Arterial upper gastrointestinal bleeding (UGIB) remains a major clinical challenge due to high rates of rebleeding even after technically successful endoscopic hemostasis. A systematic analysis of 60 contemporary publications shows that transcatheter arterial embolization (TAE) has evolved from a rescue intervention into an integral component of multidisciplinary strategies aimed at achieving durable hemostasis. Indications and contraindications for endovascular treatment are summarized, and an algorithm for embolic agent selection is proposed based on vessel caliber, anatomic variability, and pathologic remodeling of the celiac and mesenteric arterial systems. Prophylactic embolization in patients who achieve primary endoscopic hemostasis but meet high-risk criteria for rebleeding significantly reduces recurrent hemorrhage and in-hospital mortality compared with endoscopic therapy alone. In cases of refractory bleeding, TAE demonstrates high clinical efficacy and offers an organ-preserving alternative to surgery, particularly in patients with elevated operative risk. The accumulated evidence supports the incorporation of preventive embolization into clinical protocols for this patient population.

Introduction. This article presents a rare vascular complication that developed after cranioplasty. Aim. This study aims to describe the successful surgical treatment of a superficial temporal artery (STA) aneurysm that arose as a complication of cranioplasty. Materials and methods . A 60-year-old patient developed a painful, pulsatile 5-cm STA aneurysm one month after evacuation of an intracerebral hematoma followed by cranioplasty. The diagnosis was confirmed by computed tomography angiography (CTA). Emergency open aneurysmectomy was performed under endotracheal anesthesia, with arterial ligation and resection of the aneurysmal sac. Results and discussion . The postoperative course was uneventful, and the patient was discharged on postoperative day 7. Aneurysm formation was attributed to intraoperative arterial injury during the preceding procedure. This complication is exceedingly rare. Severe pain and the risk of rupture constituted clear indications for urgent open surgery, despite the theoretical feasibility of endovascular treatment. Conclusion . Open surgical resection of a superficial temporal artery aneurysm proved to be an effective and safe treatment for this rare complication of cranioplasty.

Introduction. Cutaneous melanoma is an aggressive malignant tumor of neuroectodermal origin. According to statistics, most patients begin treatment at stages 2 and 3 of the disease. This worsens the prognosis and determines the need for expanding the scope of surgical treatment. Aim: To improve the outcomes of lymphatic surgery in patients with cutaneous melanoma. Materials and methods. A total of 190 medical records of cutaneous melanoma patients is analyzed. The feasibility of escalation and de-escalation of interventions is statistically assessed. The formed prospective sample includes 43 stage 3 patients subjected to surgery by intraoperative lymphorrhea-preventing methods. Results and discussion. Prophylactic lymphadenectomy appears nonoptimal since most patients have no evidence of lymph node involvement at the time of surgery. Refusal to perform an extended intervention scarcely ever meet the requirements of oncological safety. Of 43 patients with metastatic lymph node involvement, 25 persons had involvement of only one lymph node; two or more lymph nodes were involved in 18 patients. If lymphadenectomy is not performed, a high risk of recurrence is possible in 41% of patients. Patients with stage 1 cutaneous melanoma observe a low percentage of both lymph collector damage and regional metastasis in the distant period. Stage 3 patients have an increased risk of postoperative adverse events. Sealing of lymphatic vessels, careful treatment of surrounding structures, as well as the use of optical magnification show good results in the prevention of postoperative lymphorrhea to reduce the risk of other complications. Conclusion. The type of surgical intervention in patients with cutaneous melanoma should be based on prognose analysis, considered in accordance with possible risks and, if necessary, supplemented by the use of means to prevent complications.

