Gallyamov E.A.

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 left resection of kidney

Laparoscopic left resection of kidney.
Professor Gallyamov E.A. is performing an operation (2013).

In this video the technique of laparoscopic left resection of kidney for malignant tumour, located in the lower pole, is demonstrated. Kidney mobilization and dissection of the renal artery and vein are done with the help of a 5mm Harmonic Scalpel Ethicon instrument. Hemostasis by means of manual stitching of the branch of the renal artery is demonstrated. Temporary ischemia is due to applying forceps onto the artery. Kidney resection is performed by means of 5 mm scissors by a “cold method” within the boundaries of healthy tissues. Kidney wound is stitched by V-lock system (MEDTRONIC COVIDIEN). Then the forceps are removed from the renal artery, and blood flow is restored in kidney. The tumour is placed into a special plastic container MEDTRONIC COVIDIEN, and is removed through the umbilical access.

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

Plasty of pelvic ureter segment

Plasty of pelvic ureter segment
Professor Gallyamov E.A. is performing an operation (2013).

In this film the technique of plasty of right pelvic ureter segment is presented. Troacars are introduced at their typical points for instruments (3x10 mm, 1x5 mm) under the guidance of optics. Access to the hilum of kidney is done by means of bringing down the hepatic angle of the large colon and dissection of tissues between Toldt’s fascia and fascia Gerotae by a 5 mm Harmonic Scalpel Ethicon instrument and instruments of Karl Storz Company. Mobilization of the lower pole of the right kidney is done, ureter is exposed at the level of its transition into pelvis. The pelvis has the following sizes: 4x4 cm. The ureter is dissected from the pelvis and is opened at the length of 2.5 cm in the longitudinal direction by the endoscopic scissors. Resection of the enlarged area of the pelvis is performed (the size 3x2 cm). The formation of pyeloureteroanastomosis (Anderson-Heins’s operation) has been performed, using continuous suture and “Polysorb” thread. A stent has been inserted into the pelvis through the ureter wound. Silicone drainage Ethicone has been placed into the paranephral space and in the area of anastomosis.

Laparoscopic left nephrectomy

Laparoscopic left nephrectomy.
Professor Gallyamov E.A. is performing an operation (2013).

The author is commenting on his operation. In the film the technique of laparoscopic left nephrectomy for renal cancer is presented. The access to kidney hilus is done by bringing down the splenic angle of the large colon and dissection of tissues between Toldt’s fascia and Fascia Gerotae by a 10 mm LigaSure (MEDTRONIC COVIDIEN) instrument and Karl Storz Company instruments. The renal vein and artery are ligated by the system Weck Hem-o-Lock and are transected by the endoscopic scissors. The preparation is placed into a special plastic container and is removed through the access according to Pfannenstil.

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