Current issues of clinical and organizational problems of polytrauma

The relevance of the polytrauma problem remains at a high level, and the latest statistics confirm this. In peacetime, the main causes of multiple and combined injuries are traffic accidents, traumatic injuries, and criminal accidents. Recently, great success has been achieved at the state level in solving this complex medical and social problem, primarily in organizing medical care for patients with polytrauma. Regional trauma systems have been created, a network of trauma centers has been deployed, appropriate logistical support has been provided to hospitals, and a large practical training base on polytrauma has been developed. However, there are still a number of clinical and organizational problems, theoretical and practical controversial issues. First of all, this is a debatable question about the terminology of polytrauma. Polytrauma surgery is a uniform organization and a strict algorithm of therapeutic and diagnostic measures. This necessitates the creation of a differentiation and a unified scale for assessing the severity and condition of patients, regulating the timing of surgical intervention, and defining clear indications for multi-stage surgical treatment of the wounded. There is a need for a well-established mechanism for routing patients with polytrauma and subsequent traumatic illness, a multidisciplinary approach in their treatment, and the creation of a special department for multiple and combined injuries based on all Level I trauma centers. A separate and very important issue is the training of specialists in the field of injury surgery. Solving these problems will certainly have a positive impact on both the organization of medical care and the effectiveness of treatment for this category of patients. Therefore, the purpose of this work is to identify problems affecting the provision of medical care to patients with polytrauma and possible solutions.

1. Gumanenko E.K. Zavrazhnov A.A. Suprun A.Yu., Khromov A.A. Severe combined trauma and polytrauma: definition, classification, clinical characteristics, treatment outcomes. Polytrauma. 2021;4:6-17. (In Russian). [Electronic resource]. URL: http://poly-trauma.ru/index.php/pt/article/view/347. DOI: 10.24412/1819-1495-2021-4-6-17

2. Sokolov V.A. Multiple and combined injuries. Moscow: GEOTAR-Media Publ., 2006:10-32. (In Russian). [Electronic resource]. URL: https://rusneb.ru/catalog/000199_000009_002873249/

3. Tscherne H. Die Behandlung Schwerverletzter auf einer Wachstation [The treatment of the seriously injured at an emergency station]. Chirurg. 1966;37(6):249-52. German. PMID: 5995039.

4. Border J.R., LaDuca J., Seibel R. Priorities in the management of the patient with polytrauma. Prog. Surg. 1975;14:84-120. DOI: 10.1159/000398211. PMID: 809807

5. Prokazyuk A.A., Zhanaspaev M.A., Aubakirova S.K., Musabekov A.S., Tlemisov A.S. Polytrauma: Definition of the Problem and Management Strategy [Review). General Reanimatology. 2022;18(5):78-88. (In Russian). DOI: 10.15360/1813-9779-2022-5-78-88

6. Agadzhanyan V.V. Kravtsov S.A. Polytrauma, the ways of development. Polytrauma. 2015;2:6-13. (In Russian). [Electronic resource]. URL: https://cyberleninka.ru/article/n/politravma-puti-razvitiya-terminologiya).

7. Nikitin G.D., Gryaznukhin E.G. Multiple fractures and combined injuries: monograph. Leningrad: Medicine Publ., 1983:296. (In Russian). [Electronic resource]. URL: https://rusneb.ru/catalog/000200_000018_rc_898448/

8. Kaplan AV, Pozharisky VF, Lirtsman VM. Multiple and combined injuries of the musculoskeletal system. The main problems. In: Works of the 3rd All-Union convention of trauma surgeons. Moscow: N.N. Priorov Central Institute of Traumatology and Orthopedics, 1976:29-37. (In Russian). [Electronic resource]. URL: https://rusneb.ru/catalog/000200_000018_rc_3173838

9. Petrov S.V. General surgery. Textbook. 4th edition, revised and expanded. Moscow: GEOTAR-Media Publ., 2022:365-510. (In Russian). [Electronic resource]. URL: https://www.geotar.ru/lots/NF0021454.html

10. Gumanenko Ye.K. Tactics of programmed multi-stage surgical treatment of wounds and injuries (“damage control”). Gumanenko YE.K., Samokhvalov I.M., Gavrilin S.V. Military field surgery of local wars and armed conflicts. Moscow: GEOTAR-Media Publ., 2011:135-147. (In Russian).

