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Laparoscopic anterior resection with D3 - lymphadenectomy, preserving of the left colic artery, transvaginal specimen extraction (N.O.S.E.S. technique)

The author: Puchkov D. K.

Tags: Puchkov D.K. NOTES Resection of the colon Colon cancer

Laparoscopic anterior resection with D3 - lymphadenectomy, preserving of the left colic artery, transvaginal specimen extraction (N.O.S.E.S. technique)
Surgeon D.K. Puchkov (2020y.)

This film shows the technique of performing laparoscopic anterior resection with D3 - lymphadenectomy, preserving of the left colic artery, transvaginal specimen extraction (N.O.S.E.S. technique).

Patient B., 49 years old, was treated with the diagnosis: Cancer of the upper third part of the rectum fT2N2M0, G2. During the preoperative examination, according to MRI of the small pelvis in the rectum about 11 cm from the anal verge was found a formation 2 cm in diameter. According to CT-scans along the upper rectal artery, in the area of the origin of the inferior mesenteric artery were found a few enlarged lymph nodes.

A 10 mm trocar, endoscope were introduce above the umbilicum. In the right and left mesogastrium region 5 mm trocars were introduced; in the right iliac region a 10 mm trocar was introduced. Firstly, the patient was transferred to the Trendelenburg position. The tumor was not visually defined; intraoperative colonoscopy was performed to determine the border of the resection.

The parietal peritoneum was dissected along the IMA, medial-to-lateral mobilization was performed, the left ureter was visualized, then the IMA was mobilized, the superior rectal artery and the first sigmoid artery were selectively crossed with the 5mm LigaSure device. The left part of the colon was mobilised using a Harmonic scalpel (Ethicon).

The mobilisation of the rectum to the level of resection within the mesorectal fascia was performed.

A colpotomy was performed, a plastic sleeve was inserted into the abdominal cavity to prevent tumor contamination of the vagina. The colon was removed, the proximal resection border was visualised (the demarcation line), the specimen was cut off extracorporeally. The head of the CDH-29 device was inserted into the proximal part of the colon and fixed with a purse string suture (thread “Vicryl 2.0”), immersed in the abdominal cavity. The colpotomy opening was intracorporeally sutured. Leak control - no air intake.

The CDH-29 device was transanally introduced. The head was adapted with the device; the device was removed. The trocar wounds were sutured and the skin was trimmed with OmniStrip stripes. Operation time 145 minutes.

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.

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