[Unsolved issues of pregnancy in liver cirrhosis].

Pregnancy in patients with liver cirrhosis and portal hypertension occurs very rare, because of their significantly derailed reproductive functions. Тhe risks for the mother and the fetus are connected with worsening of the portal hypertension, progression of decompensated liver cirrhosis and development of its complications: liver failure, ascites, hepatorenal syndrome, hepatic encephalopathy and variceal hemorrhage, and with increased incidence of spontaneous abortions and abnormal uterine bleeding. The decision for continuation of the pregnancy in cirrhotic patients must be based on individual approach and a multidisciplinary team consisting of obstetricians, hepatologists, anesthesiologists, surgeons and hematologists must participate in the therapy.

Robotic-assisted radical parametrectomy in patients with malignant gynecological tumors.

We describe the operative technique of robotic-assisted laparoscopic radical parametrectomy and analyze perioperative data including adequacy of resections, pathology, and complications in our initial cases. A retrospective study was performed of seven patients with gynecological cancers involving the cervix who had previously been treated with simple hysterectomies and then underwent robotic-assisted radical parametrectomies. Pathology from the initial hysterectomies and the radical parametrectomies was reviewed.

[Anatomy and physiology of autonomic pelvic innervations].

Autonomic innervation is responsible for the correct function of the organs in the pelvis. Retroperitoneal surgery is associated with trauma of the nerve structures. For this reason a detailed knowledge of topographic anatomy of the pelvis is needed, when surgery for oncological diseases or endometriosis is performed.

[Areas of risk for ureteral lesion during radical hysterectomy].

Introduction: The close interrelations of the pelvic ureter with surrounding structures and organs are a prerequisite for complications during surgical interventions in the lesser pelvis.

Objective: Exploration and visualization of the areas of risk for lesion of pelvic ureter during minimally invasive radical hysterectomy.

Results: Based on our observations and the available literature, we identified the following areas and steps of the radical hysterectomy as risky: at the entrance in the lesser pelvis, upon ligation of the infundibulopelvic ligament; incision of the back leaf of broad ligament of the uterus; dissection of the pararectal space; ligation of the uterine artery; dissection of the fourth space and transection of the vesicouterine ligaments; transection of the sacrouterine ligaments; incision of the anterior vaginal wall.