11. Pape H.C., Lefering R., Butcher N., Peitzman A. The definition of polytrauma revised: an international consensus process and proposal of the new «Berlin definition». Journal of Trauma and Acute Care Surgery. 2014;77(5):780-786. DOI: 10.1097/TA.0000000000000453. PMID: 25494433

12. Störmann P. Further refinement of high standards of care- focus on polytrauma. Eur. J. Trauma Emerg. Surg. 2024;50(3):621-622. DOI: 10.1007/s00068-024-02543-6. PMID: 38771347; PMCID: PMC11249500

13. Combined and multiple trauma accompanied by shock (Polytrauma): National clinical guidelines. Moscow. Ministry of Health, 2022. (In Russian). [Electronic resource]. URL: https://xn--2023-43damrhab1ba4ccoagg5bs7j0i.xn--p1ai/wp-content/uploads/2023/03/nkr_politravma.pdf

14. United Nations Road Safety Collaboration. Decade of Action for Road Safety 2011-2020. [Electronic resource]. URL: https://www.who.int/publications/i/item/decade-of-action-for-road-safety

15. The State report on the state of road safety in the Russian Federation. GUOBDD of the Ministry of Internal Affairs of Russia, the Scientific Center of the Ministry of Internal Affairs of Russia. Moscow, 2023. (In Russian). [Electronic resource]. URL: http://stat.gibdd.ru/

16. Maday D.Yu., Kozlov V.K., Ivanov A.G., Besaev G.M., Maday O.D. Medical tactics, approaches and effectiveness complex treatment of the patient with polytrauma as a result of falling from height. Pirogov Russian Journal of Surgery. 2021;8:69-75. (In Russian). DOI: 10.17116/hirurgia202108169

17. Mironov SP., Es'kin N.A., Andreeva T.M., Ogryzko E.V., Shelepova E.A. Dynamics of traumatism in adult population of the Russian Federation. N.N. Priorov Journal of Traumatology and Orthopedics. 2019;(3):5-13. (In Russian). DOI: 10.17116/vto20190315

18. Naimov AM, Razzokov AA, Parpiev FM. Analysis of key risk factors for the development of hospital mortality and prediction of outcomes in the acute period of severe concomitant injury. Vestnik Avitsenny [Avicenna Bulletin]. 2023;25(3):334-345. (In Russian). DOI: 10.25005/2074-05812023-25-3-334-345

19. Chikaev V.F., Akhtyamov I.F., Petukhov D.M. et al. Analysis of the lethality of victims of polytrauma in a multidisciplinary hospital. The Bulletin of Contemporary Clinical Medicine. 2022;15(6):122-126. (In Russian). DOI: 10.20969/VSKM.2022.15(6).122-126

20. Korobushkin G.V., Shigeev S.V. Analysis of the causes of death in a sample of patients with polytrauma in Moscow. Polytrauma. 2020;2:47-53. (In Russian). [Electronic resource]. URL: https://cyberleninka.ru/article/n/analiz-prichin-smerti-v-vyborke-patsientov-s-politravmoy-v-moskve

21. Practical Guide to DAMAGE CONTROL 2.0 (second edition). Professor I.M. Samokhvalov, Associate Professor A.V. Goncharov, Candidate of Medical Sciences V.A. Reva, editors. St. Petersburg, 2020. (In Russian). [Electronic resource]. URL: https://www.trauma-books.ru/product/prakticheskoe-rukovodstvo-po-damage-control

22. Agadzhanyan V.V. Organization of medical care for multiple and concomitant injury (polytrauma), clinical recommendations (treatment protocol) (project). Polytrauma. 2015;(4):6-18. (In Russian). [Electronic resource]. URL: https://cyberleninka.ru/article/n/organizatsiya-meditsinskoy-pomoschi-pri-mnozhestvennoy-i-sochetannoy-travme-politravme-klinicheskie-rekomendatsii-protokol-lecheniya/

23. Bulava G.V. Pathogenetic Mechanisms of Organ Dysfunction in Severe Concomitant Trauma. Russian Sklifosovsky Journal “Emergency Medical Care”. 2023;12(1):92-98. (In Russian). DOI: 10.23934/2223-9022-2023-12-1-92-98

24. Dmitriyev I.V., Dorosevich A.E., Abrosimov S.YU. Features of the pathomorphology of shock. Bulletin of the Smolensk State Medical Academy. 2021;2:142-149. (In Russian). [Electronic resource]. URL: https://cyberleninka.ru/article/n/osobennosti-patomorfologii-shoka

