Shumkovski, Robert

Preferred name
Shumkovski, Robert
Official Name
Shumkovski, Robert
Translated Name
Шумковски, Роберт
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    Endoscopic versus Microscopic Transsphenoidal Hypophysectomy: Comparison of the Endocrine Outcome – An Institutional Experience
    (Scientific Foundation SPIROSKI, 2020-05-08)
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    Kocevski, Ivica
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    Micunovic, Micun
    <jats:p>BACKGROUND: The transnasal transsphenoidal endoscopic approach to the sella turcica is an overwhelming alternative to the microscopic approach for the past few decades assuming into prominence as a new technique, reaching nearly gold standard for this pathology. The endoscopic approach to the pituitary has redefined accurate visualization of the sella. The panoramic view afforded by the endoscope is unparalleled as compared with the traditional conical view of the microscope. AIMS: This study aims to compare both endoscopic and microscopic technologies, including advantages and disadvantages through the results of endocrine outcome. SETTINGS AND DESIGN: Our retrospective/prospective study included 46 microscopically and 39 endoscopically treated patients during the period of 2010–2018. Tumors were classified according to the diameter and clinical outcomes were evaluated. RESULTS: Our retrospective/prospective study included 46 microscopically and 39 endoscopically treated patients during the period of 2010–2018. Tumors were classified according to the diameter, hormone activity and clinical outcomes were evaluated. Comparison results revealed more efficacious and effective endocrine control and reestablishing the endocrine homeostasis utilizing the endoscopic technique, especially in secretory active macroadenomas. Further, the extension of the resection, which was better in endoscopic approach undouptedly contributed to better endocrine control of the disease. Complication rate, including endocrine, was lower following endoscopy compared with microsurgery. CONCLUSION: This technique evidenced to have a statistically significant reduction in operative time and length of hospital stay, as well as more radical safe resection and complication control. There is also a trend toward improved endocrine outcomes and rate of return of visual defects. These two approaches are still comparable with eloquent advantages and disadvantages, formulated as balanced dialectics. In addition, the use of endoscopes, including multilocular polifilament 3D endoscope, facilitates extended approaches, reaching a delicate skull base lesions that are suprasellar, retrosellar, and parasellar, which permits visualization beyond the abilities of the microscope.</jats:p>
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    REVIVING CRANIAL OUTER TABLE PERFORATIONS AS A MODERN INNOVATION FOR COMPLEX SCALP AVULSION INJURIES RECONSTRUCTION: A CASE REPORT
    (Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, 2023)
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    Endoscopic transsphenoidal hypophisectomy versus microscopic transsphenoidal surgery in the treatment of pituitary adenomas: Evaluation of results in terms of ophthalmic affection
    (Scientific Foundation Spiroski, 2020)
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    Ivica Kocevski
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    Micun Micunovic
    Neurophtalmologic examination is part of the baseline evaluation of patients with pituitary lesions. The neuro-ophtalmologist quantifies and evaluates the impact that the sellar lesion has on afferent and efferent visual pathways, contributes to the determination of tumor growth dynamics, and monitors the success and possible complications. in cases of vision loss, blurning, damage or double vision as symptoms of a clinical presentation the neuro-ophtalmologist is often the first to recognize and define the pituitary lesion.
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    Divestment–Adventitia Resection in Order to Decrease Morbidity and Mortality and Improve R0/R1 Ratio in Curative Pancreatoduodenectomy for Advanced Pancreatic Head Carcinoma
    (Scientific Foundation Spiroski (publications), 2026-06-14)
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    Kolari, Arbijon
    Abstract BACKGROUND: Pancreatic head carcinoma (PHC) is a highly aggressive malignancy associated with substantial morbidity, mortality, and poor long-term survival. Achieving an R0 resection margin during pancreatoduodenectomy (PD) is crucial for improving oncological outcomes. However, in borderline resectable (BRPHC) and locally advanced pancreatic head carcinoma (LAPHC), arterial involvement often necessitates complex arterial resections associated with high perioperative risks. Periarterial sub-adventitial divestment has emerged as a potential alternative to arterial resection, aiming to improve radicality while reducing complications. AIM: To evaluate whether sub-adventitial arterial divestment during curative pancreatoduodenectomy decreases perioperative morbidity and mortality and improves the R0/R1 resection ratio in patients with BRPHC and LAPHC. METHODS: A retrospective study was conducted on 50 consecutive patients with BRPHC or LAPHC treated between 2009 and 2017 following neoadjuvant therapy when indicated. All patients underwent extensive pancreatoduodenectomy with triangle operation, extended lymphadenectomy, and periarterial sub-adventitial divestment of the superior mesenteric, common hepatic, and/or celiac arteries. Clinicopathological data, perioperative morbidity, mortality, length of hospital stay, and R0/R1 resection status were analyzed. RESULTS: Among the 50 patients, 27 (54%) were male and 23 (46%) were female, with a mean age of 63.1 ± 8.97 years. Overall mortality was 8% (4/50). Major complications included postoperative pancreatic fistula (24%), postoperative biliary fistula (2%), postpancreatectomy hemorrhage (4%), reoperation (6%), necrotizing pancreatitis (4%), thromboembolism (4%), cardiac failure (2%), and pulmonary complications (8%). Venous resection was required in 12% of patients. Postoperative pain relief was achieved in 92% of cases. Mean hospital stay was 10.56 ± 6.09 days. Histopathological examination demonstrated R0 resection in 28 patients (56%) and R1 resection in 22 patients (44%). Morbidity and mortality rates were comparable to standard PD and appeared lower than those reported for PD combined with arterial resection. CONCLUSION: Sub-adventitial arterial divestment during pancreatoduodenectomy is a feasible and safe technique for selected patients with borderline resectable and locally advanced pancreatic head carcinoma. The procedure provides acceptable morbidity and mortality rates while achieving favorable R0 resection outcomes, representing a promising alternative to arterial resection in specialized high-volume centers. Keywords Pancreatic head carcinoma Pancreatoduodenectomy Arterial divestment Borderline resectable pancreatic cancer R0 resection