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Laparoscopic cholecystectomy, Kalo triangle dissection

Laparoscopic cholecystectomy, Kalo triangle dissection.
Professor Puchkov K.V. is performing an operation (2018).

The video shows the technique of laparoscopic classical cholecystectomy for chronic calculous cholecystitis. At this stage, special attention is paid to careful dissection of tubular structures in the area of the Kahlo triangle with a monopolar electrode (this stage is specifically shown without mounting). After dissection of the cystic duct and artery, as well as visualization of the lateral wall of the common bile duct, the selected structures cut between the clips. A 10 mm applicator is inserted from the working port in the left hypochondrium (it was used to perform cardiomyotomy for achalasia cardia). The gallbladder is removed from the abdominal cavity in a plastic container. You can read more about the techniques on the personal site of Professor Konstantin Viktorovich Puchkov.

You can read more about the techniques on the personal site of Professor Konstantin Viktorovich Puchkov.

Simultaneous laparoscopic cardiomyotomy with partial fundoplication and cholecystectomy

Simultaneous laparoscopic cardiomyotomy with partial fundoplication and cholecystectomy
Surgeon: professor K.V. Puchkov (2018).

The operation is performed for achalasia cardia and chronic calculous cholecystitis. The film shows the technique of dissecting of esophageal-gastric junction with the 5 mm LigaSure (MEDTRONIC COVIDIEN) instrument. Cardiomyotomy was performed by the original method with a thin monopolar electrode in a reduced power mode. Attention is paid to the dissection of all muscle layers up to the submucosal layer at a distance of at least 8 cm. The defect is covered by the anterior wall of the stomach with fixation with a continuous intracorporal suture. At the end of this stage, the anterior crurography is performed. Then, in the video shows the technique of laparoscopic cholecystectomy in chronic calculous cholecystitis. At this stage, special attention is paid to careful dissection of tubular structures in the area of the Kahlo triangle. After dissection of the cystic duct and artery, as well as visualization of the lateral wall of the common bile duct, the selected structures cut between the clips. A 10 mm applicator is inserted from the working access in the left hypochondrium. The gallbladder is removed from the abdominal cavity in a plastic container.

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

Laparoscopic cholecystectomy in case of massive adhesions (calculus 5.5 cm, volume of content 400 ml)

Laparoscopic cholecystectomy in case of massive adhesions (calculus 5.5 cm, volume of content 400 ml)
Surgeon: professor K.V. Puchkov (2018).

The film shows the technique of laparoscopic cholecystectomy for chronic calculous cholecystitis and massive adhesions. The size of the gallbladder is 22cm x 4 cm (volume 400 ml), the size of the stone is about 5.5 cm. A technique for isolating the gallbladder from adhesions using a 5 mm instrument (LigaSure MEDTRONIC COVIDIEN) and a monopolar electrode is shown. Only the bottom of the gallbladder was free from adhesions. Careful extraction of the cystic duct and artery of 5 mm with a monopolar hook and mini retract tool COVIDIEN and clipping of these structures with a 10 mm Aesculap DS applicator with titanium latch clips was performed. Gallbladder is removed from the abdominal cavity in a plastic container.

You can read more about the techniques on the personal site of Professor Konstantin Viktorovich Puchkov.

Laparoscopic correction of diastasis recti and umbilical hernia, cholecystectomy

Laparoscopic correction of diastasis recti and umbilical hernia, cholecystectomy
Surgeon: professor K.V. Puchkov (2018).

Overweight patient. Gallbladder size 22 cm x 6 cm. Massive adhesions. The calculus size about 5.5 cm. Diastasis 18x5 cm, the size of the hernia gate is 4 cm. During the first stage, cholecystectomy is performed. Further, in the video it shows the technique of correction of diastasis recti and umbilical hernia by suturing them with the V-lock non-absorbable 2-0 thread (MEDTRONIC COVIDIEN) on an atraumatic needle. This stage is performed through trocars inserted for cholecystectomy. The final stage is the closure of the suture line with a ParietexComposite mesh (20x16 cm) and its fixation with transperitoneal sutures and a ProTack (MEDTRONIC COVIDIEN) hernia stapler. The duration of the whole simultaneous operation is 1 hour 30 minutes, the stage of correction of diastasis is 40 minutes.

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

Laparoscopic cholecystectomy for rare version of positioning of cystic artery

The author: Пучков К.В.

Tags: Puchkov K.V. Cholecystectomy Diseases of gallbladder

Laparoscopic cholecystectomy for rare version of positioning of cystic artery.
Professor Puchkov K.V. is performing an operation (2017)

In this film the technique of laparoscopic cholecystectomy in case of rare version of positioning of cystic artery is presented. The cystic artery originates from the common hepatic artery (it is marked in 2 % of cases), and both the common hepatic artery and the right hepatic artery are near the wall of the gallbladder. That is why it is necessary to perform a careful dissection of tubular structures near Calot’s triangle before their transection. This technique of operation is a kind of prophilaxis to prevent from severe complications-clipping and transection of the common hepatic artery.

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

Simultaneous laparoscopic cholecystectomy and resection of hepatic cyst

Simultaneous laparoscopic cholecystectomy and resection of hepatic cyst.
Professor Puchkov K.V. is performing an operation (2016).

In this film the technique of classical laparoscopic cholecystectomy in case of calculous cholecystitis, using 4 ports, is presented. The author is demonstrating the virtuosity when showing the technique of working with a 5 mm monopolar electrode in the area of Calot’s triangle. Dissection of the cystic duct and artery is performed without blood loss. The duration of cholecystectomy stage is 6 minutes. Then, using these ports, and a 5 mm Ligasure MEDTRONIC COVIDIEN instrument, resection of the cyst of the right lobe of liver (8 cm) is done. The cyst is opened by a monopolar electrode, and its contents (350 mL) is evacuated with the help of electroejection. Then, on the boundary with the hepatic tissue resection of walls of the cyst is done by means of a 5 mm LigaSure MEDTRONIC COVIDIEN instrument. Destruction of the cystic wall near its bed is done with the help of a 5 mm monopolar instrument in the mode of non-contact coagulation “spray” of the Company Karl Storz. The gallbladder and cystic walls are placed into a special plastic container MEDTRONIC COVIDIEN, then are removed through the umbilical access. Operation time is 20 minutes.

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

Minilaparoscopic cholecystectomy

Minilaparoscopic cholecystectomy.
Professor Puchkov K.V. is performing an operation (2015).

The operation is performed for polyposis of the gallbladder. In the video the technique of using only a 3 mm troacar is presented, as well as using of instruments of Karl Storz Company. The umbilical access 10 mm is required for removing gallbladder and clipping cystic duct and artery. During clipping of structures of Calot’s triangle via the umbilical port the optics are shifted into a 3 mm epigastral port. Operation duration is 25 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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