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This film shows the technique of dissecting of the left parts of the colon, modified combined approach for splenic flexure mobilization for cancer of the descending colon.

This film shows the technique of dissecting of the left parts of the colon, modified combined approach for splenic flexure mobilization for cancer of the descending colon.
Surgeon D.K. Puchkov (2019y).

This film shows the technique of dissecting of the left parts of the colon, modified combined approach for splenic flexure mobilization for cancer of the descending colon.

Patient M., 62 years old, was treated with a diagnosis of cancer of the descending colon fT3N0M0, G2. During the preoperative examination, RCT of abdominal organs in the descending colon was found a volumetric formation ~ 4 cm in diameter, no enlarged lymph nodes in the abdominal cavity were detected.

A 10 mm trocar, camera were introduced in the umbilical area. In the mesogastrium, in the right and left iliac regions three 5 mm trocars were introduced. The tumor was located in the proximal third of the descending colon, mobile, dense, the serous layer was not involved.

The parietal peritoneum was dissected along the IMA, the IMA was mobilized at the origin of its bifurcation. IMA branches were skeletonized, the left colon artery was selectively cut with a 5mm Ligasure device, and then the IMV was transsected. The left parts of the colon were mobilized with the Harmonic device in medial-to-lateral (inframesocolic) approach in the interfascial layer with visualization of the pancreatic tail.

An entrance to the omental bursa was made through the mesentery of the transverse colon, the mesentery was separated from the pancreas to the splenic flexure. The peritoneum was dissected along the left lateral canal to the splenic flexure.

Dissection of the gastro-colon ligament was performed, the splenic flexure of the colon was mobilized. The operation stage time was 65 minutes.

Laparoscopic right hemicolectomy

Laparoscopic right hemicolectomy.
D-r Puchkov D.K. (CMS) is performing an operation (2018).

• In this video the technique of laparoscopic right hemicolectomy is presented. A 53 year-old female patient was operated with diagnosis: Cancer of the hepatic flexure of the colon fT3N0M0, G2. During preoperation investigation of the abdominal cavity according to RCT, was found extensive formation about 5.5 cm in diameter and multiple increased lymphatic nodes along the artery ileocolica, without symptoms of their metastatic lesion. The first stage of operation: a 10 mm troacar was placed above the umbilicus, 10 mm optic was introduced. Then a 5 mm troacar was introduced in epigastrium along the midline of abdomen under the guidance of optic, 5 mm troacars were introduced into the right and left iliac areas. During revision of the abdominal cavity where was not found any sings of metastases in liver. The tumour was found in the cecum, movable, firm, does not involve the serous layer. Increased lymphatic nodes of the first priority were visualized. Intraoperatively surgeons decided to perform a right hemicolectomy with the high ligating of artery and vein ileocolica. Artery and vein were visualized, skeletonized, transected near the area of its origin with 5 mm LigaSure (“Medtronic Covidien”) device. The right part of the large colon was mobilized from “downwards-to- upwards” within the boundaries of Toldt’s fascia with Harmonic (“Ethicon”) scalpel, the descending part of duodenum was visualized, the head of pancreas, infrapyloric lymphatic nodes are intact. The abdomen of the right lateral canal was transected, resection of gastrocolic ligament up to the level of middle one-third of the transverse colon was done. Mesentery of the colic colon was mobilized up to the level of middle one-third of the transverse colic colon. Mesentery of the iliac colon was transected at the distance of 15 cm proximally to Bauhin’s (ileocecal) valve. Middle minilaparotomy was performed. Latex ring “Dextrus” was placed into the wound to restrict tissues of the anterior abdominal wall from the colon with tumour, the colon is exteriorized into the wound, resection of the right parts of the colon and iliac colon was done. Bistapler ileotransversoanastomosis “side –by-side” was performed. Edges of anastomosis were additionally stitched by “Vicryl” 3-0 thread. The abdominal cavity was drained via troacar incision in the right iliac area. Minilaparotomic and troacar wounds were stitched layer by layer. Aceptic bandage was applied. Operation duration is 80 minutes.

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 right hemicolectomy

Laparoscopic right hemicolectomy
D-r Puchkov D.K. (CMS) is performing an operation (2018).