25. Polytrauma — a mutually aggravating syndrome of pain, acute blood loss and infection : a guide in three volumes. I.A. Sharipov, T.A. Vasina, V.A. Sokolov [et al.], editors. Moscow : Izvestia, 2022:131. (In Russian). [Electronic resource]. URL: https://rusneb.ru/catalog/000199_000009_011509679

26. Esipov A.V., Abushinov V.V., Onishchenko A.A., Alekhnovich A.V. The application of a process approach to the organization of specialized medical care for victims of road polytrauma. Hospital medicine: science and practice. 2019;1(3):10-5. (In Russian). [Electronic resource]. URL: https://3hospital.ru/media/newspapers/gospmed_2019_01_03.pdf

27. Clinical guidelines for the diagnosis and treatment of polytrauma: a teaching aid. Prof. V.A. Manukovsky, editor. St. Petersburg I.I. Dzhanelidze Research Institute of Emergency Medicine. St. Petersburg, 2021:87. (In Russian). [Electronic resource]. URL: https://search.rsl.ru/ru/record/01010956115

28. Marsden N.J., Tuma F. Polytraumatized Patient. 2023 Jul 3. In: StatPearls [Internet]. Treasure Island (FL): StatPearls. Publishing; 2025 Jan. PMID: 32119313.

29. About confirmation of the Order of rendering medical assistants for patients with associated, multiple and single injuries accompanied by shock: the order by Ministry of Health of Russia, December, 15, 2009. N 991n. (In Russian). [Electronic resource]. URL: https://legalacts.ru/doc/prikaz-minzdravsotsrazvitija-rf-ot-15122009-n-991n

30. About confirmation of the Order of rendering medical assistants for patients with associated, multiple and single injuries accompanied by shock: the order by Ministry of Health of Russia, November, 15, 2012. N 927n. (In Russian). [Electronic resource]. URL: https://base.garant.ru/70304572

31. Shcherbak NP., Mansurov DSh., Dorofeev Yu.L., Khajdarov V.M., Tkachenko A.N. Osobennosti organizacii travmatologicheskoj pomoshchi v regionah Rossijskoj Federacii (nauchnyj obzor) [Features of the Organization of Traumatological Care in the Regions of the Russian Federation (A Scientific Review). Fizicheskaya i reabilitacionnaya medicina [Physical and Rehabilitation Medicine]. 2021;3(3):62-72. (In Russian)]. DOI: 10.26211/2658-4522-2021-3-3-62-72

32. Maskin S.S., Ermolaeva N.K., Aleksandrov V.V., Matyukhin V.V. Combined closed abdominal injury: standardization of the therapeutic and diagnostic approach from the standpoint of evidencebased medicine. Monograph. Volgograd State Medical University. Publ., 2021:122-245. (In Russian). [Electronic resource]. URL: https://rusneb.ru/catalog/000199_000009_010907629/

33. Bagnenko S.F., Minnullin I.P., Miroshnichenko A.G. Directions for improving the organization of ambulances, including specialized ambulances, medical care in emergency and emergency forms and medical evacuation in the subject of the Russian Federation. Vestnik Roszdravnadzora. 2019;3:70-74. (In Russian). [Electronic resource]. URL: DOI: 10.35576/article_5d135f4a728e49.79827942

34. Nikolaev D.V., Dyakova O.V., Fomin V.S. Evaluation scales for determining the severity of the condition in polytrauma. Moscow Surgical Journal. 2022;(4):97-104. (In Russian). [Electronic resource]. URL: DOI: 10.17238/2072-3180-2022-4-97-104

35. Sokolov Yu.A., Bogdan V.G., Nikolaev D.V. Medical triage: features of the formation and development of domestic and western systems. Voennaya medicina. 2018;3:2-7.(In Russian). [Electronic resource]. URL: https://rep.bsmu.by/handle/BSMU/20502

36. Vassoevich A.L. Edwin Smith Surgical Papyrus [Experience of comprehensive source research). Moscow: Archive of the History of science and technology. Issue I., 1995:86-144. (In Russian). [Electronic resource]. URL: https://rusneb.ru/catalog/000202_000006_790725/

37. Lupton J.R., Davis-O'Reilly C., Jungbauer R.M., Newgard C.D., Fallat M.E., Brown J.B., Mann N.C., Jurkovich G.J., Bulger E., Gestring ML., Lerne B., Chou R., Totten A.M. Under-Triage and Over-Triage Using the Field Triage Guidelines for Injured Patients: A Systematic Review. Prehosp. Emerg. Care. 2023;27(1):38-45. DOI: 10.1080/10903127.2022.2043963. PMID: 35191799

38. Oborin M.A. On the history of N. I. Pirogov's discovery of sorting the wounded. The Military Medical Journal. 1955;10:84-87. (In Russian).

