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Surgical treatment of retrocervical endometriosis with the lesion of sigmoid colon, rectum, caecum and iliac colon, using laparoscopic access

Professor Puchkov k.V. is performing an operation (2018).

A 32 year-old patient was operated laparoscopically for deep infiltrative retrocervical endometriosis of sacrouterine ligaments and lesion of sigmoid colon, rectum, caecum and iliac colon. A repeated laparoscopy to evaluate the result had been performed in a year after surgery.
During the first operation was found out an invasion of the sigmoid colon in two areas, with stenosis of lumen more than 50%. Lesion of rectum and iliac colon with invading to the wall up to the submucous layer was identified. The whole of the wall thickness of caecum had been affected. For the better visualization of the surgical site temporary fixation of ovaries by transabdominal stitching was done. In the video safe technique of removing of endometriosis of sacrouretal ligaments and “shaving” of rectum with using of 5 mm monopolar electrode is demonstrated.
A 5 mm LigaSure («MEDTRONIC COVIDIEN») instrument was used for dissection of mesentery of the sigmoid colon, transection of the distal part by a linear endoscopic stitching device took place. The affected part of colon was removed through the minilaparotomy, the dissection of proximal part of colon was near infiltrate. Then the head of stitching device was inserted into the proximal part to form circular “end-to-end” anastomosis using a 31 mm device («MEDTRONIC COVIDIEN») laparoscopically.
At the second stage, resection of caecum with endometriosis focus with a linear endoscopic stitching device was done. Trocar wound in the right iliac area was expanded up to 3 cm, and an affected area of the iliac colon is exteriorized onto the abdominal wall. Then “shaving” of endometrioid foci up to the submucous layer was done, using a monopolar electrode. An atraumatic manual suture was placed on defects of the intestinal wall, using “Polysorb” 4-0 thread. The colon was immersed into the abdominal cavity. Anti-adhesive gel was applied to the operation area. Postoperative therapy was performed with Diferiline-3.75 mg intramuscularly within 6 months. The repeated laparoscopy to evaluate the result of treatment was performed in a year after surgery. In the abdomen cavity there was no any sings of adhesions, zones of excised infiltrates was covered by peritoneum. In the area of anastomosis on the large colon and in the area of suture on the blind gut thin scars were found out. At the area of “shaving” on the iliac colon soft scar was found out. The result of treatment is excellent.

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

Laparoscopic approach in the treatment of retrocervical endometriosis with the affected iliac colon

Laparoscopic approach in the treatment of retrocervical endometriosis with the affected iliac colon.
Professor Puchkov K.V. is performing an operation (2016).

A 34 year-old patient was operated for deep infiltrating retrocervical endometriosis and affected iliac colon. In her anamnesis it is mentioned that she has had two cesarean sections. During laparoscopy it had been found out that the patient has a massive adhesions of organs of small pelvis with the involvement of greater omentum, sigmoid colon, uterus and the urinary bladder. In this video the technique of adhesion dissection by a 5 mm monopolar electrode and a 5 mm LigaSure («MEDTRONIC COVIDIEN») instrument is presented. During revision the lesion of the iliac colon by the invasive endometriosis at the distance of 4 cm from the ileocecal angle had been found out. The length of lesion was 6 cm. The focus invaded to all layers of the intestinal wall, and stenosis of organ lumen had been formed. Trocar port was expanded up to 4 cm, and an affected area of the colon was exteriorized onto the abdominal wall. Resection of some area of small colon was done with the dissection of the mesentery near the wall of colon, preserving the branches of a.ileocolica. It has given a possibility to form “end-to-end” anastomosis near the large colon, placing an atraumatic suture, using manual stitching and “Polysorb” thread 4-0. Suture line was additionally strengthened by a hemostatic patch TachoComb (Austria). Anastomosis was immersed into the abdominal cavity. Operation duration 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 approach in treatment of endometriosis cysts of ovaries with extensive lesion of the small colon (“shaving“ of foci)

Laparoscopic approach in treatment of endometriosis cysts of ovaries with extensive lesion of the small colon (“shaving“ of foci)
Professor Puchkov K.V. is performing an operation ( 2015).

A 32 year-old patient has endometriosis cyst of ovaries, external genital endometriosis and extensive lesion of the iliac colon. In this video it is shown that during laparoscopy lesion of the iliac colon had been found out. Infiltration was determined at the length of 25 cm (10 foci within the range 3-8 mm) with the deformation of the intestinal wall without involvement of the submucous layer. Trocar wound in the right iliac area was enlarged up to 4 cm, and an affected area of the colon was exteriorized onto the abdominal wall. Then “shaving” of all foci up to the submucous layer of the small colon by a thin monopolar electrode was done. An atraumatic manual suture was placed on the defects of the colon wall,“Polysorb” thread 4-0 had been used. The colon was immersed into the abdominal cavity. Anti-adhesion gel was applied onto the area of operation. Operation duration was 90 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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