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Despite the difficult situation in health care, more and more complex operations, including oncological ones, are performed in Ukraine. The idea that highly qualified care is available only abroad for big money is successfully refuted by the University Clinic of Odessa National Medical University. Every year new equipment appears here, which has no analogues in many Ukrainian and world clinics. During the excursion organized for us by the head of the department of surgery №3 ONMedU, doctor of medical sciences, professor, Honored Doctor of Ukraine Oleksandr Tkachenko, he acquaints us with modern achievements of surgical technologies not without pride.
Minor traumatic surgery
The ultrasonic destructor Sonoca 300 is the first to meet us in the clinic. Professor Oleksandr Tkachenko talks about the device. A unique device for Ukraine and even for the world surgery. It guarantees a high degree of tissue fragmentation and selectivity, which ensures the reliability of preparation with a low level of blood loss. The device is indispensable during operations on the liver and soft tissues. The special nozzle delivers liquid under very high pressure, optimum irrigation and effective aspiration improve visibility of the operated bodies. The flow of the solution allows purposeful dissection of the affected tissues, separating them from healthy ones. A 35-year-old woman has recently been operated on at the clinic. A giant desmoid tumor in the anterior chest wall, which grew into the brachial plexus, enveloped the subclavian artery, vein, with invasion into the chest. Thanks to this device it was possible to carry out radical dissection with the minimum trauma: with preservation of nervous and vascular structures, a costal framework. This made it possible to return the patient to normal life in a few days, – says Alexander Tkachenko.
An abandoned stage of cancer is not a verdict
We stop for a long time at the device for hyperthermic chemoperfusion of the abdominal organs and vessels of the limbs Performer HT. Oleksandr Tkachenko says that this device appeared in our clinic in 2016 and was the first in Ukraine. It is an indispensable assistant to the surgeon and the hope of patients with widespread abdominal tumors. Prior to the introduction of such technologies, such patients had no chance of recovery and were considered hopeless.
“A small tumor is usually easy to remove. But there are tumors that go far beyond one anatomical area. Inside the abdominal cavity, tumors sometimes grow to neighboring organs and spread along the peritoneum throughout the cavity. This is called carcinoma. This nature of metastasis is characteristic of cancer of the colon, stomach, ovaries. We have mastered the modern concept of treatment of common tumors of the abdominal cavity and pelvis – a combination of cytoreductive surgery and intra-abdominal chemoperfusion, “- explains Alexander Tkachenko.
“Simply put, after the visible tumor masses are removed, the microscopic residual harmful cells are washed out with a hot solution of chemotherapeutics for an hour and a half. This is how abandoned stages of cancer that were previously considered inoperable and incurable are treated. ”
An alternative to limb amputation
The second application of the Performer HT device is malignant tumors of the skin and soft tissues of the extremities. On the arms and legs, such tumors grow unnoticed by the patient, but very aggressively. They grow and “eat” into important anatomical structures, such as the sciatic nerve. To remove such a tumor without disturbing the functions of the limb is extremely problematic. Previously, the only radical method of treatment was amputation. Performer HT helps to solve the problem of limb preservation. At the time of the procedure, the affected limb is isolated from the systemic circulation with its help. An aggressive chemotherapy for chemoperfusion is administered through an artery. The drug washes the affected areas of the limb without getting into the general bloodstream: the liver, kidneys, heart and other vital organs.
“The drug kills only the tumor. We have a unique experience for domestic medicine. We operated on 18 patients with melanoma of the skin, with sarcomas of the lower extremities, which could not be operated on in the traditional way. We are amazed by the effect: from tumor reduction by 60−70% to complete disappearance. This makes it possible to perform less traumatic organ-sparing surgery, preserve the limb and its function, ensure quality of life and increase the survival of such patients.
This device is a unique opportunity for our students and doctors to touch the super-technologies, because today in Ukraine, except for us, no one has this method. There are only a few centers in Europe that deal with such revolutionary methods of treating malignant tumors, ”explains Oleksandr Tkachenko.
Surgery has changed a lot in recent decades. Now doctors are taking on those clinical situations in which patients with the last stages of the disease were previously forced to refuse. They refused because they could not guarantee a safe operation with the restoration of functionality. They could not guarantee that the patient would live at least a month after the operation. Today, with the development of combined treatment methods and innovative equipment, this has become possible even in Ukraine. We teach students with the formation of competence in the use of such modern technologies, conduct cycles of thematic improvement for practitioners who want to improve their skills.
X-ray technology in the operating room
With the help of video communication from the operating room, we observe the operation to restore patency of the femoral vessels affected by atherosclerosis. With this pathology, oxygen and nutrients do not enter the tissues of the foot, threatening gangrene and amputation.
Endovascular surgery is a modern high-tech method of treating vascular pathology of any localization within the perspective concept of “minimally invasive interventions”, which allows to restore blood flow through the vessels without performing a skin incision. A special stent is inserted into the vessel through a puncture of the skin, which allows to ensure blood circulation and save the leg. Above the patient there is an X-ray electron-optical transducer. It translates X-ray images into optical format, it allows you to simulate the clinical situation in real time and respond quickly to changes in blood vessels. It is impossible to perform such an operation without X-ray control. This allows you to combine this minimally invasive technique with an open surgery, which significantly reduces the trauma of the operation and accelerates the rehabilitation of patients in the postoperative period. Such hybrid operations are currently performed in the south of Ukraine only in our clinic. Students and trainees studying at Odessa National Medical University have the opportunity to study modern methods of treatment of vascular pathology.
Fluorescent technologies
Fluoptics is another innovation of modern surgery. Technology has appeared in the world relatively recently. Odessa Medical University purchased such a device for the university clinic to optimize the educational and treatment process. Its main task is to identify lymph nodes affected by metastases. It is most often used for tumors of the skin, breast and other localizations. Such a lesion can be recognized by ultrasound, but if the metastasis is microscopic, it is impossible to detect in time. The technology is as follows: a special contrast that glows in the infrared beam is injected into the affected area. If the doctor sees a glow – the lymph node is affected.
“We can remove it and use microscopic examination to find out if there are metastases or not. The result determines the prognosis and tactics of further treatment. The equipment is unique for Ukraine and the world. The ability to touch such technology is the dream of every modern oncologist. At Odessa Medical University, all students and trainees have this opportunity, ”explains Oleksandr Tkachenko.
Neuromonitoring
He says that the real quest for a surgeon is to operate on tumors located near functionally important nerves. For example, the thyroid gland, on the back of which passes a nerve that provides the work of the vocal cords. Its damage can disrupt the patient’s speech and even breathing. Neuromonitoring makes it possible to operate safely.
“During the operation, we connect a special device, use probes, look for a nerve that passes through the area of interest to us. If we are close to a nerve, a beep sounds indicating that we are operating in a danger zone. Visualization of nerve structures in surgery avoids formidable complications. Safety is the most important trend in surgery. We must not only perform the operation, but also ensure the quality of life of the patient, “Oleksandr Tkachenko emphasizes.
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