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Laparoscopic excision of a giant (22 cm) presacral teratoma

Laparoscopic excision of a giant (22 cm) presacral teratoma.
Professor Puchkov K.V. is performing an operation (2018).

A 22 year-old female patient had the following complaints: pain in perineum, difficulties in passage of gases, and episodic urinary retention. During investigation presacral cyst was found out with the size 22 cm, wall thickness up to 1.5 cm, without contrast accumulation dye to MRT research. Teratoma was located in the area of sacral and coccygeal bones, with compression of rectum, ureters and urinary bladder. In this video the technique of laparoscopic dissection of rectum and the posterior wall of vagina, exposure of cyst out of the surrounding tissues by a 5 mm monopolar electrode and LigaSure («MEDTRONIC COVIDIEN») instrument is demonstrated. The cyst was dotted, an ejector (1500 mL) evacuated the contents. In the lumen hair and fat was found. The cyst was dissected from m.levator ani, wall of rectum and vagina. Hemostasis was performed by bipolar forceps and hemostatic PerClot (Italy). Operation area was drained.

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 giant presacral teratoma (14 cm)

Laparoscopic approach in treatment of giant presacral teratoma (14 cm)
Professor Puchkov K.V. is performing an operation (2017).

This patient had 2 attempts to perform a laparotomic operation for presacral teratoma. During investigation presacral cyst, having the size 14 cm with wall thickness up to 4 cm, haв been found out. During MRT research, contrast substance had not been accumulated. Teratoma was located in the area of the sacral bone and promontorium, with compression of common iliac veins. In this video the technique of laparoscopic dissection of rectum and urinary bladder, exposure of the cyst out of the surrounding tissues by a 5 mm monopolar electrode and LigaSure («MEDTRONIC COVIDIEN») instrument is demonstrated. Taking into consideration the cyst size and wall thickness of the cyst, during the first stage the cyst was incised, without opening the lumen, with leaving its wall in the area of sacral vessels. Then carefully the remnants of the cyst were removed by a monopolar electrode. Hemostasis was performed by bipolar forceps and hemostatic PerClot (Italy). There was no need to place drainage. Operation duration was 1 hour 50 minutes.

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

Excision of presacral teratoma (8 cm), complicated by fistula, using laparoscopic approach

Excision of presacral teratoma (8 cm), complicated by fistula, using laparoscopic approach
Professor Puchkov K.V. is performing an operation (2016).

This patient was operated for perineal fistula several times. During investigation presacral teratoma (the size is 8 cm) was found out, it had draining outside. Fistula was opened on the skin of the sacrococcygeal area. In this film the technique of laparoscopic dissection of rectum and exposure of the cyst out of the surrounding tissue by a 5 mm LigaSure («MEDTRONIC COVIDIEN») instrument is demonstrated. At the final stage excision of fistula by perineal access and its removal alongside with the cyst was performed. The cavity was drained from the perineal side, and pelvic abdomen was restored by continuous suture, using laparoscopic approach. The way the excised fistula and teratoma look like has been shown. Operation duration was 1 hour 30 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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