LigaSure MEDTRONIC COVIDIEN

Da Vinci surgical system Laparoscopic approach in the treatment of recurrent genital prolapse. Redo promontofixation procedure.

Da Vinci surgical system Laparoscopic approach in the treatment of recurrent genital prolapse. Redo promontofixation procedure.
Professor Puchkov K.V. is performing an operation (2019).

The film shows the technique of redo promontofixation procedure for genital prolapse III stage. In 2017, the patient underwent a robotic (da Vinci) hysterectomy without appendages and promontofixation with a mesh implant fixation to the anterior wall of the vagina. After 5 months, relapse developed. At the first stage, the pararectal space on the right was dissected with a 5 mm monopolar electrode and the dissection of the right lower hypogastric nerve. An excess mesh length was detected (stretching or inadequate selection of its length during the first operation). The fixation of the proximal edge to the promontory is reliable. In this regard, it was decided not to cut off its proximal part, but to cross the implant in the middle part. Next, lightweight promontofixation with a soft mesh implant MEDTRONIC COVIDIEN was performed according to the author's methodology (patent from 2015). The new implant was fixed to the distal part of the mesh in the area of the dome of the vagina and its proximal part, with adequate tension. The suture material was non-absorbable V-lock (MEDTRONIC COVIDIEN) and Prolen thread. Peritoneum was closed with Monocryl thread. The anterior and posterior colporrhaphy with levatoroplasty was also performed. The duration of the laparoscopic phase of the operation was 40 minutes. The patient was examined after 3 months, no complaints.

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

Laparoscopic partial Toupet fundoplication (270 gr.) with recurrent HH after Nissen fundoplication with an additional prosthetic mesh implant

Laparoscopic partial Toupet fundoplication (270 gr.) with recurrent HH after Nissen fundoplication with an additional prosthetic mesh implant
Surgeon: professor K.V. Puchkov (2019).

The patient is 49 years old; a year ago he underwent laparoscopic Nissen fundoplication on HH. After 4 years there was a recurrence of the HH over the esophagus, the place of cruroraphy is wealthy.
The video shows a reoperation technique for relapsed HH by laparoscopic approach. Mobilization of the gastroesophageal junction is performed with a 5 mm monopolar electrode and LigaSure MEDTRONIC COVIDIEN instrument. There is marked adhesions in the area of operation. The Nissen cuff is untenable. Particular attention is paid to the careful separation of the esophagus and the upper part of the stomach from adhesions, the elimination of the fundoplication cuff. Surgery is carried out quickly and bloodless. Next step - the top cruroraphy and partial Toupet fundoplication (270 gr.). The line of stitches is strengthened with the help of additional prosthetics of this zone with a special 3D with the Parietex Composite mesh and its fixation according to the author's safe technique with a flexible Relia Tack MEDTRONIC COVIDIEN bend hernia stapler. Implant fixation is performed by absorbable takers. The duration of the operation is 1 hour and 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 (270 gr.) Toupet fundoplication with cruroraphy and mesh implant.

Laparoscopic partial (270 gr.) Toupet fundoplication with cruroraphy and mesh implant.
Surgeon: professor K.V. Puchkov (2019).

The video shows the technique of correction of the paraesophageal hernia of the diaphragm (5 cm) by the laparoscopic approach. Mobilization of the gastroesophageal junction is performed with 5 mm LigaSure MEDTRONIC COVIDIEN instrument. Surgery is carried out quickly and bloodless. Attention is paid to the sequential intersection of the esophageal - phrenic and fundal-phrenic ligaments. Short gastric vessels intersect with the LigaSure instrument, under the esophageal space. Particular attention is paid to thorough cruroraphy with additional prosthetics of this zone with a special mesh implant of the 3D grid Parietex Composite and its fixation according to the safe author's technique with a flexible Relia Tack MEDTRONIC COVIDIEN bend hernia stapler. The implant is fixed by absorbable tackers, at 4,6,9,11 hours along the inner edge of the mesh at an angle to the esophagus. The paper entry vector is perpendicular to the pedicle of the diaphragm and from the pericardium to the esophagus. At the final stage, a partial Toupet fundoplication is performed (270 gr.). The duration of the operation is 80 minutes.

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

Excision of retroperitoneal dermoid cyst (mature teratoma 15 cm) by laparoscopic approach

Excision of retroperitoneal dermoid cyst (mature teratoma 15 cm) by laparoscopic approach
Professor Puchkov K.V. is performing an operation (2019).

