Vol 15, No 1 (2025)

BACKGROUND: In Russian pediatrics, a critical role is played by medical care for children in life-threatening conditions, ensuring consultations (including remote consultations), patient monitoring, and medical evacuation to specialized hospitals. The concept of the resuscitation and consultation center (RCC) was first developed by the Leningrad school of scientists in 1980. Over the following years, the system expanded and evolved, albeit without adequate regulatory and legal support.

AIM: To determine the current organizational and clinical models for providing consultation assistance, including remote consultations, to children in critical conditions, as well as for their medical evacuation. The study also aims to identify trends in the development of this field across Russian regions and to justify prospective measures for improving specialized emergency and urgent medical care.

MATERIALS AND METHODS: The study design is an observational retrospective study. Information was gathered from analytical reports prepared by the Association of Children’s Hospitals from 2011 to 2023. An expert evaluation method was applied based on a report analysis of pediatric hospital directors from 74 regions of Russia regarding the activities of the medical institutions they lead from 2021 to 2023. A total of 59 responses were collected. Additionally, state and departmental regulations were reviewed in terms of their compliance with hospitals’ responsibilities in providing consultation assistance and medical evacuation for children. The dataset was analyzed using descriptive statistics.

RESULTS: Between 2021 and 2023, consultation assistance and medical evacuations were provided to 120,477 children. The distribution of organizational forms was as follows: resuscitation and consultation centers 60.9%; emergency medical consultation departments of adult hospitals 6.7%; regional disaster medicine and emergency medical services centers 5.0%; mobile medical teams of pediatric hospitals 3.7%; and other medical service divisions 23.7%. More than 10 different names were used for divisions performing similar functions, indicating a lack of unified terminology and a standardized approach to organizing and providing consultation assistance (including remote consultations) and medical evacuation for children. The frequency of using the abbreviation RCC for pediatric hospital divisions declined from 44 hospitals in 2006 to 18 in 2023 due to the absence of a regulatory framework.

CONCLUSIONS: The study substantiates the need to establish a dedicated medical service division within multidisciplinary pediatric hospitals named the Department of emergency consultation and medical evacuation.

BACKGROUND: Skin injuries associated with the adhesive components of medical dressings compromise the barrier function of the skin, delay wound healing, increase the risk of infection, and may cause pain and stress in patients. Evaluation of such injuries is important due to the frequent use of these dressings in clinical practice.

AIM: To compare the use of dressings with silicone wound contact layer and medical adhesive dressings in pediatric surgery.

MATERIALS AND METHODS: The study included 100 pediatric patients aged 5 to 17 years who underwent surgery for uncomplicated acute appendicitis. Dressings were applied to wounds following minimally invasive laparoscopic access. The study was designed as a prospective, single-center, randomized trial. Patients were randomly assigned using the sealed envelope method into two groups. Group 1 (main group, n=50; mean age, 10.9±2.9 years) received a silicone-based dressing (Cosmopor® Silicone, Paul Hartmann, Germany), whereas group 2 (control group, n=50; mean age, 8.6±3.1 years) received a dressing with medical adhesive (Cosmopor® E Steril, Paul Hartmann, Germany). Skin integrity was assessed both macroscopically and via dermatoscopy at four sites daily over a 7-day period. Skin damage severity was quantified using a mathematical model that accounted for the number of adhesive removals and the surface area of damaged skin.

RESULTS: By postoperative day 7, the incidence of skin damage in group 2 was nine times higher than in the group treated with silicone-coated dressings (36% vs 4%, p =0.001). The average pain score in the control group was 6 points. Dressing changes in the main group were associated with significantly lower pain scores, averaging 1.7 points—3.5 times lower than in the control group (p <0.001). Pre-dressing anxiety levels in group 2 remained high (8.5–6.9 points) throughout hospitalization, while in group 1 they did not exceed 3 points from postoperative day 4 onward.

CONCLUSIONS: The use of silicone-based dressings significantly reduced skin trauma in the postoperative wound area. Pain intensity was 3.5 times lower with silicone dressings compared to adhesive dressings, which also helped minimize pre-procedural anxiety.

