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Laparascopic operations in gynecology

Da Vinci surgical system Laparoscopic approach in the treatment of recurrent genital prolapse. Redo promontofixation procedure.

Da Vinci surgical system Laparoscopic approach in the treatment of recurrent genital prolapse. Redo promontofixation procedure.
Professor Puchkov K.V. is performing an operation (2019).

The film shows the technique of redo promontofixation procedure for genital prolapse III stage. In 2017, the patient underwent a robotic (da Vinci) hysterectomy without appendages and promontofixation with a mesh implant fixation to the anterior wall of the vagina. After 5 months, relapse developed. At the first stage, the pararectal space on the right was dissected with a 5 mm monopolar electrode and the dissection of the right lower hypogastric nerve. An excess mesh length was detected (stretching or inadequate selection of its length during the first operation). The fixation of the proximal edge to the promontory is reliable. In this regard, it was decided not to cut off its proximal part, but to cross the implant in the middle part. Next, lightweight promontofixation with a soft mesh implant MEDTRONIC COVIDIEN was performed according to the author's methodology (patent from 2015). The new implant was fixed to the distal part of the mesh in the area of the dome of the vagina and its proximal part, with adequate tension. The suture material was non-absorbable V-lock (MEDTRONIC COVIDIEN) and Prolen thread. Peritoneum was closed with Monocryl thread. The anterior and posterior colporrhaphy with levatoroplasty was also performed. The duration of the laparoscopic phase of the operation was 40 minutes. The patient was examined after 3 months, no complaints.

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

Laparoscopic myomectomy (intramural node 11 cm) with temporary occlusion of the arterial supply

Laparoscopic myomectomy (intramural node 11 cm) with temporary occlusion of the arterial supply
Professor Puchkov K.V. is performing an operation (2018)

The video presents a technique of laparoscopic myomectomy with a temporary occlusion of the arterial supply (internal iliac arteries) according to the author's method (2007 year patent). The operation is performed for a 29-year-old patient with an intramural uterine myoma, ~ 11 cm in diameter. At the first stage, in the area of bifurcation of the common iliac artery, the pelvic peritoneum is opened and the De Bekey vascular clamp is temporarily imposed on the internal artery. This trick reduce blood loss during the surgery. Then, using the J-hook RK Technology OLYMPUS, the muscular tissue is dissected up to the myoma node in the transverse direction and the fibroids are exfoliated from the surrounding tissues with two 10 mm rigid clamps. The wound is sutured with the V-lock system (MEDTRONIC COVIDIEN), made of a monofilament absorbable polydioxanone thread with notches oriented in space at a given angle. This system allows to close the uterus wound quickly and layers by layers with good hemostasis. The final line of stitches is made with Monocryl 2-0 thread on an atraumatic needle. Next, the clamp is removed from the internal iliac artery and blood flow is restored in the uterus. The myoma node is extracted from the abdominal cavity using the OLYMPUS bipolar PK MORCELLATOR tool.

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

Laparoscopic excision of nodular adenomyosis and myomectomy with transient occlusion of arteries

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

In this video the technique of laparoscopic excision of nodular adenomyosis ( 9 cm), located on the posterior wall of uterus and myomectomy with the transient occlusion of arteries (internal iliac arteries) according to the author’s method of Professor Puchkov K.V. is demonstrated. A 34 year-old patient is operated on for mentioned above problems. At the first stage, immediately after bifurcation of the common iliac artery, pelvic abdomen is opened, and De Bekey vascular forceps are transiently applied onto the internal artery. It gives a possibility to avoid blood loss during the operation. Then nodular adenomyosis is dissected by a monopolar electrode within the boundaries of healthy tissues, without opening uterine cavity. The wound is stitched by V-lock system (MEDTRONIC COVIDIEN), having monofilament resorbable polydioxanone thread, oriented in space with the set angle. It gives a possibility to thread to slide freely in one direction and not to be shifted in the opposite direction. This system gives a possibility to stitch uterine wound fast and layer by layer with the proper hemostasis. Additionally the wound is strengthened by three interrupted Z-shaped stitches, using “Monocril” thread. At the second stage myomectomy is performed with stitching uterine wound, using interrupted suture. Then the forceps are removed from the internal iliac artery; and blood circulation is restored in uterus. Myomatous and adenomyosis nodes are removed from the abdominal cavity by means of electromechanical morcellation Rotocut G1 of Karl Storz Company. Anticommissural gel is applied onto the suture line.

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

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 reimplantation of the ureter in surgical treatment of endometriosis infiltration

Laparoscopic reimplantation of the ureter in surgical treatment of endometriosis infiltration.
Professor M.Malzoni (2018) is performing an operation

The patient, aged 30, has infiltrating endometriosis, invading to the anal wall and the right ureter. In this video the technique of the exposure of endometrioid infiltrate by means of the bipolar forceps and endoscopic scissors with the preliminary exposure of the right ureter up to the stenosis level is presented. Then the transection of the colon by the linear endoscopic stitching apparatus is immediately performed when infiltration is noticed. Then, using a 5-mm Thunderbeat Olympus instrument, dissection of the urinary bladder is performed. When the urinary bladder is inflated, the right wall of it is fixed to the lumbar muscle. The ureter and the urinary bladder are opened, and the ureter stent is inserted into the lumen. Then anastomosis is performed between the urinary bladder and the ureter by the interrupted suture, using “Polysorb” thread.

Laparoscopic vaporization of the endometrioid foci of the diaphragm

Laparoscopic vaporization of the endometrioid foci of the diaphragm.
Professor Puchkov K.V. is performing an operation (2018).

The operation is being performed for the external genital endometriosis, stage 4, the patient is 32 years old. In this video the technique of vaporization of endometrioid foci of the diaphragm with the help of the monopolar ball-shaped electrode (Karl Storz Company) is presented. The removal is done by means of non-contact method in “spray” mode”. The duration of this stage of operation is 10 minutes.

Laparoscopic myomectomy. Removal from the abdominal cavity by means of morcelation

Laparoscopic myomectomy. Removal from the abdominal cavity by means of morcelation.
Professor Puchkov K.V. is performing an operation (2018).

The patient is 40 years old. In her anamnesis it was mentioned that several years ago she was operated on for laparoscopic supracervical hysterectomy (the weight of her uterus was 2 kg); the uterus was removed from the abdominal cavity by means of morcelation. In this video the technique of the laparoscopic myomectomy is demonstrated where myomas (4 nodes, having the size 2-5 cm) have been dissected on the abdomen of the right lateral canal, in the left ileal area and pre-bladder space. Removal of nodes from the abdominal cavity is done with the help of electromechanical morcelation Rotocut G1 (Karl Storz Company) into the plastic container. The conclusion is as follows: it is necessary to observe carefully the abdominal cavity and to do proper lavage of it after morcelation.

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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