Pelvic lymphadenectomy

Laparoscopic radical hysterectomy with pelvic lymphadenectomy

Laparoscopic radical hysterectomy with pelvic lymphadenectomy
Professor Puchkov K.V. is performing an operation (2017)

A 52 year-old patient is operated on for cancer of endometrium (adenocarcinoma, size is 4 cm, invading to endometrium more than 50 %, G 2). Video presents the technique of radical hysterectomy with pelvic lymphadenectomy for cancer of endometrium. Hysterectomy is performed by means of a 5 mm LigaSure instrument (MEDTRONIC COVIDIEN) and ultrasound dissector of Ethicon company. Ultrasound use helps to “weld” thin lymphatic vessels. As lymphorrhea is absent, there is no need to drain the abdominal cavity after operation. A special attention should be paid to the restorative period – stitching of vagina and its attaching to sacrouteral ligaments for the sake of prophilaxis of prolapse after operation.

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

Extraperitoneal radical prostatectomy with pelvic lymphadenectomy for cancer of the prostate gland

Extraperitoneal radical prostatectomy with pelvic lymphadenectomy for cancer of the prostate gland
Professor Gallyamov E.A. is performing an operation (2013).

In this video the technique of extraperitoneal radical prostatectomy with pelvic lymphadenectomy for cancer of the prostate gland is presented. The midline incision (the length is 3 cm) is done beneath the umbilicus, the anterior and posterior leaves of fascia of abdomival rectus muscle. A spacemaker is introduced into the preabdominal space, and the preabdominal space has been formed. A spacemaker is removed, and optic troacar is placed there. Under the visual guidance 4 working ports are established: three 5mm troacars, one 11 mm troacar. Symphysis, prostate, urinary bladder are visualized. Pelvic lymphadenectomy has been performed. Puboprostatic ligaments are transected, using Inseal Ethicon apparatus. The dorsal venous complex is exposed and stitched by “Vicryl” 1-0 thread. Detrusor fold is transected, intrapelvic fascia is opened, prostate pedicles are exposed, urethra is visualized. The urethra is transected by “cold” scissors with preserving narrow neck of urinary bladder. Deferent ducts are exposed along their length and are transected. Seminal vesicles are exposed, and are separated from tissues that are adjacent to prostate. Prostate pedicles are transected, using LigaSure apparatus. Prostate is mobilized along the posterior surface with opening Denonvillier’s fascia. Prostate apex is exposed. Dorsal venous complex is transected. The distal part of urethra is exposed. Urethra is transected by scissors. The prostate is placed into the container. Ureterocystoanastomosis has been formed by means of 2 threads V-lock 3-0 15 cm, using continuous suture. Whether anastomosis is hermetic or not, is checked by introducing 150 mL of saline solution into urinary bladder.

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.