Robot-assisted surgery has emerged as the most transformative technological advancement in this field of medicine over the past two decades. Since the U.S. Food and Drug Administration (FDA) approved the da Vinci robotic surgical system (Intuitive Surgical, Sunnyvale, California, USA) in 2000, it has revolutionized minimally invasive surgery by shortening the learning curve and facilitating reconstructive steps in many procedures compared to conventional laparoscopy. Today, the da Vinci system accounts for approximately 80% of the global surgical robotics market. However, its high acquisition and maintenance costs remain a significant barrier for many hospitals, including those in the United States. As many of the original patents filed by Intuitive Surgical have reached their 20-year expiration, opportunities have arisen for the development of alternative systems. In addition to cost, common criticisms of the da Vinci system include limited communication between the surgeon and the operating team due to the closed-console design, lack of haptic feedback, rigid arm positioning, and the large physical footprint of the platform. Over the past decade, several new robotic systems have been introduced, some of which have been approved for clinical use. Each of these platforms incorporates key innovations aimed at addressing the technical and economic limitations of the da Vinci system. The entry of these systems into the market has effectively ended Intuitive Surgical’s monopoly. Although none of them is currently available worldwide, platforms such as Senhance, Versius, and Hugo RAS have gained traction primarily in Europe, whereas others—such as the KangDuo surgical robot, Toumai, Revo-I, and Hinotori—are used in China, South Korea, and Japan. Comparative evaluation of these systems against the da Vinci must account for several factors. Since its initial launch in 2000, five generations of the system have been developed: the original 2000 model, S, Si, Xi, and the fifth-generation model. Most of the systems reviewed here are still in their first generation and are expected to undergo further improvements and refinement. This review provides an overview of both well-established and emerging robotic surgical platforms, their distinct design features, clinical applications, and surgical outcomes. It covers widely used systems such as da Vinci, Senhance, Versius, and Hugo RAS, as well as less extensively reported platforms including Revo-I, Avatera, KangDuo, Hinotori, Dexter, and Chinese alternatives to the da Vinci system, notably the first domestically developed Chinese surgical robot, Toumai.

The efficacy and safety of intravesical ureteral reimplantation in children have been demonstrated in an extensive clinical data, widely reported in the literature over the past two decades. However, its widespread adoption remains limited due to significant technological challenges, primarily the need to operate within an extremely confined space inside the bladder and the non-ergonomic positioning required for the surgeon. Robotic-assisted surgery may help overcome these limitations by improving both the learning curve and surgical ergonomics. This article presents our first experience with robot-assisted intravesical ureteral reimplantation using the da Vinci Xi system in a 13-year-old girl with vesicoureteral reflux and recurrent urinary tract infections. A Cohen ureteroneocystostomy was successfully completed without conversion and with no intraoperative complications. The total operative time was 160 minutes, with 85 of console time. Estimated blood loss was 10 mL. In the postoperative period, a single complication was observed—a urinary tract infection, which was successfully managed conservatively. Our experience demonstrates that robot-assisted intravesical ureteral reimplantation is a feasible and minimally invasive alternative to both laparoscopic and conventional intravesical ureteroneocystostomy, providing a higher level of surgical comfort. However, further studies are needed to assess the feasibility and outcomes of intravesical da Vinci Xi surgery in younger pediatric patients.

Bone cement implantation syndrome in pediatric oncology patients remains poorly understood. A multimodal pathogenetic model determines the existence of two distinct clinical and pathophysiological phenotypes of this condition: the anaphylactic phenotype (distributive shock) and the embolic phenotype (obstructive shock). Both phenotypes are associated with coagulopathy, with thrombotic catastrophes representing their most severe manifestation. The pathways of thrombotic complications depend on the clinical and pathophysiological phenotype of this critical condition: in anaphylactic bone cement implantation syndrome, they are primarily driven by microthrombogenesis, whereas in embolic bone cement implantation syndrome, both microthrombogenesis and fibrinogenesis contribute to thrombosis. In the first clinical case, bone cement implantation syndrome developed through an anaphylactic mechanism. A boy with femoral osteosarcoma underwent bone cement spacer implantation following tumor resection. We assume that sensitization occurred during this period. This is supported by the presence of a periosteal reaction in the upper third of the right femur, as revealed by computed tomography (CT). During knee endoprosthesis implantation, the patient developed severe hemodynamic instability, cardiac rhythm disturbances, and oxygenation impairment. Despite the characteristic microthrombogenesis mechanism of this pathophysiological phenotype, multiorgan failure and life-threatening thrombotic complications were successfully averted due to effective anti-shock measures and early initiation of heparin therapy. Second clinical case illustrates the embolic phenotype of bone cement implantation syndrome. A boy with tibial osteosarcoma experienced hypotension, tachyarrhythmia, desaturation, and hypocapnia following bone cement application during endoprosthetic surgery. Postoperatively, desaturation persisted. CT revealed a mural defect in the left pulmonary artery and segmental obstructions in multiple branches of both lungs, along with elevated D-dimer levels and echocardiographic evidence of increased right heart pressure. By postoperative day 20, oxygen saturation normalized (the patient was breathing ambient air). CT imaging showed resolution of the filling defect in the left pulmonary artery; however, signs of segmental pulmonary artery obstruction remained in the upper and middle lobes of the right lung and the lower lobe of the left lung. Thus, the hemodynamic catastrophe in the embolic phenotype of bone cement implantation syndrome represents a classic presentation of obstructive shock with subsequent thrombotic complications, driven by the combined mechanisms of microthrombogenesis and fibrinogenesis. The proposed pathogenetic phenotyping of bone cement implantation syndrome allows for a targeted approach to the prevention and treatment of hemodynamic and thrombotic complications in affected patients. This approach appears to be relevant and has the potential to reduce the incidence of adverse outcomes and complications.