39. Karsanov A.M., Maskin S.S., Aleksandrov V.V., Matyukhin V.V. Advantages of laparoscopic technologies for blunt abdominal trauma: a systematic review and meta-analysis. Pirogov Russian Journal of Surgery. 2022;(5):86-96. (In Russian). DOI: 10.17116/hirurgia202205186

40. Yarcev P.A., Levitskij V.D., Rogal' M.M. The use of minimally invasive technologies in the treatment of abdominal trauma. Moscow: Russian Academy of Sciences. Publ., 2019:4-21. (In Russian). [Electronic resource]. URL: https://new.ras.ru/upload/iblock/9a4/x5tmuirpvwdvv3arz5yqqusdo2wl48l9.pdf

41. Nicolau A.E., Craciun M., Vasile R., Kitkani A., Beuran M. The Role of Laparoscopy in Abdominal Trauma: A 10-Year Review. Chirurgia (Bucur). 2019;114(3):359-368. PMID: 31264574. DOI: 10.21614/chirurgia.114.3.359

42. Cherkasov M.F., Startsev Yu.M., Cherkasov D.M., Sitnikov V.N., Melikova S.G., Galashokyan K.M. Diagnosis and treatment of patients with abdominal trauma. Pirogov Russian Journal of Surgery. 2022;(8):75-82. (In Russian). DOI: 10.17116/hirurgia202208175

43. Military field surgery: textbook. E.K. Gumanenko, editor. Moscow: GEOTAR-Media Publ., 2012:768. (In Russian). [Electronic resource]. URL: https://www.geotar.ru/lots/Q0119380.html

44. Petrovskij B.V Selected lectures on military surgery. Moscow: Medicine Publ., 1998:10-35. [Electronic resource]. URL: https://rusneb.ru/catalog/000200_000018_RU_NLR_bibl_128539

45. Krajnyukov P.E., Samokhvalov I.M., Reva V.A. Tactical medicine is a new concept for “new type” wars. The Military Medical Journal. 2021;(342)5:4-17).(In Russian).

46. Dufour-Gaume F., Frescaline N., Cardona V., Prat N.J. Danger signals in traumatic hemorrhagic shock and new lines for clinical applications. Front Physiol. 2023;13:999011. DOI: 10.3389/fphys.2022.999011. PMID: 36726379; PMCID: PMC9884701

47. Eastridge B.J., Holcomb J.B., Shackelford S. Outcomes of traumatic hemorrhagic shock and the epidemiology of preventable death from injury. Transfusion. 2019;59(S2):1423-1428. DOI: 10.1111/trf.15161. PMID: 30980749

48. Pringle J.H. V. Notes on the Arrest of Hepatic Hemorrhage Due to Trauma. Ann. Surg. 1908;48(4):541-9. DOI: 10.1097/00000658190810000-00005. PMID: 17862242; PMCID: PMC1406963

49. Roberts D.J., Bobrovitz N., Zygun D.A., Kirkpatrick A.W., Ball C.G., Faris P.D., Stelfox H.T. Indications for trauma damage control surgery international study group. evidence for use of damage control surgery and damage control interventions in civilian trauma patients: a systematic review. World J. Emerg. Surg. 2021;16(1):10. DOI: 10.1186/s13017-021-00352-5. PMID: 33706763; PMCID: PMC7951941

50. Talbert S., Trooskin S.Z., Scalea T, Vieux E., Atweh N., Duncan A., Sclafani S. Packing and re-exploration for patients with nonhepatic injuries. J. Trauma. 1992;33(1):121-4; discussion 124-5. DOI: 10.1097/00005373-199207000-00022. PMID: 1635096

51. Pirogov N.I. The beginnings of general military field surgery, taken from observations of military educational practice and memories of the Crimean War and the Caucasian expedition. Dresden. 1863-1866, Parts 1-2. Second ed. Moscow Leningrad: Medgiz Publ., 1941: 338 p.; 1944: 535 p. (In Russian). [Electronic resource]. URL: https://rusneb.ru/catalog/000199_000009_004822643/

52. Oppel' V.A. Grounds for sorting the wounded from a medical point of view in the theater of military operations. The Military Medical Journal. 1915;10:151-165. (In Russian).

