Harmonic Scalpel Ethicon

Laparoscopic low anterior resection of rectum (partial TME-total mesorectal excision) with the use of a monopolar “hook” electrode

Laparoscopic low anterior resection of rectum (partial TME-total mesorectal excision) with the use of a monopolar “hook” electrode.
D-r Jim Khan is performing an operation (Great Britain, Portsmouth) (2018).

In this film the technique of performing low anterior resection of rectum (partial TME - total mesorectal excision) with the use of a monopolar “hook” electrode is presented. A 44 year-old male patient was treated, having the diagnosis: Cancer of middle third part of rectum fT2N0M0, G2. During the preoperation investigation of organs of abdominal cavity and small pelvis, using MRT and RCT, no data about pathologic lymphatic nodes in the abdominal cavity, small pelvis and mesorectum had been obtained. The “classical” scheme of positioning of trocars was used: on the right in the iliac area, to the right and to the left-in the mesogastric area. Operation started with the incision of peritoneum to the right of rectum, identification of interfascial layer without vessels with the help of a monopolar instrument “hook” (“Karl Storz”). Transection of the inferior mesenteric artery took place near the origin with Harmonic (“Ethicon”) device after preliminary clipping of it by titanic clips. Then exposure of rectum along its posterior wall took place with identification of the left ureter. The next stage was exposure of the inferior mesenteric vein, identification of embryological layer of the large colon, its exposure in the medialateral direction towards the splenic flexure. For safe mobilization of the splenic flexure of the colic colon inframesocolic access was used. Preliminary dissection of pancreas was done, opening of omentum sac, after that peritoneum of the left lateral canal was dissected, mobilization of the descending part of the colic colon and the splenic flexure of the colic colon was done. Exposure of rectum was done in 5 cm lower than lower border of tumour along the posterior wall, then-along the right and left semicircumference, and only at the end-along the anterior wall. Transection of the colon in its distal part was done EchelonFlex-60 instrument (a blue reload) (“Ethicon”). Then midline minilaparotomy (approx.5 cm) was performed, the latex ring “Dextrus” was placed in the wound for restriction the tissue of the anterior abdominal wall from the colon with tumour. The colon was exteriorized, resection of specimen was done, CDH-29 (”Ethicon”) device head was inserted into the proximal part, it was fixed by purse-string suture, using “Vicryl” 2-0 thread, and immersed into the abdominal cavity. CDH-29 device was inserted transanally, stitching was done, then CDH-29 was removed. The next stage loop ileostoma was created in the right iliac area. The operation was finished by placing drainage transabdominally via trocar wound in the left mesogastric area. Operation duration was 240 minutes.

Laparoscopic left hemihepatectomy

Laparoscopic left hemihepatectomy.
Professor A.Forgione (Italy) is performing an operation (2017).

Operation is performed for metastasia into the left lobe of the liver. In this video the technique of laparoscopic left hemihepatectomy with the help of a 5 mm Harmonic Scalpel Ethicon instrument, bipolar, clipping of the vascular structures and bile ducts, stitching and transecting of the vein by Endo GIA MEDTRONIC COVIDIEN apparatus with a 45 mm white cassette, is presented. The preparation is placed into a special plastic container MEDTRONIC COVIDIEN, that is removed at the end of operation through the expanded access.

Laparoscopic tubectomy in case of ectopic pregnancy

Laparoscopic tubectomy in case of ectopic pregnancy.
Professor Puchkov K.V. is performing an operation (2017).

The operation is performed in case of progressive ectopic pregnancy, the term of pregnancy is 5 weeks. The patient is 39. In her anamnesis it is mentioned that she has been operated on for tubectomy on the left and for three cesarean sections.150 ml of blood have been found out during the operation. In the right fallopian tube fetus, having the sizes 4x2 cm, has been determined. For fast and successful operation performing Clermont Ferrand (KARL STORZ) uterine manipulator and a 5 mm Harmonic Scalpel Ethicon instrument are used. With the help of them tubectomy on the right is done. The dissected fallopian tube is removed from the abdominal cavity in a special plastic container. Then a careful lavage of operation zone by means of the saline solution is done. After that anticommisural gel is introduced. Operation duration is 15 minutes.