Introduction. Surgical staging is an essential component of breast cancer treatment. Sentinel lymph node biopsy (SLNB) can be used to exclude or confirm metastatic involvement of lymphatic collectors. Despite minimal invasiveness of this procedure, surgeons still encounter adverse events in the postoperative period. The aim of this study was to explore ways of reducing the risk of postoperative complications after minimally invasive interventions on the lymphatic system. Materials and methods . We analyzed the medical records of 114 patients who underwent SLNB. The incidence of post‑operative complications was assessed in patient groups stratified by the number of excised lymph nodes. Based on prior experience in managing lymphorrhea, a subgroup of 28 patients was formed, in whom SLNB was performed with optical magnification, a double coagulation technique, and gentle principles of electrosurgery. Results and discussion . Reducing the number of excised nodes decreased the likelihood of complications, including seroma formation. Dividing patients into subgroups according to the number of removed lymph nodes revealed cases of metastatic spread to more collectors than the method could resolve. Taking this into account, the issue of abandoning lymph node dissection in the presence of sentinel node metastasis necessitates excision of at least two lymph nodes, with three excised nodes being considered optimal. Surgical interventions performed in accordance with these principles and using the described techniques were associated with lower risks of complications. Conclusion . The development of new technical solutions in surgical practice is very promising in improving patients’ quality of life. However, de-escalation of surgical management must be consistent and safe; otherwise, all the advantages of a well-performed operation are negated by excessive oncological risk.

Introduction. Papillary thyroid carcinomas (PTC) are considered relatively common occult and incidental findings, with generally good prognosis and favorable outcome. Despite this, metastases to the central lymph nodes (CLN) occur frequently and are associated with adverse consequences and prognosis for patients. The aim of the present study was to assess the frequency of central lymph node metastases in patients with papillary thyroid carcinoma staged as pT1a over a 10-year period, and to identify possible risk factors associated with the presence of CLN metastases. Materials and methods. A retrospective cohort study was conducted at the Interterritorial Endocrine Surgery Center, Krasnodar. Between January 2010 and January 2022, thyroidectomy was performed in 3013 patients. A total of 2818 patients were excluded from the study following thyroidectomy due to final benign histological findings, age under 18 years, follicular, medullary, anaplastic carcinoma, mixed-type thyroid carcinoma, tumor size > 1 cm, and stages pT1b–pT4. The analysis included 195 patients with pT1a papillary thyroid carcinoma. All patients underwent thyroidectomy and prophylactic or therapeutic standardized lymph node dissection. Results and discussion. Multivariate analysis demonstrated that central lymph node metastases were present in a significant number of cases in patients with PTC after organ preservation surgery. Therefore, in order to choose the most effective surgical treatment, careful preoperative evaluation is warranted for patients without confirmed lymph node metastases (N0). Conclusion. The results of our study indicate that CLN metastases are present in a considerable proportion of patients with PTC after thyroid resection. Combining these findings with preoperative ultrasonography may assist clinicians in accurately assessing whether CLN metastases are present in patients with PTC, thereby facilitating appropriate surgical planning for each individual patient.

Introduction. This article presents the study of 110 female patients diagnosed with stage 0 breast cancer conducted at the P. Hertsen Moscow Oncology Research Institute between 2023 and 2024. Materials and methods . By histological type, ductal carcinoma in situ (Tis, DCIS) predominated in 100/110 cases (90.9%), followed by Paget’s disease (Tis, Paget) in 7/110 (6.4%), and lobular carcinoma in situ (Tis, LCIS) in 3/110 (2.7%). Mastectomy was performed in 17 patients (15.5%), skin-sparing mastectomy with reconstruction in 44 (40%), and breast-conserving surgery in 49 (44.5%). Results . According to routine histological examination, progression of DCIS was identified in 42/110 patients (38.2%). Among them, stage I breast cancer was diagnosed in 33.6% and stage II in 4.5%. In routine morphological examination, positive resection margins (R1) were detected in 15 patients (13.6%). Discussion . Breast MRI in non-invasive breast cancer is an essential procedure for determining disease extent, assessing multifocality or multicentricity, and thus guiding the decision on breast-conserving surgery versus mastectomy. Another important issue is the need to evaluate sentinel lymph nodes in cases of non-invasive breast cancer. Conclusion . Local recurrences of breast cancer in the analyzed group were diagnosed in 2 patients (1.8 ± 1.6%). Progression of stage 0 breast cancer to higher stages, i.e., cTis → pT+, was observed in 42/110 patients (38.2%). Despite the extent of disease (mean size of carcinoma in situ was 42 mm), breastconserving surgery or nipple-/skin-sparing mastectomy with reconstruction were performed in 93% of cases. Thus, carcinoma in situ may progress to higher stages in about 40% of patients. The role of diagnostic methods in assessing breast cancer stage is therefore crucial for selecting an optimal surgical management.

