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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 disc-shaped resection of the rectal wall by means of the circular stitching apparatus

Laparoscopic disc-shaped resection of the rectal wall by means of the circular stitching apparatus.
Professor Puchkov K.V. is performing an operation (2017).

The patient had infiltrating endometriosis, invading to the anterior wall of the rectum without deformation of the lumen. In this situation “shaving” is not efficient. In this video the technique of exposure of endometriosis infiltrate from the surrounding tissue is presented, using a 5 mm monopolar electrode and LigaSure («MEDTRONIC COVIDIEN») instrument. At the first stage the endometriosis infiltrate was dissected as much as possible up to the submucous layer (in order to decrease the volume of the affected tissue), and the affected area is immersed with the help of the thread between the edges of a 31 mm circular stitching («MEDTRONIC COVIDIEN») device, that was inserted in the lumen of rectum. The affected area of rectum was resected with a stitching device in the transverse direction – it is one/third of its circumference. The duration of this stage aws 36 minutes.

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

Laparoscopic disc-shaped resection of rectum with using of a linear stitching device

Laparoscopic disc-shaped resection of rectum with using of a linear stitching device
Professor Puchkov K/V. is performing an operation (2017).

A patient haв infiltrative endometriosis, invading to the anterior wall of rectum without deformation of lumen. In this situation “shaving “ was not efficient. In this film the technique of exposure of endometriosis infiltrate out of surrounding tissues by a 5 mm LigaSure instrument («MEDTRONIC COVIDIEN») was demonstrated. Endometriosis infiltrate was stitched by thread that was used as a “holder”. An affected part of colon was resected by a linear endoscopic stitching device («MEDTRONIC COVIDIEN») in the transverse direction. Duration of this stage was 16 minutes.

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

Laparoscopic radical hysterectomy with aortoileac and pelvic lymphadenectomy (operation according to Wertheim) with the resection of rectum

Laparoscopic radical hysterectomy with aortoileac and pelvic lymphadenectomy (operation according to Wertheim) with the resection of rectum.
Professor Puchkov K.V. is performing an operation (2017).

The patient was 48 years old, had retrocervical infiltrating endometriosis, invading to the uterine cervix, sacroiliac ligament on the left side, vaginal wall and rectum, with the development of moderately differentiated adenocarcinoma of an endometrioid type with the focus of planocellular metaplasia of fornix of vagina, invading to the cervix and vaginal wall (in rectum the tumor had not been found out). In this video the technique of radical hysterectomy with aortoileac and pelvic lymphadenectomy with transsection of sacrouterine and cardinal ligaments near the pelvic wall and removal of the upper one-third of vagina is demonstrated. Hysterectomy was performed with the help of a 5 mm LigaSure («MEDTRONIC-COVIDIEN») instrument. When performing aortoileac and pelvic lymphadenectomy, the technique of removing of nodes simultaneously by a 5 mm ultrasonic dissector, called Harmonic Scalpel, produced by Ethicon Company, was demonstrated. The use of ultrasound gives a possibility “to weld” thin lymphatic ducts, it is a kind of prophylaxis to prevent development of lymphatic cysts. This technique of operation gives a possibility not to use the drainage system. Lymphatic nodes were placed in separate plastic bags and were removed from the abdominal cavity alongside with the uterus. The author had shown a safe technique of exposure of tumorous infiltrate and exposure of ureter until the area where it confluences into the urinary bladder by means of a 5 mm thin hook. The zone of rectum exposure was 2/3 of its circumference, then the edge resection of colon was performed with using of a 45 mm EndoGIA («MEDTRONIC COVIDIEN») intestinal reloads, leaving the affected area in the tumorous infiltrate. Vagina was exposed as low as possible in the caudal direction and was transected at the distance of 4 cm from the cervix within the limits of healthy tissues (1/3 of it was removed). In this video a special attention is paid to the restorative stage-stitching of vagina, that was done by the interrupted suture, using “Monocril” thread. The operation time was 2 hours 50 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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