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MainMINIMALLY INVASIVE PROCEDURESGynecologyUterine cancer (and that of endometrium)Laparoscopic radical hysterectomy

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Laparoscopic radical hysterectomy with pelvic lymphadenectomy

Laparoscopic radical hysterectomy with pelvic lymphadenectomy
Professor Puchkov K.V. is performing an operation (2017)

A 52 year-old patient is operated on for cancer of endometrium (adenocarcinoma, size is 4 cm, invading to endometrium more than 50 %, G 2). Video presents the technique of radical hysterectomy with pelvic lymphadenectomy for cancer of endometrium. Hysterectomy is performed by means of a 5 mm LigaSure instrument (MEDTRONIC COVIDIEN) and ultrasound dissector of Ethicon company. Ultrasound use helps to “weld” thin lymphatic vessels. As lymphorrhea is absent, there is no need to drain the abdominal cavity after operation. A special attention should be paid to the restorative period – stitching of vagina and its attaching to sacrouteral ligaments for the sake of prophilaxis of prolapse after operation.

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.

Laparoscopic radical hysterectomy with the pelvic lymphadenectomy

Laparoscopic radical hysterectomy with the pelvic lymphadenectomy.
Professor Puchkov K.V. is performing an operation (2011)

In this video the technique of the radical hysterectomy with the pelvic lymphadenectomy in case of cancer of endometrium is presented. Hysterectomy is performed with the help of a 10 mm Liga Sure MEDTRONIC COVIDIEN instrument. There is an indication to remove nodes en block while performing lymphadenectomy; the ultrasonic dissectors, produced by MEDTRONIC COVIDIEN and Ethicon companies, are used. Ultrasound use gives a possibility to “weld” thin lymphatic ducts properly to prevent from lymphorrhea development. And there is no need to use drainage after the operation. A special attention is paid to the restoration stage-stitching of vagina –stitching it to the sacrouterine ligaments to prevent from prolapse of uterus after 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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