In Russia, breast cancer is the most prevalent oncological pathology among female patients, accounting for approximately 22.5% of all cancer cases. Approximately 90% of mortalities associated with this condition are attributed to the metastasis of cancer cells. Consequently, the effective detection of metastases within the regional lymphatic system during breast tumor progression is a critical diagnostic component. In recent decades, methodologies for verifying metastatic regional lymph nodes in breast cancer patients have advanced significantly, demonstrating high efficacy. The identification of sentinel lymph nodes became feasible through the use of various dyes, radioisotopes, and superparamagnetic nanoparticles. Detection techniques for metastatically affected formations include radioisotope lymphoscintigraphy, single-photon emission computed tomography (SPECT) often in combination with computed tomography (CT), and positron emission tomography (PET) typically integrated with CT. The accumulated data enabled an assessment of the advantages and limitations of current diagnostic methods. Radioisotope lymphoscintigraphy offers minimal invasiveness, high accuracy, and a low risk of complications; however, it remains insufficiently safe and cost-prohibitive. The application of superparamagnetic nanoparticles exerts negligible adverse effects on the human body and is characterized by straightforward administration. However, this method remains understudied, with its implementation being limited. Although the SPECT in combination with CT offers high sensitivity, thereby facilitating precise sentinel lymph node localization, it is associated with. exposure to ionizing radiation for the patient and the associated high procedural costs. Published data confirm the significance and efficacy of modern techniques for verifying metastatic regional lymph nodes in breast cancer. Therefore, the optimal diagnostic approaches can be selected, while reducing the invasiveness of mastectomy and lymph node dissection, improving survival rates, and decreasing the probability of recurrence or cancer progression.

Introduction. One of the main goals in the treatment of thrombophlebitis of saphenous veins is to separate the superficial veins from the deep ones at the sites of the most frequent transition of thrombotic masses. At the same time, the implementation of endovenous treatment methods for thrombophlebitis lacks an evidence base regulating all aspects of this procedure. Aim. This study aims to increase the effectiveness of endovenous laser coagulation for patients with varicose complicated by declined thrombophlebitis of subcutaneous veins. To that end, a modified technique of endovenous laser coagulation of the great saphenous vein was developed and implemented in clinical practice at Bashmedcenter LLC. This modified surgical intervention aims to reduce the economic costs of performing the procedure, shorten surgery duration, and improve the cosmetic result and the quality of patients’ lives. The procedure of the operation was patented, and the patent for invention No. RU 2827090 C1 was issued.Materials and methods. From 01.01.2022 to 31.12.2022, 50 patients with varicose of the lower extremities and moderate-risk thrombophlebitis of the great saphenous vein underwent endovenous laser coagulation in Bashmedcenter LLC. The examined patients were divided into a control group (34 patients) and a comparison group (16 patients). All patients underwent an assessment of the quality of life before and after surgery using a visual analog scale (VAS). A primary economic assessment of the costs for surgical intervention in patients with standard and modified endovenous laser coagulations was also performed.Results and discussion. Before surgery, no statistically significant difference in quality of life between the two groups was observed. After surgery, positive clinical and aesthetic results were obtained in the group of modified endovenous laser coagulation. An economic evaluation of the costs for surgical treatment and measurement of the laser-coagulation duration were performed, which showed the advantage of the modified technique. According to statistics, patients who underwent a modified technique of endovenous laser coagulation of the great saphenous vein showed a significantly better quality of life at follow-up examinations on days 7, 30, and 90 after surgery.Conclusion. The data obtained during the comparative analysis of treatment results showed the effectiveness of a modified technique of endovenous laser coagulation of the great saphenous vein in patients with varicose and declined moderate-risk thrombophlebitis, which is proved by a higher quality of life, better clinical outcome, and shorter surgery duration.

