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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 nerve-preserving resection of rectum in the treatment of retrocervical endometriosis

The author: M.Malzoni

Tags: M.Malzoni Circular colon resection

Laparoscopic nerve-preserving resection of rectum in the treatment of retrocervical endometriosis.
The operation is performed by Professor M.Malzoni (2017).

The 38 years old patient had infiltratiing endometriosis, growing into the rectal wall. In this video the technique of exposure of the endometrioid infiltration with using of the bipolar forceps and endoscopic scissors with the preliminary exposure of the left ureter has been demonstrated, as well as the exposure of the right and left hypogastric nerves. The dissection of the colon was performed with the linear endoscopic stitching device right behind the infiltrate. The final stage - formation of a circular “end-to-end” anastomosis was done with the 31 mm («MEDTRONIC COVIDIEN») device, and manual stitching was done in the area of anastomosis for the sake of its safety, using “Polysorb” 3-0 thread.

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

Laparoscopic “shaving” of the rectal wall in case of retrocervical endometriosis

Laparoscopic “shaving” of the rectal wall in case of retrocervical endometriosis
The operation is performed by Professor Puchkov K.V. (2017).

The 29 years old patient with the deep infiltrating endometriosis. According to MRT investigation there is the invasion of endometriosis focus in the rectal wall, without the involvement of the submucous layer into the process. In this video the technique of exposure of the endometriosis infiltrate from the surrounding tissues with using of 5 mm monopolar electrode is demonstrated. A careful dissection of ureters was done, and they were led aside laterally. An affected area of the colon was dissected within the submucous layer and was stitched by the interrupted manual suture, using “Polysorb” 3-0 thread. The operation duration was 110 minutes.

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

Laparoscopic nerve-preserving resection of rectum

Laparoscopic nerve-preserving resection of rectum
Professor Puchkov K.V. is performing an operation (2017).

A patient was operated for infiltrative endometriosis, invading to the wall of rectum, and stenosis of lumen more than 50 %. In this film a safe technique of exposure of the left ureter, the right and left inferior hypogastric nerves with using of 5 mm electrode is demonstrated. For the better visualization of the surgical site, temporary fixation of ovaries by transabdominal stitching was done. Then carefully endometriosis infiltrate was exposed out of surrounding tissues, with dissecting the layer between the posterior wall of vagina and the anterior wall of colon. Then, using a 5 mm LigaSure instrument («MEDTRONIC COVIDIEN»), dissection of rectum was done. The technique of colon transection with a linear endoscopic stitching device right behind the infiltrate, is shown. The final stage - forming a circular ”end-to-end” anastomosis, using a 31 mm («MEDTRONIC COVIDIEN») device and strengthening of anastomosis zone by manual stitching, using “Polysorb” 3-0 thread.

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

Laparoscopic resection of vaginal wall and rectal wall in case of endometriosis infiltration

Laparoscopic resection of vaginal wall and rectal wall in case of endometriosis infiltration
The operation is performed by Professor Puchkov K.V. (2017).

The patient was admitted with the infiltrating endometriosis that invades to the anterior wall of rectum without deformity of the lumen, it also invades to the posterior fornix of vagina. In this video the technique of exposure of endometriosis infiltrate from the surrounding tissues with using of the monopolar electrode and Liga Sure instrument («MEDTRONIC COVIDIEN») has been demonstrated. The affected area of vagina was resected and removed with the infiltrate. The anterior intestinal wall alongside with the vaginal area and infiltrate were resected by the linear endoscopic («MEDTRONIC COVIDIEN») stitching device in the transverse direction. The specimen was removed from the abdominal cavity through the vagina. The wound was stitched by the single-knot suture, using Monocril 2-0 thread.

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 the treatment of retrocervical endometriosis, stage IV. Nerve-preserving resection of rectum with the circular “end-to-end” anastomosis

Laparoscopic approach in the treatment of retrocervical endometriosis, stage IV. Nerve-preserving resection of rectum with the circular “end-to-end” anastomosis
Professor Puchkov K.V. is performing an operation (2017).

The patient was admitted with endometriosis infiltration, it invades to the rectal wall in three areas, the lumen stenosis that more than 50 %. In this video the safe technique of exposure of the right and left lower hypogastric nerves with using of 5 mm monopolar electrode is presented. Using a 5 mm Liga Sure («MEDTRONIC COVIDIEN») instrument, dissection of the rectum and vaginal dome was performed. For the better visualization of the surgical site the temporary fixation of ovaries was created with transabdominal sutures. We recommend performing a transsection of colon with the linear endoscopic stitching device right behind the infiltrate. We remove the specimen out of the abdomen and the head of the stitching device was inserted into the proximal part of colon. Final stage- creation of the circular ”end-to-end” anastomosis, using a 31 mm («MEDTRONIC COVIDIEN») stapler.

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 hypogastic plexus in case of nerve-preserving resection of rectum

Laparoscopic dissection of the hypogastic plexus in case of nerve-preserving resection of rectum
Professor Puchkov K.V. is performing an operation (2017).

A 32 year-old patient was operated for infiltrative endometriosis, invading to the wall of rectum, with stenosis of lumen more than 50%.The film presents safe technique of exposure of the right and left inferior hypogastric nerves by a 5 mm monopolar electrode during resection of colon.

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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