Mesh implant

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 access in the treatment of the genital prolapse. Resection of the cupula of vagina and nerve-preserving promontofixation

Laparoscopic access in the treatment of the genital prolapse. Resection of the cupula of vagina and nerve-preserving promontofixation.
Professor Puchkov K.V. is performing an operation (2017).

In this video the technique of vagina cupula resection and nerve-preserving promontofixation in case of the genital prolapse, stage 3, is presented. At the first stage dissection of promontorium and exposure of the right inferior hypogastric nerve is performed with the help of a 5 mm monopolar electrode. Then dissection of the anterior rectal wall and cupula of vagina is performed by means of a 6 mm LigaSure MEDTRONIC COVIDIEN instrument. At the second stage resection of the expanded and thin area of vagina is performed, it is stitched by Monocril 2-0 thread, with the simultaneous attaching it to the sacrouterine ligaments. Then the facilitated promontofixation by a soft MEDTRONIC COVIDIEN mesh implant is performed according to the author’s method (the patent obtained in 2015). In addition the anterior and posterior colporaphy with levatoroplasty are performed. The duration of the operation is one hour 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 nephropexy, using mesh implant

Laparoscopic nephropexy, using mesh implant.
Professor Puchkov K.V. is performing an operation (2017).

In this film the technique of laparoscopic nephropexy for nephroptosis, degree 3, is presented. Mobilization of the anterior surface of kidney and periosteum of the 12-th rib is performed by a 5 mm Harmonic Scalpel Ethicon instrument and Karl Storz Company instruments. Tissue dissection is performed fast and without blood loss. Only the anterior surface of kidney is exposed for fixation of mesh implant. It is done for the sake of prophilaxis to prevent nephrosclerosis formation after operation. Prolene mesh implant is fixed to the periosteum of the 12-th rib. Then it is fixed to the capsule of the kidney by placing an atraumatic interrupted suture, with extracorporeal knots, using monofilament thread. Stitching of fascia Gerotae is done, using continuous suture and ‘Monocril” thread. Operation duration is 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 plasty of pelvicoureter segment and nephropexy

Laparoscopic plasty of pelvicoureter segment and nephropexy
Professor Puchkov K.V. is performing an operation (2016).

In this video the technique of plasty of right pelvicoureter segment is presented. The access to the kidney hilum is by means of bringing down the hepatic angle of the large colon and dissection of tissues between fascia Gerotae and Toldt’s fascia with the help of a 5 mm LigaSure ( MEDTRONIC COVIDIEN) instrument and instruments of Karl Storz Company. Mobilization of the anterior surface of kidney and periosteum of the 12-th rib, of the lower pole of the right kidney; ureter is exposed at the level of transition to pelvis. At the first stage fixation of the soft mesh implant MEDTRONIC COVIDIEN to the periosteum of the 12-th rib and kidney capsule is done by placing an atraumatic suture, using separate interrupted stitches, with monofilament thread. After dissection pelvis (sizes 4x4 cm) is found out at the hilum of the kidney. Ureter is dissected from pelvis and is opened at the length of 2.5 cm in the longitudinal direction by endoscopic scissors. Resection of the enlarged area of pelvis is done. The next stage is formation of anastomosis, using interrupted and continuos suture, with “Polysorb” 4-0 thread. A stent is inserted into the pelvis through the ureter wound. And silicone drainage Ethicon is placed into the paranephral space and in the area of anastomosis. Mesh implant is covered by the parietal abdomen. Operation duration is 1 hour 50 minutes.

Laparoscopic nephropexy , using mesh implant

Laparoscopic nephropexy , using mesh implant. Professor Puchkov K.V. is performing an operation (2012).

In this film the technique of laparoscopic nephropexy for nephroptosis, degree 3, is demonstrated. Mobilization of the anterior surface of kidney and periosteum of the 12-th rib is performed with the help of a 5 mm Thunderbeat Olympus instrument, where the conception “one operation- one instrument” has been realized. Tissue dissection is done fast and without blood loss. Only the anterior surface of kidney is exposed for fixation of mesh implant, it is the kind of prophilaxis to prevent development of nephrosclerosis after operation. A special attention should be paid to a careful fixation of the soft mesh implant MEDTRONIC COVIDIEN to the periosteum of the 12-th rib and kidney capsule. An atraumatic suture is placed, using monofilament thread. Operation duration is 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 rectopexy with mesh implant

Laparoscopic rectopexy with mesh implant.
Professor Puchkov K.V. is performing an operation (2012).

In this video the technique of laparoscopic rectopexy for rectal prolapse, is presented. Rectum mobilization and dissection of promontorium was done with the help of a 5 mm Thunderbeat («Olympus») instrument, where the conception “one operation-one instrument” was realized. Tissue dissection was done fast and without blood loss. Rectopexy was performed with soft mesh implant («MEDTRONIC COVIDIEN») that was fixed to promontorium. Atraumatic suture was placed, monofilament thread. Mesh implant fixation to the colon was performed, using non-resorbable thread and intracorporeal suture. A special attention was paid to peritonization of the operation area. Operation duration was 60 minutes.

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