Hemostatic PerClot

Laparoscopic excision of a giant (22 cm) presacral teratoma

Laparoscopic excision of a giant (22 cm) presacral teratoma.
Professor Puchkov K.V. is performing an operation (2018).

A 22 year-old female patient had the following complaints: pain in perineum, difficulties in passage of gases, and episodic urinary retention. During investigation presacral cyst was found out with the size 22 cm, wall thickness up to 1.5 cm, without contrast accumulation dye to MRT research. Teratoma was located in the area of sacral and coccygeal bones, with compression of rectum, ureters and urinary bladder. In this video the technique of laparoscopic dissection of rectum and the posterior wall of vagina, exposure of cyst out of the surrounding tissues by a 5 mm monopolar electrode and LigaSure («MEDTRONIC COVIDIEN») instrument is demonstrated. The cyst was dotted, an ejector (1500 mL) evacuated the contents. In the lumen hair and fat was found. The cyst was dissected from m.levator ani, wall of rectum and vagina. Hemostasis was performed by bipolar forceps and hemostatic PerClot (Italy). Operation area was drained.

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

Laparoscopic right resection of kidney with wound stitching

Laparoscopic right resection of kidney with wound stitching.
Professor Puchkov K.V. is performing an operation (2017).

In this film the laparoscopic resection of the right kidney for malignant tumour (4.5 cm), located in the area of the upper pole, is demonstrated. Mobilization of kidney and dissection of the renal artery and vein are done with the help of a 5 mm Harmonic Scalpel Ethicon instrument, as well as LigaSure (MEDTRONIC COVIDIEN) instrument. De Bekey vascular forceps are temporarily applied onto the renal artery. Kidney resection is performed by a 5 mm Harmonic Scalpel Ethicon instrument within the limits of healthy tissues. Hemostasis in the area of bed is done by a bipolar instrument of Karl Storz Company. An atraumatic interrupted suture is placed on the kidney wound, using “Vicryl” thread. For the sake of additional hemostasis the wound is stitched by hemostatic PerClot (Italy). Then the forceps are removed from the renal artery, and blood circulation is restored in the kidney. The time of ischemia is 32 minutes. The tumour is placed in a special container MEDTRONIC COVIDIEN and is removed through the umbilical access. Operation time is 1 hour 20 minutes.

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

Laparoscopic right resection of kidney with wound stitching

Laparoscopic right resection of kidney with wound stitching.
Professor Puchkov K.V. is performing an operation (2017).

In this film the technique of the right laparoscopic resection of kidney for malignant tumour (2 cm), that is located on the anterior surface, is demonstrated. In the abdominal cavity there is an extensive adhesion process, developed after open cholecystectomy. Mobilization of kidney and dissection of the renal artery and vein are done with the help of a 5 mm LigaSure (MEDTRONOC COVIDIEN) instrument. De Bekey forceps are temporarily applied onto the renal artery. Kidney resection is performed by a 5 mm monopolar instrument within the limits of healthy tissues. An atraumatic interrupted suture is placed on the kidney wound, using “Polysorb” thread. For the sake of additional hemostasis the wound is covered by hemostatic PerClot (Italy). Then the forceps are removed from the renal artery, and blood circulation is restored in the kidney. The ischemia time is 25 minutes. The tumour is placed into a special container MEDTRONIC COVIDIEN and is removed through the umbilical access. Operation duration is 1 hour 30 minutes.

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 treatment of giant presacral teratoma (14 cm)

Laparoscopic approach in treatment of giant presacral teratoma (14 cm)
Professor Puchkov K.V. is performing an operation (2017).

This patient had 2 attempts to perform a laparotomic operation for presacral teratoma. During investigation presacral cyst, having the size 14 cm with wall thickness up to 4 cm, haв been found out. During MRT research, contrast substance had not been accumulated. Teratoma was located in the area of the sacral bone and promontorium, with compression of common iliac veins. In this video the technique of laparoscopic dissection of rectum and urinary bladder, exposure of the cyst out of the surrounding tissues by a 5 mm monopolar electrode and LigaSure («MEDTRONIC COVIDIEN») instrument is demonstrated. Taking into consideration the cyst size and wall thickness of the cyst, during the first stage the cyst was incised, without opening the lumen, with leaving its wall in the area of sacral vessels. Then carefully the remnants of the cyst were removed by a monopolar electrode. Hemostasis was performed by bipolar forceps and hemostatic PerClot (Italy). There was no need to place drainage. Operation duration was 1 hour 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 resection of left renal cyst (7 cm) (Bosniak 3)

Laparoscopic resection of left renal cyst (7 cm) (Bosniak 3)
Professor Puchkov K.V. is performing an operation (2015).

In this film the technique of laparoscopic resection of complex renal cyst (Bosniak 3) , having the size 7 cm, located at the posterior wall, is presented. Access to the cyst is done by means of bringing down the splenic angle of the large colon and dissection of tissues between Toldt’s fascia and fascia Gerotae by a 5 mm Ligasure (MEDTRONIC COVIDIEN) instrument and Karl Storz Company instruments. At the next stage exposed and removed lower pole of kidney with the cyst is placed into a plastic container MEDTRONIC COVIDIEN for the sake of prophilaxis of dissemination of the contents of the container in the abdominal cavity. Then, using ultrasonic scissors MEDTRONIC COVIDIEN, the cyst is maximally excised out of the renal parenchyma. The remaining part, 4 cm, is coagulated by a monopolar electrode in non-contact mode , until dry coagulated eschar is formed. For the sake of additional hemostasis the wound is covered by hemostatic PerClot (Italy). Operation time is 1 hour

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 endometrioid cyst of the left ovary and dissection of the external genital endometriosis

Laparoscopic dissection of the endometrioid cyst of the left ovary and dissection of the external genital endometriosis.
Professor Puchkov K.V. is performing an operation (2014).

A 22 year-old patient is operated on for endometrioid cyst of the left ovary (7 cm) and external genital endometriosis, stage 3. Having the aim to preserve the ovulatory potential, the final hemostasis near the cyst bed is done with the help of PerClot hemostatic preparation (Italy). In this video the technique of dissection of the centres on the abdomen by means of Karl Storz Company instruments is demonstrated. One should pay attention to the preliminary opening of the abdomen near the centre, giving a possibility to the carbonic acid gas to penetrate into the retroperitoneal space. Gas presence helps to perform safer dissection of the affected tissues. Simultaneously traction of the endometrioid centre is done in the opposite direction, giving a possibility to visualize clearly the structures of the retroperitoneal space. The cyst is opened, and its contents are evacuated. Then enucleation of the cyst membrane is performed, and point hemostasis is done by a bipolar instrument. The final hemostasis is performed by PerClot preparation (Italy). To prevent adhesion development the anticommisural “Mesogel” barrier is introduced into the small pelvis area. Operation duration is 40 minutes.

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

Laparoscopic partial adrenalectomy, using Thunderbeat system and PerClot hemostatic

Laparoscopic partial adrenalectomy, using Thunderbeat system and PerClot hemostatic.

Professor Puchkov K.V. is performing an operation (2012).

The operation is performed for benign tumour of the adrenal gland (the diameter is 6 cm), it is located in the lateral pedicle. In this film the technique of organopreserving operation, dissection of tissues by endoscopic scissors with the exposure of the inferior vena cava and adrenal vein is presented. Transection of the vascular structures and tissue of the adrenal gland is performed by a 5 mm Thunderbeat Olympus instrument. The operation is performed fast and without blood loss. Operation duration is 25 minutes. Additional hemostasis is done by PerClot system (Italy).

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