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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 access in the treatment of the genital prolapse. Resection of the cupula of vagina and nerve-preserving promontofixation

Laparoscopic access in the treatment of the genital prolapse. Resection of the cupula of vagina and nerve-preserving promontofixation.
Professor Puchkov K.V. is performing an operation (2017).

In this video the technique of vagina cupula resection and nerve-preserving promontofixation in case of the genital prolapse, stage 3, is presented. At the first stage dissection of promontorium and exposure of the right inferior hypogastric nerve is performed with the help of a 5 mm monopolar electrode. Then dissection of the anterior rectal wall and cupula of vagina is performed by means of a 6 mm LigaSure MEDTRONIC COVIDIEN instrument. At the second stage resection of the expanded and thin area of vagina is performed, it is stitched by Monocril 2-0 thread, with the simultaneous attaching it to the sacrouterine ligaments. Then the facilitated promontofixation by a soft MEDTRONIC COVIDIEN mesh implant is performed according to the author’s method (the patent obtained in 2015). In addition the anterior and posterior colporaphy with levatoroplasty are performed. The duration of the operation is one hour 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 supracervical hysterectomy and promontofixation

Laparoscopic supracervical hysterectomy and promontofixation.
Professor Puchkov K.V. is performing an operation (2012).

In this video the technique of performing of supracervical hysterectomy by means of a 10 mm Liga Sure MEDTRONIC COVIDIEN instrument and facilitated promontofixation according to the author’s own method is demonstrated (the patent, dated 2007). Operation is performed in case of combination of the genital prolapse and multiple myomas of uterus. Promontofixation is performed with the help of a soft MEDTRONIC COVIDIEN mesh implant. Operation is performed by the additional anterior and posterior colporrhaphy and levatoroplasty.

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

Laparoscopic supracervical hysterectomy and promontofixation

Laparoscopic supracervical hysterectomy and promontofixation
Professor Bochorishvili R.G. is performing an operation (France)

n this video the technique of laparoscopic supracervical hysterectomy and classic promontofixation with the use of combination of monopolar scissors MEDTRONIC COIVIDIEN and bipolar forceps (Karl Storz Company) is demonstrated. Excision of the body of uterus from its cervix is done by means of the original monopolar loop SupraLoop Karl Storz. Promontofixation is performed with the help of a special mesh implant with the split shreds. Uterus morcellation is done mechanically in a special plastic container. The video presents all detailed comments on of all the stages of the operation.

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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