Uteterolysis
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Laparoscopic approach in treatment of the retrocervical endometriosis, stage 4. Uteterolysis
The author: Puchkov K.V.
Laparoscopic approach in treatment of the retrocervical endometriosis, stage 4. Uteterolysis. The operation is performed by Professor Puchkov K.V. (2015 )
A 31 year-old patient is operated on for retrocervical infiltrating endometriosis, invading to the wall of rectum and vagina, uterine cervix and sacrouterine ligaments. Both ureters are involved into the infiltration. In this video the safe technique of consecutive exposure of the right and left ureters by means of a 5 mm monopolar electrode and a 5 mm Liga Sure MEDTRONIC COVIDIEN instrument is demonstrated. For the better visualization of the surgical site compulsory temporary fixation of ovaries, using transabdominal stitching, is done. Using the soft forceps, the tubular structures are exposed subperitoneally, moving them aside from the endometrioid centre. While dissecting tissues on the left, the change of the anatomy of ureter positioning due to the infiltrative changes in this area has been clearly seen. During dissection it has been found out that the ureter is shifted to the right, coming into close contact with the right ureter. One should bear in mind possible changes of anatomy in this area in order not to injure ureters during the dissection of the endometrioid centres.
You can read about this technique in detail on the personal cite of Professor Puchkov Konstantin Viktorovich. To go to the link.