical ultrasound examination of the area of surgery to specify the pathologically changed parathyroid gland location was performed in some cases. Jugular notch of sternum, lower pole of thyroid gland, lateral surface of trachea, tracheo-oesophageal groove, and inferior thyroid artery were used as reference points for identification of recurrent laryngeal nerve and parathyroid glands while using video equipment. As a rule, the recurrent laryngeal nerve was located behind and below the parathyroid glands. The distance from a skin section to a recurrent laryngeal nerve and lower parathyroid glands was 3.6 and 3.1 cm respectively. Conclusion. Use of video endoscopic equipment allows to reduce traumatic surgeries on neck organs and promotes the better visualization of anatomical structures in an area of surgery.

The review describes perioperative complications of laparoscopic cholecystectomy. Over the past 30 years, laparoscopy has become the «gold standard» for cholecystectomy and one of the most frequently performed procedures in abdominal surgery. Nevertheless, despite the advantages of the method, it has an «Achilles heel» - the frequency of iatrogenic damage to the extrahepatic bile ducts is 3-5 times higher than with an open cholecystectomy. This complication has a negative effect on the survival of patients after surgery, leads to deterioration in the quality of life and is a major source of legal costs in many countries. In general, the total range for any damage to the biliary tract during laparoscopic cholecystectomy is 0.32-0.52%, while the complication rate and mortality rate are 1.6-5.3% and 0.08-0.14%, respectively. Patients who have undergone a complete intersection of the hepaticoholedochus, become «bile cripples» for life. Recurrent cholangitis, strictures of anastomoses with a possible outcome in liver cirrhosis are quite likely in later periods after damage to the intrahepatic bile ducts. Technological efforts to improve the results of laparoscopic cholecystectomy reside. These include the routine use of intraoperative cholangiography, infrared fluorescent cholangiography, etc. Nevertheless, despite the growing number of methods designed to reduce these complications, evidence of their effectiveness remains limited. The most important factors ensuring the safety of laparoscopic cholecystectomy are recognized: understanding of anatomy, adequate exposure when using electrosurgery, psychological readiness to invite a senior colleague in time for help, the ability to recognize a situation that requires conversion and rejection of laparoscopy.

Nowadays connective tissue disorders are considered to play a great role in abdominal hernia formation and recurrence. Benign hypermobility syndrome is associated with diffe-rent diseases of locomotive system (flat foot, scoliosis), varices of lower extremities, progressive myopia, mitral valve prolapse, tracheobronchomalacia etc. This predisposing factor favors abdominal wall debilitation, anatomical aperture’s enlargement and hernia formation. As a result, benign hypermobility syndrome hampers the post-operative scar organization even in small-sized hernias and is an important risk factor of abdominal hernia recurrence. That is why the individual choice of abdominal hernioplasty technique is justified. There is no established optimal technique of abdominal hernioplasty allowing no complications and recurrences. Thus, the understanding of morphological manifestations of tissue reaction inside the mesh endoprosthesis particularities may become of great importance to prevent abdominal hernioplasty complications. Abdominal hernioplasty technique choice is based on individual selection of endoprosthesis, depending on individual characteristics of patient’s connective tissue, abdominal hernioplasty method and endoprosthesis tendency to shrinking in late postoperative period.

Aim. To estimate the influence of anesthesia type on the inguinal hernia rate surgery complication rate, considering the hernia type. Methods. 276 patients aged 35-65 years treated for inguinal hernia (history of hernia from 3 months to 3 years) from 2007 to 2011 were analyzed. The surgery was performed using local anesthesia in 146 patients (first group) and using epidural anesthesia in 102 patients (second group); 28 patients underwent surgery using general anesthesia (third group). A combination of 4 mL 10% lidocaine, 20 mL of 7.5 mg/mL ropivacaine solution and 60 mL 0.9% saline were used for local anesthesia in patients of the first group. 2% solutions of lidocaine and ropivacaine were used for epidural or spinal anesthesia in patients of the second group. Results. Mean surgery duration was shortest at the first group - 50.5±1.2 min. Mean surgery duration at the second group was 73.2±2.2 min, 61.8±5.0 min - at the third group (р1,2 0.001, р1,3=0.003, р2,3=0.017). Mean activation terms were 4.2±0,1 hours for the patients of the first group (local anesthesia), 20.3±0.2 hours - for the patients of the second group (epidural anesthesia), 10.5±0.2 hours - for the patients of the second group (general anesthesia). Postoperative pain measured by visual analogue scale occurred at significantly shorter terms after the surgery and was more intense for the first 3 days in patients of the first group. The pain intensity elevated gradually in patients of the first group starting from the second day after the surgery, pain lasted significantly in the second and third group patients compared to the first group. Complications were registered in 15 (10.3%) of the first group patients, in 12 (11.8%) of the second group patients and in 5 (17.9%) of the third group patients (р1,2=0.836; р1,3=0.237; р2,3=0.525). Conclusion. A combination of analgesics solutions based on their pharmacologic features and two-phase vasoactivity ability has shown good analgesic effect at local anesthesia. The type of anesthesia determines the duration of surgery and the rate of post-surgical complications as a consequence.

With the help of ultrasound and NMR tomography, the diagnosis of stones in the biliary tract has improved significantly. In this regard, the number of patients who want to get rid of stones, the existence of which they did not even suspect before the examination, is growing significantly. The low trauma of laparoscopic cholecystectomy (LCE) is captivating, and there is a danger of expanding the indications for this, already quite common operation. But the removal of the organ necessary for digestion excludes the possibility of new painful disorders.