Lymphadenectomy

Laparoscopic D3 lymphadenectomy for right-sided colon cancer

Laparoscopic D3 lymphadenectomy for right-sided colon cancer.
D-r Puchkov D.K. (CMS) is performing an operation (2018).

In this film the technique of performing D-3 lymphadenectomy (operation stage) for right-sided colon cancer is presented. A 50 year-old male patient was treated with diagnosis: Cancer of hepatic flexure of colon fT3N1M0, G2. During preoperation investigation, on RCT research a few findings was detected: a big formation in the transverse colon, closer to the hepatic flexure about 5 cm in diameter, there were multiple increased lymphatic nodes in the mesentery of the ascending colon, without sings of metastatic lesion. There is no RCT information about local spreading of tumour. The first stage of operation: a 10 mm troacar was placed above the umbilicus and then 10 mm optic was introduced. Then a 5 mm troacar was introduced into epigastrium along the midline of abdomen under the guidance of optic and then 5 mm troacars were introduced into the right and left iliac area. During the revision of the abdominal cavity where was no evidence for liver metastases. The tumour was located in the proximal one-third of the transverse colon, is movable, firm, does not invade the serous layer, increased paracolic lymphatic nodes. Taking into consideration the intraoperation situation of the patient, we decided to perform a right hemicolectomy with D3 lymphadenectomy, high ligation of main arteries and veins. V.ileocolica was visualized, skeletonized and transected at the origin into the superior mesenteric vein with a 5 mm LigaSure (“Medtronic Covidien”) device, a. ileocolica is ligated in the origin of the superior mesenteric artery. Then the right part of the colon was mobilized from “downwards-to upwards” within the Toldt’s fascia by Harmonic Scalpel (“Ethicon”) device, a descending part of duodenum is visualized. The head of pancreas, infrapyloric lymphatic nodes were intact. Lymphatic nodes along the superior mesenteric artery and vein were removed. The operation is continued. Mesocolonectomy has been performed. The duration of this stage was 50 minutes.

Laparoscopic radical hysterectomy with aortoileac and pelvic lymphadenectomy, peritoneumectomy, extirpation of greater omentum and transvaginal resection of rectum

Laparoscopic radical hysterectomy with aortoileac and pelvic lymphadenectomy, peritoneumectomy, extirpation of greater omentum and transvaginal resection of rectum.
Professor Puchkov K.V. is performing an operation (2016).

ВIn this video the modern approach to treatment of cancer of ovary-neoadjuvant chemotherapy with the further interval cytoreduction (performing a radical operation with the removal of all affected tissues and lymphatic nodes) is demonstrated laparoscopically. This method implies performing a laparoscopic diagnostics at the first stage, and at this time blood is taken for the cytologic investigation; during this stage the assessment of the condition of the abdominal cavity and small pelvis, greater omentum, lymphatic nodes, pelvic abdomen is done, samples for biopsy of tumour and ovary are taken, as well as samples for biopsy from liver and diaphragm metastases. Then, in 7-10 days the second stage starts: neoadjuvant chemotherapy is done thrice. After control MRT and MLCT treating laparoscopy is performed, aimed at the radical removal of the initial center of tumour-panhysterectomy with the extirpation of greater omentum, aortocaval and pelvic lymphadenectomy, pelvic peritoneumectomy and removal of detected metastases. After the final histological investigation further chemotherapy is done

A 32 year-old patient has had cancer of ovaries pT3bNxM0 (canceromatous of the abdomen, metastases into the omentum, acsites). In case of laparoscopic diagnostics the following things have been found out: about 100 mL of muddy fluid, and millet-shaped mass have been observed, having the sizes 2-1.5 cm, on the parietal and visceral abdomen of the abdominal cavity and small pelvis, diaphragm. The greater omentum has millet-shaped mass up to 10 mm. The left ovary presents a round –shaped mass, with the even surface of the whitish colour, having the sizes 85x70 mm, that is adhered to the sigmoid colon. In the wall of the sigmoid colon that is located near the left ovary, there is an infiltrate -50x20 mm. On the abdomen of the retrouterine space there are multiple excrescences, reminding of a cauliflower. Swab has been taken from the abdominal cavity, samples from the tumour, greater omentum and metastases from the parietal abdomen have been taken for biopsy.