53. Penetrating abdominal wounds. injuries to parenchymal organs. Volume XII. Gunshot wounds and abdominal injuries. The experience of Soviet medicine in the Great Patriotic War of 1941-1945. In 35 volumes. General E. I. Smirnov, editor. Moscow: State Publishing House of Medical Literature: 142-322. (In Russian). [Electronic resource]. URL: https://search.rsl.ru/ru/record/01005582562

54. Nikolaev D.V., Fomina M.N., Diakova O.V., Fomin V.S. Damage control. The history and modern view on surgical tactics. Moscow Surgical Journal. 2023;(1):110-117. (In Russian). DOI: 10.17238/2072-3180-2023-1-110-117

55. Rotondo M.F., Schwab C.W., McGonigal M.D., Phillips G.R. 3rd, Fruchterman T.M., Kauder D.R. et al. ‘Damage control': an approach for improved survival in exsanguinating penetrating abdominal injury. J. Trauma. 1993;35(3):375-382; discussion 82-83. PMID: 8371295.

56. Rodriguez-Holgurn F., Gonzalez Hadad A., Mejia D., Garda A., Cevallos C., Himmler A.N. et al. Abdominal and thoracic wall closure: damage control surgery's cinderella. Colomb. Med. (Cali). 2021;52(2):e4144777. DOI: 10.25100/cm.v52i2.4777. PMID: 34908622; PMCID: PMC8634273

57. Hirshberg A., & Walden R. (1997). Damage control for abdominal trauma. Surgical Clinics of North America, 1997;77(4):813-820. DOI: 10.1016/s0039-6109(05)70586-7.10.1016/s0039-6109[05)70586-7

58. Balogh Z.J. Polytrauma: It is a disease. Injury. 2022;53(6):1727-1729. DOI: 10.1016/j.injury.2022.05.001. PMID: 35643732

59. Chung C.Y., Scalea T.M. Damage control surgery: old concepts and new indications. Curr Opin. Crit. Care. 2023;29(6):673. DOI: 10.1097/MCC.0000000000001097. Epub 2023 Sep 26. PMID: 37861194

60. Ghneim M.H., O'Connor J.V., Scalea T.M. Damage control thoracic surgery: What you need to know. J. Trauma Acute Care Surg. 2025;98(1):11-19. DOI: 10.1097/TA.0000000000004458. Epub 2024 Oct 8. PMID: 39375907

61. Campbell K., Naumann D.N., Remick K., Wright C. Damage control resuscitation and surgery for indigenous combat casualties: a prospective observational study. BMJ Mil. Health. 2021;167(1):18-22. DOI: 10.1136/jramc-2019-001228. Epub 2019 Jun 20. PMID: 31227598.

62. Fulton II M.R., Schwartfeger S. EMS Tactical Damage Control Resuscitation Protocol. 2024 Jan 11. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan. PMID: 38261675

63. Leibner E., Andreae M., Galvagno S.M., Scalea T. Damage control resuscitation. Clin. Exp. Emerg. Med. 2020;7(1):5-13. DOI: 10.15441/ceem.19.089. Epub 2020 Mar 31. PMID: 32252128; PMCID: PMC7141982

64. Elkbuli A, Ehrhardt JD. Jr., McKenney M., Boneva D. Successful utilization of angioembolization and delayed laparoscopy in the management of grade 5 hepatic laceration: Case report and literature review. Int. J. Surg. Case Rep. 2019;59:19-22. DOI: 10.1016/j.ijscr.2019.05.011. PMID: 31100482; PMCID: PMC6522772

65. Iyengar K.P., Venkatesan A.S., Jain V.K., Shashidhara M.K., Elbana H., Botchu R. Risks in the Management of Polytrauma Patients: Clinical Insights. Orthop. Res. Rev. 2023;15:27-38. DOI: 10.2147/ORR.S340532. PMID: 36974036; PMCID: PMC10039633

66. Smith S.R. Morris S. Spreadborough L. et al. Management of blunt splenic injury in a UK major trauma center and predicting the failure of non-operative management: a retrospective, cross-sectional study. Eur. J. Trauma Emerg. Surg., 2018;44(3):397-406. DOI: 10.1007/s00068-017-0807-5