The patient is 21 years old. Complaints of arching pain in the right hypochondrium and lumbar region. The video shows a cross-sectional CT scan, where a large cyst with dense walls and fragments bone inside was determined, which was located between the inferior vena cava and aorta. During the laparoscopy, topographic anatomy is shown. Areas of surgical intervention: hepatoduodenal ligament, right kidney, duodenum, left renal vein, inferior vena cava. Clearly visible front wall of the cyst under the IVC, duodenum and hepatoduodenal ligament. The operation was started with dissection of the parietal peritoneum at the lower pole of the cyst between Toldi’s fascia and Gerota fascia. Next step - with 5 mm Thunderbeat Olympus device the dissection of the retroperitoneal cyst was performed. Cyst wall capsule was tightly soldered to the rear wall of the IVC. In this regard, the peritoneum was dissected medially to the IVC and the inferior vena cava was maximally separated from the cyst wall. Further cyst was opened with a monopolar electrode and contents (800 ml) aspirated. Fat, hair and bone fragments were founded in the lumen. After aspiration, the separation of IVC and anterior cyst wall in a "blunt" way. Further visualized the right renal artery that was intimately soldered from a cyst capsule. The medial margin of the cyst was separated from the anterior walls of the aorta and surrounding tissues. The lumbar artery was clipped and crossed. The base of the cyst in the lumbar muscles was coagulated. The cyst was placed in a plastic container and removed from abdomen. The duration of the operation was 1 hour and 50 minutes. Histological examination - the wall of the tumor consists of well differentiated germline derivatives with predominance of ectodermal derivatives: the elements are determined skin with all its components (epidermis, fibrous layer), elastic and fatty tissues, sweat and sebaceous glands, hair follicles), elements of fibrous and bone tissue. Mature teratoma (dermoid cyst).

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

Laparoscopic appendectomy for complicated appendicitis (phlegmon)

Laparoscopic appendectomy for complicated appendicitis (phlegmon).
Professor Puchkov K.V. is performing an operation (2018).

The operation is performed in acute complicated appendicitis with phlegmon. In film the dissection technique of the mesentery of the appendix with 5 mm LigaSure MEDTRONIC COVIDIEN instruments and Karl Storz instruments is shown. Then its base is stitched and intersected with a linear white stapler (MEDTRONIC COVIDIEN) (since there is no infiltration of the base of the appendix and the dome of the cecum). A specimen was removed from the abdominal cavity through a 12 mm trocar in a plastic container. Then the abdominal cavity is washed with warm saline solution. The duration of the operation is 12 minutes.

Laparoscopic fundoplication and radiofrequency ablation (RFA) in treatment of Barrett esophagus

Laparoscopic fundoplication and radiofrequency ablation (RFA) in treatment of Barrett esophagus.
Professor Puchkov K.V. is performing an operation (2018).

A 37 year-old male patient is operated on for Barrett esophagus (has been proved by the morphological method) on the background of hiatal hernia.

In this video the technique of endoscopic radiofrequency ablation (RFA) and laparoscopic partial (270 g) fundoplication according to Toupe in surgical treatment of Barrott esophagus on the background of axial hiatal hernia is demonstrated. At the first stage, after the morphological verification RFA has been performed, using self-setting balloon catheter (Barrx 360 Express RFA Medtronic Company), providing ablation area up to 3 cm and it gives a possibility to deliver point circular energy of RFA to the affected tissue of mucous membrane (endoscopic surgeon –Tishchenko E.S.).

In 2 months the second stage was performed-pathogeneric operation to prevent pathological reflux into esophagus-correction of hiatal hernia and fundoplication, using laparoscopy (Prof. Puchkov K.V. is performing an operation).Mobilization of gastroesophageal isthmus is performed by a 5 mm LigaSure MEDTRONIC-COVIDIEN instrument. The operation is performed fast and without blood loss. Attention is paid to the consecutive transection of esophageal-diaphragmatic and fundodiaphragmatic ligaments. Short gastric vessels are transected by LigaSure instrument, using inferior access, under the esophagus. A special attention is paid to careful cruroraphy. Then bilateral partial fundoplication according to Toupet is performed (270 g) with the help of interrupted intracorporeal suture. 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 abdominal perineal resection (APR) of rectum, using a monopolar hook

Laparoscopic abdominal perineal resection (APR) of rectum, using a monopolar hook
Professor Puchkov K.V. is performing an operation (2018).

In this film the technique of performing of abdominal perineal resection (APR) of rectum with the expanded lymphadenectomy, using a monopolar “hook” electrode is presented. A 59 year-old female patient was treated with the diagnosis: Low rectal cancer fT3N1M0, G1. She had a course of neoadjuvant chemotherapy (CLT) with preoperative radiotherapy.
Exposure of rectum had done within the injuring of mesorectal fascia, with preserving the structures of upper and lower hypogastral plexus (sympatic and parasympatic nerves) laparoscopically. The “classical” positioning of trocars had been used: in the right and left iliac area, and in the mesogastric area to the left. The operation was started with dissection of pelvic in the right side of rectum, then exposure of rectum along the posterior wall with identification of the left ureter. Lymphodissection was performed in the area of origin of the inferior mesenteric artery, transection of superior rectal artery (with preserving of the left colic artery) was done with a 5 mm “LigaSure” («MEDTRONIC COVIDIEN») instrument. The next stage was dissection of the left lateral canal and mobilization of the descending part of the colic colon. Exposure of rectum up to pelvic floor along the posterior semicircumference took place within the injuring of the mesorectal fascia, then along the right and left semicircumference, and only at the end-along the anterior wall. Transection of the large colon in its proximal part had performed with EndoGIA-60 (a blue reload) device («MEDTRONIC COVIDIEN»).
The perineal stage had done in a classical approach. Stoma was created in the left iliac area. The drainage was placed via perineal wound. Operation duration was about 150 minutes.

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