Vol 29, No 2 (2025)

Background. A skin scar is an important component of satisfaction with surgical treatment. Both the patient’s comfort level and the possible treatment tactics depend on the variant of scarring changes.

Aim. Development of a new instrument for assessing a skin scar in a child. It should take into account the requirements of clinometric.

Methods. A total of 170 children participated in the study at various stages of the development and validation of the scale. The study period is from 2021 to 2024. The procedures of exploratory factor analysis and multiple regression analysis were carried out, taking into account all the standard criteria necessary for this.

Results. The Subjective pediatric assessment scar scale (SPASS) perception consists of three sheets with questions. Each of them is intended for personal filling by the child, his parent and, finally, the doctor. The questionnaire sheets for children are divided depending on the age periodization. The average level of inter–expert reliability among doctors was 0.96 (95% CI 0.93–0.99). Intra–expert reliability had a variation from 0.85 (95% CI 0.88–0.82) to 0.97 (95% CI 0.95–0.99). The overal convergent validity value for the questionnaire was 0.95. The overall Cronbach’s alpha level among parents was 0.83. The overall subjective assessment of a skin scar significantly correlates positively with the following indicators: social aspects of the presence of a scar (R₀ = 0.899, p < 0.001), physical inconveniences (R₀ = 0.835, p < 0.001), problems of aesthetics and treatment (R₀ = 0.733, p < 0.001).

Conclusion. The developed SPASS is the first tool of its kind to be used among children. The questionnaire is adapted for children of different ages, taking into account the periodization of mental development. The scale is ready for use in clinical practice.

The present review of current scientific and practical literature is devoted to the analysis of modern diagnostics and management of acetabulum fractures in children. Systematized research and clinical findings have proven that computed tomography remains the “gold standard” for diagnostics (accuracy up to 80%) of acetabulum fractures in children. However, it is not available in some regional hospitals what increases the risk of intraoperative errors committed by an orthopedic traumatologist and a pediatric surgeon. Conservative management (plaster casts, skeletal traction) is acceptable in undisplaced fractures, but it is associated with a high risk of complications: thrombosis, deformities (including the extremity discrepancy in the growing organism), osteoarthritis, etc. Surgical intervention is indicated in dislocated fragments of more than 2 mm, joint instability or damage to the posterior wall of the cavity. The optimal access depends on the fracture location and surgeon’s experience. The key success factors for treating acetabulum fractures in children are: reposition of the dislocation within the first 6 hours, compliance with aseptic rules, and early rehabilitation. The authors emphasize the need to equip regional and district hospitals with computer/magnetic resonance devices, to develop unified protocols and to train surgeons in minimally invasive techniques. The results obtained in the study are important for improving pediatric traumatology.

The new version of the clinical guidelines, developed by specialists from the Russian Association of Pediatric Surgeons, provides updated information on the diagnosis and management of the disease in line with recent advancements. These recommendations are based on the results of completed domestic and international randomised clinical trials, including systematic reviews and meta-analyses. For the first time, the guidelines highlight the role of nonspecific mesadenitis in the etiopathogenesis of ileocecal intussusception in children, as well as shifts in the disease’s age distribution from infancy to early childhood. This updated version also revises the long-standing national approach to age and time restrictions for conservative management. It now recommends conservative treatment for all uncomplicated cases of ileocecal invagination. Surgical intervention is advised in cases of complications such as intussusception necrosis, peritonitis, or small intestinal obstruction, as well as when an anatomical abnormality is suspected on ultrasound or if the disease recurs.

This publication is intended for practicing paediatric surgeons, anaesthesiologists, paediatricians, and specialists in related fields, as well as residents and postgraduate students in these disciplines.

BACKGROUND. Urolithiasis is a very common disease in all age groups. The incidence of urolithiasis in children is rapidly increasing worldwide. In this study, we describe a case of robotic ureteral stone removal and present a literature review on robotic-assisted surgeries for treating urolithiasis in children.

CLINICAL CASE DESCRIPTION. An 11-year-old boy was admitted to the children’s hospital with complaints of recurrent urinary tract infection and pain on the left side for the last year. Computed tomography revealed a stone located at the level of the proximal left ureter and the ureteral stricture located right above the stone. The child had robot-assisted ureterolithotomy and ureteroplasty. During the surgery, intraoperative contact ultrasound examination was used to locate the stone. After dissection of the ureteral wall above the stone, the calculus was grasped with a clamp and removed externally. Longitudinal ureterotomy was closed transversely with interrupted absorbable sutures. No postopreative complications were registered after the surgery. The surgery lasted for 135 minutes. Foley catheter was removed next postoperative day. The drainage catheter was removed on the 2nd postoperative day. The patient was discharged home on the 5th postoperative day. The stent was removed in 4 weeks after the surgery. Repeated ultrasound examination performed 6 months after demonstrated less dilation of the renal pelvis and ureter, and no signs of stone formation.

CONCLUSION. Our study has demonstrated that robotic-assisted surgery is a feasible, safe and effective option for treating urinary tract stones in children in some cases, such as upper urinary tract stones which are accompanied by urinary tract obstruction and require simultaneous ureterolithotomy and ureteroplasty.

The assembly speech is dedicated to the formation of the pediatric surgical service in the Tver region. The history of the Department of Pediatric Surgery at Tver Medical University and its diverse activities are vividly presented. The methodological support of the students' educational process includes monitoring the initial level of knowledge, optional discussion of the results of scientific research, conducting webinars, abstract conferences, distance learning, as well as clinical analysis of newly admitted patients. The training programs developed at the department include recommendations on the care of children after surgical interventions in the primary level of pediatric services. The educational process covers all levels of medical care, including emergency and emergency room doctors for the diagnosis of urgent surgical conditions. The article describes the efforts spent on the creation of a pediatric surgical service, the close relationship between the Department of Surgery at the university and the surgical departments of the regional hospital, which the department regularly replenishes with trained specialists. Morality, morality, and professional ethics have been implemented at the department for more than 30 years. The department lives under the coat of arms, which depicts its postulate — work, faith, loyalty.