Monopolar hook

Laparoscopic low anterior resection of rectum (partial TME-total mesorectal excision) with the use of a monopolar “hook” electrode

Laparoscopic low anterior resection of rectum (partial TME-total mesorectal excision) with the use of a monopolar “hook” electrode.
D-r Jim Khan is performing an operation (Great Britain, Portsmouth) (2018).

In this film the technique of performing low anterior resection of rectum (partial TME - total mesorectal excision) with the use of a monopolar “hook” electrode is presented. A 44 year-old male patient was treated, having the diagnosis: Cancer of middle third part of rectum fT2N0M0, G2. During the preoperation investigation of organs of abdominal cavity and small pelvis, using MRT and RCT, no data about pathologic lymphatic nodes in the abdominal cavity, small pelvis and mesorectum had been obtained. The “classical” scheme of positioning of trocars was used: on the right in the iliac area, to the right and to the left-in the mesogastric area. Operation started with the incision of peritoneum to the right of rectum, identification of interfascial layer without vessels with the help of a monopolar instrument “hook” (“Karl Storz”). Transection of the inferior mesenteric artery took place near the origin with Harmonic (“Ethicon”) device after preliminary clipping of it by titanic clips. Then exposure of rectum along its posterior wall took place with identification of the left ureter. The next stage was exposure of the inferior mesenteric vein, identification of embryological layer of the large colon, its exposure in the medialateral direction towards the splenic flexure. For safe mobilization of the splenic flexure of the colic colon inframesocolic access was used. Preliminary dissection of pancreas was done, opening of omentum sac, after that peritoneum of the left lateral canal was dissected, mobilization of the descending part of the colic colon and the splenic flexure of the colic colon was done. Exposure of rectum was done in 5 cm lower than lower border of tumour along the posterior wall, then-along the right and left semicircumference, and only at the end-along the anterior wall. Transection of the colon in its distal part was done EchelonFlex-60 instrument (a blue reload) (“Ethicon”). Then midline minilaparotomy (approx.5 cm) was performed, the latex ring “Dextrus” was placed in the wound for restriction the tissue of the anterior abdominal wall from the colon with tumour. The colon was exteriorized, resection of specimen was done, CDH-29 (”Ethicon”) device head was inserted into the proximal part, it was fixed by purse-string suture, using “Vicryl” 2-0 thread, and immersed into the abdominal cavity. CDH-29 device was inserted transanally, stitching was done, then CDH-29 was removed. The next stage loop ileostoma was created in the right iliac area. The operation was finished by placing drainage transabdominally via trocar wound in the left mesogastric area. Operation duration was 240 minutes.

Laparoscopic abdominal perineal resection (APR) of rectum, using a monopolar hook

Laparoscopic abdominal perineal resection (APR) of rectum, using a monopolar hook
Professor Puchkov K.V. is performing an operation (2018).

In this film the technique of performing of abdominal perineal resection (APR) of rectum with the expanded lymphadenectomy, using a monopolar “hook” electrode is presented. A 59 year-old female patient was treated with the diagnosis: Low rectal cancer fT3N1M0, G1. She had a course of neoadjuvant chemotherapy (CLT) with preoperative radiotherapy.
Exposure of rectum had done within the injuring of mesorectal fascia, with preserving the structures of upper and lower hypogastral plexus (sympatic and parasympatic nerves) laparoscopically. The “classical” positioning of trocars had been used: in the right and left iliac area, and in the mesogastric area to the left. The operation was started with dissection of pelvic in the right side of rectum, then exposure of rectum along the posterior wall with identification of the left ureter. Lymphodissection was performed in the area of origin of the inferior mesenteric artery, transection of superior rectal artery (with preserving of the left colic artery) was done with a 5 mm “LigaSure” («MEDTRONIC COVIDIEN») instrument. The next stage was dissection of the left lateral canal and mobilization of the descending part of the colic colon. Exposure of rectum up to pelvic floor along the posterior semicircumference took place within the injuring of the mesorectal fascia, then along the right and left semicircumference, and only at the end-along the anterior wall. Transection of the large colon in its proximal part had performed with EndoGIA-60 (a blue reload) device («MEDTRONIC COVIDIEN»).
The perineal stage had done in a classical approach. Stoma was created in the left iliac area. The drainage was placed via perineal wound. Operation duration was about 150 minutes.

You can read about this technique in detail on the personal cite of Professor Puchkov Konstantin Viktorovich. To go to the link.

Laparoscopic cholecystectomy, using the single access (S.I.L.S.Port COVIDIEN)

Laparoscopic cholecystectomy, using the single access (S.I.L.S.Port COVIDIEN).
Professor Puchkov K.V. is performing an operation (2018).

In this video the technique of laparoscopic cholecystectomy for chronic calculous cholecystitis, using the single port (SILS port COVIDIEN), is presented. The sizes of the gallbladder are as follows: 14x7 cm. The doctor is commenting on positioning of the port. Taking into consideration big sizes of the gallbladder, its puncture is being done and evacuation of 100 mL of thick bile is taking place. The technique of transcutaneous fixing stitches, a careful exposure of the cystic duct and artery by a 5 mm monopolar hook and mini retract COVIDIEN instrument and clipping of all these structures by a 5 mm automatic applicator is presented. The dissected gallbladder is removed from the abdominal cavity in a plastic container.

You can read about this technique in detail on the personal cite of Professor Puchkov Konstantin Viktorovich. To go to the link.

Laparoscopic cholecystectomy, using the single access (S.I.L.S. Port COVIDIEN)

Laparoscopic cholecystectomy, using the single access (S.I.L.S. Port COVIDIEN).
Professor Puchkov K.V. is performing an operation. (2015).

In this video the technique of laparoscopic cholecystectomy, using the single port (SILS port COVIDIEN) for chronic calculous cholecystitis, is presented. The size of the gallbladder is as follows: 12x5 cm. The technique of transcutaneous fixing stitches, a careful exposure of the cystic duct and arteries by a 5 mm monopolar hook and mini retract COVIDIEN instrument and clipping of these structures by a 10 mm applicator is demonstrated.

You can read about this technique in detail on the personal cite of Professor Puchkov Konstantin Viktorovich. To go to the link.