CURRENT ISSUE

ABSTRACT: Introduction: Intestinal intussusception is the most common form of acquired intestinal obstruction in childhood. Diagnostic errors reach 50%, and complications occur in up to 53.7% of cases. Pneumoirrigoscopy under fluoroscopic control (PIS) has been the standard conservative technique, but its radiation burden and single-attempt limitation prompted the development of ultrasound-guided hydroechocolonographic disinvagination (HEC). This study aimed to compare the clinical outcomes of HEC and PIS in paediatric intestinal intussusception.
Methods: A retrospective comparative study of 132 children aged 2 months to 10 years treated at the Specialized Paediatric Surgical Clinic of Samarkand State Medical University between 2000 and 2023. The control group (CG, n=59; January 2000–December 2013) received conventional PIS; the study group (SG, n=73; January 2014–December 2023) underwent ultrasound-guided HEC, a radiation-free technique developed at our institution. Primary outcomes were the rate of successful conservative reduction (assessed per patient), length of hospital stay, and mortality. Chi-squared and Student’s t-tests were used; p<0.05 was considered significant.
Results: The predominant age group was 6 months to 1 year (51.5%); males predominated (70.5%, p<0.001). The ileocaecal variant was found in 90.1% of patients. Successful conservative reduction was achieved in 53.4% (39/73) of the study group versus 39.0% (23/59) in the control group. Mean hospital stay was significantly shorter in the study group (2.5±0.66 vs 4.6±0.51 days, p<0.05). Group-specific mortality was 2.7% (2/73) in the SG versus 8.5% (5/59) in the CG.
Conclusion: Ultrasound-guided HEC is a safe, effective, and radiation-free alternative to PIS, achieving a higher rate of conservative reduction, a significantly shorter hospital stay, and enabling multiple reduction attempts. Disease duration alone should not determine treatment modality; clinical condition and the absence of peritoneal signs must be considered jointly.

ABSTRACT: Minimally invasive surgery (MIS) has become a dominant surgical paradigm over the last two decades due to its benefits such as less tissue trauma and shorter convalescence for patients. This narrative review presents the progress in MIS from conventional laparoscopic to robotic surgical interventions, highlighting advancements in technology, clinical and educational applications. Early advances in fiber-optic imaging, video-laparoscopy, and creation of corresponding surgical instruments enabled the transition from a purely diagnostic to therapeutic MIS approach and facilitated surgical innovation among many specialties. However, conventional laparoscopy is constrained by several factors, including rigidity of surgical instruments, two-dimensional imaging, and surgical ergonomics.
Recent advances in robotic-assisted surgery have sought to address several of these limitations by providing surgeons with greater dexterity, tremor filtering, motion scaling, improved three-dimensional visualization and enhanced intra-abdominal working space. Early clinical results are promising with evidence suggesting reduced postoperative morbidity in selected complex procedures, although outcomes for robotic and conventional laparoscopic approaches remain comparable for many standard operations. Moreover, MIS is influencing surgical training through the use of surgical simulation models, structured credentialing and performance-based skill assessments.
Although much has been achieved with MIS, there are barriers to its widespread adoption, namely cost and access in less well-resourced surgical environments, as well as concerns relating to equity, accountability and informed patient consent. Moving forward, incorporating emerging technologies such as artificial intelligence, augmented reality and semi-autonomous systems will be pivotal to optimizing MIS. The future of MIS lies in the provision of personalized surgical care as part of an overall vision for precision surgery.

ABSTRACT: Post-infarction ventricular septal rupture (VSR) is a rare but life-threatening mechanical complication of acute myocardial infarction (MI). We report a 52-year-old male who presented with acute inferior wall ST-elevation MI complicated by cardiogenic shock and a 12-mm apical VSR. Initial serum lactate was 4.8 mmol/L, peaking at 5.7 mmol/L preoperatively, with oliguria, progressive renal dysfunction (peak creatinine 3.0 mg/dL), and hepatic injury (peak AST 1312 U/L; ALT 965 U/L). Coronary angiography revealed 100% distal occlusion of a dominant right coronary artery. Intra-aortic balloon pump (IABP) support was initiated on admission with concurrent vasopressor therapy. Delayed surgical repair was performed on hospital day 8 following recurrent hypoperfusion despite temporary stabilization. Total IABP duration was 11 days. Postoperative echocardiography demonstrated trivial residual shunt with left ventricular ejection fraction (LVEF) of 35%. At 1-year follow-up, the patient remained asymptomatic (NYHA class I) with LVEF 40% and no clinically significant residual shunt. This case illustrates a pragmatic application of serial physiological and end-organ perfusion assessment to help individualize timing of delayed surgical repair in a patient with post-infarction VSR bridged by prolonged IABP support.