67. Matyuhin V.V., Maskin S.S., Aleksandrov V.V., Gol'brajkh V.A., Alimov M.N., Rashid A., Sigaev S.M., Biryulev D.S. Synthesis and transformation of various therapeutic tactics in patients with severe combined closed abdominal injury. Polytrauma. 2024:2:68-76. [Electronic resource]. URL: https://cyberleninka.ru/article/n/sintez-i-transformatsiya-razlichnyh-lechebnyh-taktik-u-postradavshih-s-tyazheloy-sochetannoy-zakrytoy-travmoy-zhivota

68. Pape H.C., Halvachizadeh S., Leenen L., Velmahos G.D., Buckley R, Giannoudis PV. Timing of major fracture care in polytrauma patients — An update on principles, parameters and strategies for 2020. Injury. 2019;50(10):1656-1670. DOI: 10.1016/j.injury.2019.09.021. Epub 2019 Sep 13. PMID: 31558277

69. Pfeifer R., Kalbas Y., Coimbra R., Leenen L., Komadina R., Hildebrand F. et al. Indications and interventions of damage control orthopedic surgeries: an expert opinion survey. Eur. J. Trauma Emerg. Surg. 2020;26. DOI: 10.1007/s00068-020-01386-1

70. Pape H.C., Moore E.E., McKinley T., Sauaia A. Pathophysiology in patients with polytrauma. Injury. 2022;53(7):2400-2412. DOI: 10.1016/j.injury.2022.04.009. PMID: 35577600

71. Gumanenko E.K., Khromov A.A., Rud' A.A., Chapurin V.A., Ehskhan U.KH. Dynamic prediction of complications in patients with combined trauma. Sovremennye problemy nauki i obrazovaniya. 2016;4:24-31. [Electronic resource]. URL: https://science-education.ru/ru/article/view?id=24888. DOI: 10.17513/spno.24888

72. Jeong T.S. A Multidisciplinary Approach to Polytrauma Management. Korean J Neurotrauma. 2024;20(1):1-2. DOI: 10.13004/kjnt.2024.20.e5. PMID: 38576497; PMCID: PMC10990699

73. Pavlov A.I. Establishing a Department of Concomitant Injuries at a Major District Hospital. Economics and Management. 2016;(9):48-51. (In Russian). [Electronic resource]. URL: https://emjume.elpub.ru/jour/article/view/144

74. Pushkov A.A. Combined injury. The view of a practical surgeon. Rostov-on-Don: Phoenix, 1998:10-98. [Electronic resource]. URL: https://i.twirpx.link/file/1779104/

75. Gvenetadze V.V Dulaev A.K. Tsed A.N. Kazhanov I.V., Mayorov B.A. Mushtin N.E. Shmelev A.V. Application of the improved algorithm for the diagnosis and treatment of unstable pelvic injury in patients with polytrauma. Polytrauma. 2024;4:36-45. (In Russian). [Electronic resource]. URL: https://cyberleninka.ru/article/n/primenenie-usovershenstvovannogo-algoritma-diagnostiki-i-lecheniya-nestabilnoy-travmy-taza-u-postradavshih-s-politravmoy

76. Makhnovsky AI. Prognostic criteria for substantiation of surgical and evacuation tactics in patients with polytrauma in level II and III trauma centers [Dissertation]. St. Petersburg, 2020:9-21. (In Russian). [Electronic resource]. URL: https://rusneb.ru/catalog/000199_000009_010256925

77. Grigor'ev N.N., Bobrovskaya E.A., Grigor'ev S.N. Current issues of surgery training technology. Sovremennye problemy nauki i obrazovaniya. 2016;4:141. (In Russian). [Electronic resource]. URL: https://science-education.ru/ru/article/view?id=24912

78. Rogachikov V.V., Bogorad I.V. The state and problems of the personnel training system for surgical specialties. Eksperimental'naya i klinicheskaya urologiya. 2019;2:14-19. (In Russian). DOI: 10.29188/2222-8543-2019-11-2-14-19

79. Bogomolov N.I., Goncharov A.G., Kashafeeva A.A. Modern educational technologies at the departments of surgery. Grekov's Bulletin of Surgery. 2022;181(1):94-98. (In Russian). DOI: 10.24884/0042-4625-2022181-1-94-98).

80. Surgery at the Central district Hospital: the guide for doctors. E.M. Blagitko, editor. Novosibirsk: Nauka. Publ. 1994:1398. (In Russian). [Electronic resource]. URL: https://rusneb.ru/catalog/010003_000061_e468cdaba22af014be5d2964ccdcfac4