TOMSK, Sep 30 – RIA Tomsk, Elena Taylasheva. The international conference "New Operational Technologies" is held at Tomsk State University (TSU). It was visited by the stars of plastic and reconstructive surgery, for example, Milomir Ninkovic from Munich, one of the first in the world who successfully transplanted cadaverous upper limbs. Whether it is necessary to cut out hemangiomas, how to become pregnant after chemotherapy and who in Siberia uses da Vinci robot – in the material of RIA Tomsk.

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The sixth international interdisciplinary conference "New Operational Technologies" began its work on Thursday, September 28, and will end today, September 30. Its participants are practicing doctors and scientists who create new materials and approaches in the surgical treatment of patients.

Interdisciplinary, probably is the key definition in the title. People of related specialties, unfortunately, have little contact with each other, and the organizers of the Tomsk forum – SAU Institute of Smart Materials and Technology of Tomsk State University, Tomsk NRMC, Tomsk Scientific Research Institute of Microsurgery, Institute of Strength Physics and Materials Science of Siberian Branch of Russian Academy of Sciences (ISPMS SB RAS), TP "Medicine of the Future" are trying to solve this problem.

"Last year we had surgeons from the Sklifosovsky Institute, they showed us a lung transplant operation. They had a problem with artificial ventilation of the transplanted organs. And then a professor from  Bauman MSTU rises and says: it's not difficult, we have been doing this for many years, technically it needs to be realized this way and that", – the president of the Scientific Research Institute of Microsurgery Vladimir Baytinger gives an example.

According to Irina Kurzina, the director of the SAU Institute of Smart Materials and Technology, professor of the Department of Physical and Colloid Chemistry of TSU, medical breakthroughs occur precisely when representatives of different scientific fields work at one site.

"We (at the university) are not clinicians – we can not do the operations ourselves. But we can help to solve clinical problems, for example, studying the processes at the level of fundamental chemistry, biology, biochemistry. Now there is a big project between TSU, TPU, Cancer Research Institute and Heidelberg University in Germany on the mechanism of formation of tumor cells.

We worked out a test system that allows us to see at the level of the cellular mechanisms how the organism reacts to the implant, radiochemistry and other methods of treatment, because each organism is individual and at somebody chemotherapy will not suppress the tumor, but will cause its growth. This is the so-called personalized medicine", – says Kurzina.

As native

Theo Kielz, a former police officer from Innsbruck, shows his hands in a video session. Nothing special – if you do not know that once as a result of the trauma, he lost both limbs to the middle of the forearm, and 17 years ago he was transplanted by new ones from just deceased person.

The operation, conducted by the Innsbruck surgeon Milomir Ninkovic, was one of the first in the world which ended successfully. Vessels, muscles, nerves – old and new ones – were sewn so filigree that they completely retained their functions. The former policeman abruptly changed his life: he became a biker and went on a round-the-world trip.

"Aesthetic surgery – is a surgery without medical indications: you are dealing with healthy people who need a delightful result and psychological stress relief. But it is harder to work with them. In reconstructive surgery, on the contrary, we face serious health problems.

You have a sick patient who just wants to become normal. For example, if a tumor has been removed, it is necessary to restore the aesthetic appearance and functionality to the damaged areas", – told in an interview of RIA Tomsk Ninkovic, now – is the head doctor of the clinic of plastic, reconstructive surgery, hand surgery and combustiology in the hospital of the Bogenhausen district in Munich.

Bless and save

According to Ninkovich, in the reconstructive surgery are developed, generally not technologies, but methods. For plastic surgeries supertechnological devices like da Vinci robot surgical system aren't necessary. Only very precision microscope and tools are required. And here the new ideas which will yield the best result are very necessary. For example, recently Ninkovich offered a new way to reconstruct a lower lip.

"To the patient who had the lower lip removed because of an oncological disease we just pull the skin from his cheeks. We thought of replacing the muscle from the inside of the thigh. Nerves, vessels – everything must be restored, and then the functions are restored", – says Ninkovic.

From Tomsk developments, a well-known surgeon noted biocompatible ceramic implants. One of the problems of reconstructive surgery is that about a third of the implants used in traumatology are rejected.

Tomsk scientists – employees of the Laboratory for Medical Materials Science and the Laboratory of Physics of Nanostructural Functional Materials of the Institute of Strength Physics and Materials Science of Siberian Branch of Russian Academy of Sciences – created ceramics on the basis of oxide materials (zirconium oxide, magnesium). It is identical to the bone structure and therefore perfectly takes root.

Each implant is individual – on the basis of a computer tomography of the patient, a 3D-model of the skeleton is created, and to the problem place – any cavity – a new "bone" created for this concrete place is adjusted. At the exhibition, which was working within the framework of the conference, it was possible to look at a copy of the first implant of this type – it was received by an cancer patient from Tomsk, who was removed the cheekbone because of the cancer.

New trends

Some new trends, on the contrary, have not yet reached Tomsk. As it turned out, Tomsk doctors in the overwhelming majority either cut out or burn out vascular tumors in children (hemangiomas) with liquid nitrogen. In Europe so long ago do not do this.

"In fact, 90% of cases can be treated with a conservative method – tablets", – the president of the European Association of Plastic Surgeons Beatris Berenguer told.

In turn, Tomsk citizens showed their colleagues a laser that allows to perform sparing operations to remove vascular tumors at children – if tablets have not helped.

The laser was manufactured by a special order by P.N. Lebedev Physical Institute, and a master class for conference guests was held at the Scientific Research Institute of Microsurgery with its use. If to continue the theme of the achievements of Tomsk microsurgeons, then a big interest was caused by the report of Baytinger on the method of restoring reproductive function of women cured of lymphoma.

"Now there are very effective courses of chemotherapy against lymphoma. But after recovering, women remain infertile – their ovaries functionally "die". The world used a method when a part of the ovary – a cortical substance – was taken from a patient before chemotherapy, and frozen in a cryocenter.

When the treatment ended, a cortical substance was "hemmed" onto the second stored non-functioning ovary and waited for restoration of the functions to take the eggs for IVF. But out of 1000 women this method helped only to 35. We with colleagues from Petersburg and Brussels came up with another way.

The ovary is frozen completely, and when the time comes – it is transplanted to the patient either in the original place or in a certain area in the inguinal area that has a suitable temperature. Microsurgeons include an ovary in the real blood stream. We have already developed the protocol of the operation. Now we are solving another serious problem: we create a technology for effective defrosting of biomaterial", – Baytinger told RIA Tomsk.

Less blood, more chances

Now Tomsk surgeons dream of the da Vinci robotic surgical complex, which allows to performi operations with high accuracy and minimal blood loss. All physical manipulations are performed by the robot through small punctures in the skin, it is controlled by a doctor sitting at the console and using special joysticks. The device was created by NASA scientists, so that it was possible to operate cosmonauts remotely from the Earth.

In total, about two dozen of such complexes have been purchased in Russia. But there is a big problem with the specialists: the robot must be managed by a surgeon of the highest level who has undergone special training. For example, in Surgut, money to buy da Vinci was found, but there is no shots of such level.

At Novosibirsk Scientific Research Institute of Pathology of Blood Circulation named after E.N. Meshalkin da Vinci was established five years ago. Representatives of the Institute said that at first they did cardiosurgical operations with its help. Recent years they learned to operate tumors of the uterus, prostate. And recently there was the first experience of lung cancer surgery.

According to them, with new technologies it became possible to look into those areas that were previously inaccessible to the human eye and to separate the tumor tissue as much as possible from the healthy one. It means – to increase the chances for a complete cure of the patient.