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MainMINIMALLY INVASIVE PROCEDURESGynecologyAdenomyosisLaparoscopic dissection of the adenomyosis

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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.

Laparoscopic dissection of the nodular adenomyosis (the node is 7 cm) with the temporary occlusion of the arterial stream

Laparoscopic dissection of the nodular adenomyosis (the node is 7 cm) with the temporary occlusion of the arterial stream
Professor Puchkov K.V. is performing an operation (2015)

In this video the technique of laparoscopic dissection of the nodular adenomyosis with the temporary occlusion of the arterial stream (the internal iliac arteries) according to the author’s own method (the patent, dated 2007) is presented. A 32 year-old patient is operated on for the nodular adenomyosis (the node is 7 cm) on the left lateral wall. On the MRT image the endometrioid cavity, having the diameter 5 cm with the fluid contents, has been found out in the centre of the node. At the first stage, immediately after the bifurcation of the common iliac artery the pelvic abdomen is opened, and De Bekey vascular forceps are temporarily applied onto the internal artery. It gives a possibility to exclude blood loss during the operation. Then, using a monopolar electrode, the muscular tissue is dissected up to the node, and by means of two 10 mm hard forceps and the monopolar electrode resection of the node from the surrounding tissues is performed. The wound is stitched by separate П- shaped stitches and the additional V-lock system (MEDTRONIC COVIDIEN). Then, the forceps are removed from the internal iliac artery, and blood flow is restored in the uterus. The adenomyous node is removed from the abdominal cavity with the help of Rotocut G1 electromechanical morcellation (Karl Storz Company). It is seen, that the node has a cavity, and ”Chocolade colour” contents are pouring out from it. The anticommisural gel is applied on the wound line.

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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