A 61 year-old female patient was treated with diagnosis: Cancer of the hepatic flexure of the colon fT2N0M0, G2. During preoperation investigation of the abdominal cavity an extensive mass about 3.5 cm in diameter had been found out in the hepatic flexure of the colon according to the results of RCT. No lymph nodes were involved. The first stage: incision was done in paraumbilical area-3 cm. Platform QuadroPort+ (“Olympus”)was introduced into the abdominal cavity for performing one-port operation, CO2 gas was used for peritoneum. A 10 mm laparoscope, a 5 mm soft straight forceps and 5 mm curved forceps (“Medtronic Covidien”) and Harmonic scalpel device was introduced into the port. Firstly adhesion was separated. A. ileocolica was visualized, skeletonized and transected at the origin with 5 mm LigaSure (“Medtronic Covidien”) device. Then right part of the large colon was mobilized “downwards-to-upwards” within the boundaries of Toldt”s fascia with Harmonic Scalpel (“Ethicon”) device, descending part of duodenum and the head of pancreas were visualized. The peritoneum of the right lateral canal was transected, the gastrocolic ligament was resected up to the level of middle one-third of the transverse colon. Mesentery of the colon was mobilized up to the level of middle one-third of the transverse colic colon. Mesentery of the iliac colon was transected at the 10 cm proximally to Bauhin’s valve. The platform QuadroPort+ was removed from the abdominal cavity, resection of the right parts of the iliac and colon was done. Bistapler ileotransversoanastomosis “side-by-side” was formed. Anastomosis edges were additionally stitched by “Vicryl” 3-0 thread. The abdominal cavity was drained. Minilaparotomic wound was stitched layer by layer. Aceptic bandage was applied. Operation was about 145 minutes.

Laparoscopic right hemicolectomy

The author: A.Forgione

Tags: A.Forgione Hemicolectomy Colon cancer

Laparoscopic right hemicolectomy
Professor A.Forgione is performing an operation (2016).

In this film the technique of performing laparoscopic right hemicolectomy for tumour of cecum was demonstrated. The first step was - the exposure of the superior mesenteric vein near the return of v. ileocolica, then exposure of a. ileocolica, then their separate transection. Exposure of colon took place within the boundaries of the mesocolic fascia in medilateral direction. After mobilization of the colon, ligation of the right branch of middle colic artery and vein takes place, then exposure of colon along the lateral canal. Colon transection and formation of intracorporeal anastomosis were done with using of a linear stitching device (“Ethicon”) with the blue cassette. Anastomosis area was additionally covered by sero-serous single interrupted suture.

Laparoscopic resection of cecum and appendectomy for infiltrative endometriosis

Laparoscopic resection of cecum and appendectomy for infiltrative endometriosis.
Professor Puchkov K.V. is performing an operation (2016).

The operation was performed for infiltrative endometriosis of cecum and base of appendix. The right fallopian tube and ovary were involved in the infiltrate. In the video the technique of adhesiolysis between appendages of uterus and cecum with 5 mm monopolar electrode, was demonstrated. Dissection of the mesentery of vermiform process was performed with a 5 mm LigaSure (“MEDTRONIC COVIDIEN”) instrument and instruments of Karl Storz Company. After mobilization it should be determined whether the whole of the cecum was involved into the process or it was without involving of ileocecal valve. Then the intestinal wall, lower than infiltrate level, was stitched and transected by a linear stitching device (“MEDTRONIC COVIDIEN”). Revision of the wound suture was done-there was no deformity and narrowing of ileocecal isthmus. Specimen was removed through the abdominal cavity via a 12 mm troacar. Duration of this stage was 16 minutes.

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

Simultaneous laparoscopic hysterectomy, right hemicolectomy with intracorporeal anastomosis creation and extraction of specimen via vagina (N.O.S.E. technique)

Simultaneous laparoscopic hysterectomy, right hemicolectomy with intracorporeal anastomosis creation and extraction of specimen via vagina (N.O.S.E. technique)
Professor Puchkov K.V. is performing an operation (2013).

A 51 year-old woman was operated for myoma of uterus in combination with adenomyosis and hyperplasia of endometrium, carcinoid of the ascending colon, stage 2. In this film the technique of hysterectomy and ligation of the ascending branch of the uterine artery with a 10 mm LigaSure («MEDTRONIC COVIDIEN») instrument and «Karl Storz Company» instruments was demonstrated. Hemicolectomy was performed in lateral to medial approach with a 5 mm Harmonic Scalpel Ethicon instrument, with dissection of mesocolon along the superior mesenteric vein. Transection of the iliac colon and ascending colon was performed with Endo GIA («MEDTRONIC COVIDIEN») device with a 60 mm length. Anastomosis was performed intracorporeally, “side-to-side” by mechanic and manual stitching. Then the affected part of the colon was removed from the abdominal cavity through the colpotomic opening. The final stage – vagina was stitching by interrupted resorbable suture.

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

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