During the histological investigation highly differentiated endometrioid adenocarcinoma of solid structure has been found out, as well as metastases in all preparations. Cytology has presented metastatic effusion.

After chemotherapy- has been done thrice- laparoscopic radical hysterectomy with aortoileac and pelvic lymphadenectomy, peritoneumectomy, extirpation of the greater omentum and resection of rectum with aortoileac and pelvic lymphadenectomy have been performed. Operation is performed with the help of a 5 mm Liga Sure MEDTRONIC COVIDIEN instrument and Ethicon Harmonic Scalpel. For fast and successful operation performing Clermont Ferrand (KARL STORZ) uterine manipulator is used. Dissected lymphatic nodes are placed into separate plastic packets and are removed from the abdominal cavity alongside with the uterus and omentum. The rectum is exposed, preserving mesorectal fascia and is transsected by Endo GIA MEDTRONIC COVIDIEN apparatus (a 60 mm intestinal cassette).The proximal end is exteriorized transvaginaly, and an affected area is removed with the immersion of the head of a stitching apparatus into the lumen of the colon. The stump is placed into the abdominal cavity. Vagina is stitched by interrupted suture, using “Monocril” thread. The final stage is a formation of circular “end-to-end” anastomosis of large colon by means of a 31 mm MEDTRONIC COVIDIEN apparatus. Operation time is 3 hours 10 minutes.

In 10 days after the radical operation chemotherapy is continued.

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

Laparoscopic anterior resection of rectum with aortocaval lymphadenectomy

Laparoscopic anterior resection of rectum with aortocaval lymphadenectomy
Professor Puchkov K.V. is performing an operation (2015).

A 59 year-old female patient was treated, having the diagnosis: Cancer of the upper third part of rectum fT3N1M0, G2. During preoperation investigation of abdominal cavity due to RCT, multiple increased up to 1.5-2 cm lymphatic nodes along the inferior mesenteric artery, aorta until the area of aorta bifurcation have been found out. The “classical” scheme of positioning of trocars was used: in the right and left iliac area and to the left of mesogastric area. The operation was started with performing an aortocaval lymphadenectomy with a 5 mm Harmonic Scalpel instrument (“Ethicon”). Transection of the inferior mesenteric artery was at the origin with applying two titanic clips. Then dissection of peritoneum to the right of rectum was done, exposure of rectum along the posterior wall with the identification of the left ureter. The next stage was dissection of peritoneum of the left lateral canal and mobilization of the descending part of the colic colon. Exposure of rectum was done in 5 cm lower from the distal border of the tumour along the posterior wall and then along the right and left semicircumference, and only at the end-along the anterior wall. Transection of the large colon in its distal part was done with Endo GIA-45 (a violet reload) device («MEDTRONIC COVIDIEN»). Extraction of specimen was done via minilaparotomy. At the end of operation, continuous suture was placed between peritoneum and the proximal part of rectum, higher then anastomosis level. Operation time was 120 minutes.

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

Laparoscopic radical hysterectomy with the pelvic lymphadenectomy

Laparoscopic radical hysterectomy with the pelvic lymphadenectomy.
Professor Puchkov K.V. is performing an operation (2011)

In this video the technique of the radical hysterectomy with the pelvic lymphadenectomy in case of cancer of endometrium is presented. Hysterectomy is performed with the help of a 10 mm Liga Sure MEDTRONIC COVIDIEN instrument. There is an indication to remove nodes en block while performing lymphadenectomy; the ultrasonic dissectors, produced by MEDTRONIC COVIDIEN and Ethicon companies, are used. Ultrasound use gives a possibility to “weld” thin lymphatic ducts properly to prevent from lymphorrhea development. And there is no need to use drainage after the operation. A special attention is paid to the restoration stage-stitching of vagina –stitching it to the sacrouterine ligaments to prevent from prolapse of uterus after operation.

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