Introduction. Urinary incontinence is an urgent problem in urogynecology and the number of patients with this pathology is steadily increasing. The main treatment method of urinary incontinence in women includes synthetic suburethral slings. Currently, more than 200 operations for stress urinary incontinence are carried out. One of the methods of surgical treatment of this pathology implies Burch colposuspension, which has been considered the gold standard treatment of stress urinary incontinence for recent decades. Aim. This study aims to describe a clinical case of using an alloplant in a robotic-assisted Burch operation for urinary incontinence.Materials and methods. A 48-year-old patient was admitted to the BSMU Clinic in a planned manner with complaints of urinary incontinence during coughing, sneezing, and physical exertions as well as of a feeling of a foreign body in the vagina. The examination results confirmed a diagnosis of stress urinary incontinence. Comorbidities: Pelvic floor weakness. 2–3 degrees omission of the anterior vaginal wall. Cystocele. POP-Q 2. It was decided to perform a robotic-assisted Burch operation using an alloplant.Results and discussion. The postoperative period proceeded without complications. A Foley’s catheter was removed on the first day. After its removal, natural urination was restored. The stitches were removed on the fifth day. The wound healed by primary intention healing. Urine was retained well during functional tests. On the 7th and 30th days, magnetic resonance imaging (MRI) revealed no inflammatory processes at the fixation site of the allograft. The allograft was retained, its integrity was preserved, and no pathology was detected. Patient examination at a distant time after surgery (2, 4, and 12 months) revealed that the function of the bladder to hold urine was preserved.Conclusion. Robotic colposuspension using an alloplant is safe and can significantly improve quality of life indicators. The main advantages of this operation include the absence of allograft deformation and disease recurrence during patient examination as well as slighter injuries to the paraurethral tissues assisting the bladder in holding urine.

Introduction. Minimally invasive direct coronary artery bypass (MIDCAB) of the anterior descending artery provides a means to avoid artificial circulation and full sternotomy, reducing the risks of associated complications. Aim. To evaluate the short-term results of MIDCAB.Materials and methods. The retrospective study included a total of 172 patients (132 men and 40 women) who underwent surgery in 2017–2022. The mean age was 60.83 ± 8.36 years, and the BMI was 28.7 (25.8–32.3) kg/m2. The left ventricular ejection fraction amounted to 55 (49–59)%. Diabetes mellitus was diagnosed in 27.9% of patients, and atrial fibrillation was identified in 15.1% of patients. The medical history of patients included stroke (4.7%), percutaneous coronary intervention (PCI, 25.6%), and myocardial infarction (60.5%). The endpoints were in-hospital mortality and postoperative complications.Results. Hybrid interventions (MIDCAB + PCI) were performed in 4.7% of patients. The surgery took 112(90–130) minutes. Perioperative myocardial infarction and acute kidney injury occurred in 1.2% of patients. No strokes were observed. Atrial fibrillation was diagnosed in 13.4% of patients; reexploration for bleeding occurred in 2.9% of cases; postoperative wound suppuration was observed in 0.6% of patients. The in-hospital mortality amounted to 0.6%. The length of ICU stay was 22 (18–24) hours, and the inpatient stay lasted 9 (8–11) days.Discussion. MIDCAB shows good short-term results, combining the advantages of minimally invasive access and standard bypass surgery.Conclusion. MIDCAB is an effective technique to achieve revascularization of the anterior descending artery that ensures low mortality and complication rates.