Inflammatory myofibroblastic tumor is a rare type of mesenchymal tumor, predominantly benign but with intermediate malignant potential. This article presents a clinical case of successful surgical treatment of a child with an extremely rare localization of inflammatory myofibroblastic tumor in the rectum (the fourth reported case worldwide), initially misdiagnosed as Crohn disease. A 4-year-old girl presented with diarrhea, blood, and mucus in stool. Examination revealed ulcerative pancolitis and a rectal mass, initially presumed to be of inflammatory origin. Treatment with mesalazine led to clinical improvement; however, follow-up endoscopy showed no significant regression. Therapy was escalated to topical and systemic budesonide, with a positive response, but symptoms recurred after glucocorticoid withdrawal, including ribbon-like feces and painful defecation. High fecal calprotectin levels persisted throughout the observation period. The condition was interpreted as a stricturing form of Crohn disease. Anti-TNF therapy (infliximab) initially led to clinical improvement, but the rectal mass continued to grow, with progressive anal canal stenosis. A decision was made to perform rectal resection with tumor excision. Histopathological examination confirmed the diagnosis of inflammatory myofibroblastic tumor. Due to the overlapping clinical, laboratory, and imaging features of inflammatory myofibroblastic tumor and Crohn disease, differential diagnosis can be challenging, potentially delaying accurate diagnosis. In this case, a child with an extremely rare localization of an inflammatory myofibroblastic tumor successfully underwent radical surgery, resulting in favorable long-term outcomes.

Congenital hydronephrosis is a common developmental anomaly typically diagnosed prenatally. Laparoscopic pyeloplasty is considered the gold standard for the treatment of ureteropelvic junction obstruction due to its high success rate (93–98%) and low incidence of complications. However, hemorrhagic complications remain a concern, particularly in cases of abrupt reductions in intrapelvic pressure, inadequate hemostasis, or coagulopathy, and may be exacerbated by antifibrinolytic therapy. This report describes a clinical case of a male patient with prenatally diagnosed right-sided hydronephrosis, who underwent initial radiologic evaluation at the age of 4. Surgical treatment was recommended but declined by his parents. At age 6, the child was urgently hospitalized with recurrent abdominal pain and vomiting. After stabilization and pain relief, ultrasonography, contrast-enhanced computed tomography, and voiding cystourethrography confirmed the diagnosis of right-sided hydronephrosis and recurrent renal colic. Laparoscopic antevascular pyeloplasty was performed. On postoperative day 2, hemorrhagic urine output was observed through the drain, accompanied by pyelostomy dysfunction. Tranexamic acid, an antifibrinolytic agent, was administered to manage hematuria, resulting in tamponade of the renal pelvis due to blood clot formation. A repeat laparoscopic procedure was required for clot evacuation and placement of additional drains. Subsequent recovery was favorable, with restoration of renal function and urinary drainage, and an uneventful postoperative course. This case underscores the importance of meticulous intraoperative hemostasis and adequate fluid therapy to prevent postoperative complications. The use of antifibrinolytics for gross hematuria following pyeloplasty requires an individualized approach due to the risk of intraluminal thrombosis, renal pelvis tamponade, and potential loss of renal function. In such cases, timely surgical intervention may help preserve renal function.

Year 2025 has been declared in Russia as the Year of the 80th Victory anniversary in the Great Patriotic War. Numerous documentary and literary works have been dedicated to the heroic efforts of medical personnel during the war and the Siege of Leningrad. However, the true complexity of their work is best understood through the study of archival records. This article examines unique historical documents preserved in the archives of the Saint Petersburg State Pediatric Medical University (formerly the Leningrad Pediatric Medical Institute), specifically surgical records and hospital admission logs from 1939 to 1946. These records serve as a chronicle of courage, where each entry stands as evidence of the selfless professionalism of medical workers in extreme wartime conditions. Despite constant enemy shelling and bombings, surgeons, nurses, and hospital attendants at the Leningrad Pediatric Medical Institute continued their urgent medical work, providing care to both children and adults in hospital units established within the institute. Unfortunately, the number of surviving witnesses of these historical events dwindles with each year. This makes the preservation and study of archival documents an essential task in safeguarding the memory of the heroic contributions made by medical professionals during the Great Patriotic War.