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Laparoscopic dissection
Laparoscopic dissection of the external genital endometriosis of the pelvic abdomen. Ureterolysis. Ureter duplication on the left
Автор: Puchkov K.V.
Laparoscopic dissection of the external genital endometriosis of the pelvic abdomen. Ureterolysis. Ureter duplication on the left. Professor Puchkov K.V. is performing an operation (2017).
A 25 year-old patient is operated on for the external genital endometriosis, stage 3. In this video the technique of dissection of centres on the abdomen, using instruments of Karl Storz Company, is presented. Attention should be paid to the preliminary opening of the abdomen by means of a monopolar electrode near the centre, giving a possibility to carbonic acid gas to penetrate into the retroperitoneal space. Gas presence gives a possibility to perform more safe dissection of affected tissues. Simultaneously traction of the endometrioid centre in opposite direction is performed, giving a possibility to see clearly the structures of the retroperitoneal space. Using the soft forceps, the exposure of the tubular structures is done subperitoneally, they are moved aside from the endometrioid centre. During the tissue dissection the ureter duplication has been found out. One should bear in mind the variants of anatomy to prevent the injury of ureters during the dissection of the endometrioid centres. Antiсommisural “Mesogel” barrier is introduced into the pelvic area. The operation duration is 50 minutes.
The details of this technique you can read on the personal cite of Professor Puchkov K.V. To go to the link
Laparoscopic dissection of the hypogastic plexus in case of nerve-preserving resection of rectum
Автор: Puchkov K.V.
Laparoscopic dissection of the hypogastic plexus in case of nerve-preserving resection of rectum
Professor Puchkov K.V. is performing an operation (2017).
A 32 year-old patient was operated for infiltrative endometriosis, invading to the wall of rectum, with stenosis of lumen more than 50%.The film presents safe technique of exposure of the right and left inferior hypogastric nerves by a 5 mm monopolar electrode during resection of colon.
You can read about this technique in detail on the personal cite of Professor Puchkov Konstantin Viktorovich. To go to the link.
Laparoscopic dissection of the lower hypogastric plexus in case of nerve-preserving resection of rectum
Автор: Puchkov K.V.
Laparoscopic dissection of the lower hypogastric plexus in case of nerve-preserving resection of rectumProfessor Puchkov K.V. is performing an operation (2016).
A 37 year-old patient with infiltrative endometriosis was operated for dissection of lower hypogastric plexus with nerve-preserving resection of rectum. The film demonstrates safe technique of exposure of the right and left lower hypogastral nerves by a 5 mm monopolar electrode when rectum was resected.
You can read about this technique in detail on the personal cite of Professor Puchkov Konstantin Viktorovich. To go to the link.
Laparoscopic approach in treatment of the retrocervical endometriosis, stage 4. Uteterolysis
Автор: Puchkov K.V.
Laparoscopic approach in treatment of the retrocervical endometriosis, stage 4. Uteterolysis. The operation is performed by Professor Puchkov K.V. (2015 )
A 31 year-old patient is operated on for retrocervical infiltrating endometriosis, invading to the wall of rectum and vagina, uterine cervix and sacrouterine ligaments. Both ureters are involved into the infiltration. In this video the safe technique of consecutive exposure of the right and left ureters by means of a 5 mm monopolar electrode and a 5 mm Liga Sure MEDTRONIC COVIDIEN instrument is demonstrated. For the better visualization of the surgical site compulsory temporary fixation of ovaries, using transabdominal stitching, is done. Using the soft forceps, the tubular structures are exposed subperitoneally, moving them aside from the endometrioid centre. While dissecting tissues on the left, the change of the anatomy of ureter positioning due to the infiltrative changes in this area has been clearly seen. During dissection it has been found out that the ureter is shifted to the right, coming into close contact with the right ureter. One should bear in mind possible changes of anatomy in this area in order not to injure ureters during the dissection of the endometrioid centres.
You can read about this technique in detail on the personal cite of Professor Puchkov Konstantin Viktorovich. To go to the link.
Laparoscopic dissection of the endometrioid cyst of the left ovary and dissection of the external genital endometriosis
Автор: Puchkov K.V.
Laparoscopic dissection of the endometrioid cyst of the left ovary and dissection of the external genital endometriosis.
Professor Puchkov K.V. is performing an operation (2014).
A 22 year-old patient is operated on for endometrioid cyst of the left ovary (7 cm) and external genital endometriosis, stage 3. Having the aim to preserve the ovulatory potential, the final hemostasis near the cyst bed is done with the help of PerClot hemostatic preparation (Italy). In this video the technique of dissection of the centres on the abdomen by means of Karl Storz Company instruments is demonstrated. One should pay attention to the preliminary opening of the abdomen near the centre, giving a possibility to the carbonic acid gas to penetrate into the retroperitoneal space. Gas presence helps to perform safer dissection of the affected tissues. Simultaneously traction of the endometrioid centre is done in the opposite direction, giving a possibility to visualize clearly the structures of the retroperitoneal space. The cyst is opened, and its contents are evacuated. Then enucleation of the cyst membrane is performed, and point hemostasis is done by a bipolar instrument. The final hemostasis is performed by PerClot preparation (Italy). To prevent adhesion development the anticommisural “Mesogel” barrier is introduced into the small pelvis area. Operation duration is 40 minutes.
You can read about this technique in detail on the personal cite of Professor Puchkov Konstantin Viktorovich. To go to the link.