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.

Anterior resection of rectum with the expanded D4 lymphadenectomy

Anterior resection of rectum with the expanded D4 lymphadenectomy
D-r Puchkov D.K. (CMS) is performing an operation (2017).

In this film the technique of performing the anterior resection of rectum with the expanded D4 lymphadenectomy is demonstrated. A 51 year-old female patient was treated, having the diagnosis: Cancer of upper third of rectum f T3N2M0, G2. During preoperation investigation of abdominal cavity organs by RCT multiple increased (up to 1.5-2 cm) lymphatic nodes along the inferior mesenteric artery, aorta, in the area of aorta bifurcation have been found out-mass of lymphatic nodes with the diameter up to 4 cm. The “classical” scheme of positioning of trocars had been used: to the right of the iliac area, and in the mesogastric area –to the left and right. The operation was started with aortocaval lymphadenectomy by a 5 mm Harmonic Scalpel instrument (“Ethicon”). Transection of the inferior mesenteric artery took place at the origin with LigaSure device («Medtronic Covidien»). Then dissection of peritoneum took place to the right of rectum, exposure of rectum along the posterior wall with the identification of the left ureter. The next stage was exposure of the inferior mesenteric vein, identification of embryologic layer of the large colon, its exposure in medialateral direction towards the splenic flexure. Then peritoneum of the left lateral canal was dissected, and mobilization of descending part of the colic colon took places. Exposure of rectum was done in 5 cm lower than the distal border of tumour along the posterior wall and then along the right and left semicircumference and only at the end-along the anterior wall. Transection of the large colon in its distal part was done with the EchelonFlex-60 (a blue reload) device (“Ethicon”). Then midline minilaparotomy was performed (approx. 5 cm), the latex ring “Dextrus” was placed into the wound to restrict tissues of the anterior abdominal wall from the colon with tumour. Colon was exteriorized, resection of specimen was done, CDH-29 device head (“Ethicon”) was inserted into the proximal end, it was fixed by purse-string suture, using ‘Vicryl” 2-0 thread and immersed into the abdominal cavity. CDH-29 device was inserted transanally, stitching was done. The operation was finished by placing drainage transabdominally via trocar wound in the right iliac area. Operation time was 140 minutes.

Laparoscopic splenectomy

Laparoscopic splenectomy.
Professor A.Forgione (Italy) is performing an operation (2017).

In this video the technique of laparoscopic splenectomy by means of a 5 mm Harmonic Scalpel Ethicon instrument is demonstrated. Operation is performed for idiopathic thrombocytopenic purpura (ITP). At first splenic artery is exposed and temporarily clipped. It is done to prevent the risk of bleeding during handling of vascular pedicle of spleen. Then, using Endo GIA MEDTRONIC COVIDIEN apparatus (with a 60 mm white casette), splenic vessels are stitched and transected. Preparation is placed into a special plastic container MEDTRONIC COVIDIEN, that is removed through the expanded access at the end of operation.

Gastric shunting – Roux-en-Y gastric bypass-for morbid obesity

Gastric shunting – Roux-en-Y gastric bypass-for morbid obesity.
Professor A.Forgione is performing an operation (2016).

In this video the technique of bariatric operation – Roux-en-Y gastric bypass for morbid obesity is demonstrated. At the first stage the positioning of troacars is presented. For tissue dissection a 5 mm Harmonic Scalpel Ethicon instrument is used. Stitching of the colon and stomach is performed by a 60 mm Endo GIA MEDTRONOC COVIDIEN apparatus with white and blue casettes. Gastrointestinal anastomosis is formed by circular stitching apparatus.