Video of operations
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Monocril thread
Da Vinci surgical system Laparoscopic approach in the treatment of recurrent genital prolapse. Redo promontofixation procedure.
Автор: Puchkov K.V.
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 excision of nodular adenomyosis and myomectomy with transient occlusion of arteries
Автор: Puchkov K.V.
Professor Puchkov K.V. is performing an operation (2018).
In this video the technique of laparoscopic excision of nodular adenomyosis ( 9 cm), located on the posterior wall of uterus and myomectomy with the transient occlusion of arteries (internal iliac arteries) according to the author’s method of Professor Puchkov K.V. is demonstrated. A 34 year-old patient is operated on for mentioned above problems. At the first stage, immediately after bifurcation of the common iliac artery, pelvic abdomen is opened, and De Bekey vascular forceps are transiently applied onto the internal artery. It gives a possibility to avoid blood loss during the operation. Then nodular adenomyosis is dissected by a monopolar electrode within the boundaries of healthy tissues, without opening uterine cavity. The wound is stitched by V-lock system (MEDTRONIC COVIDIEN), having monofilament resorbable polydioxanone thread, oriented in space with the set angle. It gives a possibility to thread to slide freely in one direction and not to be shifted in the opposite direction. This system gives a possibility to stitch uterine wound fast and layer by layer with the proper hemostasis. Additionally the wound is strengthened by three interrupted Z-shaped stitches, using “Monocril” thread. At the second stage myomectomy is performed with stitching uterine wound, using interrupted suture. Then the forceps are removed from the internal iliac artery; and blood circulation is restored in uterus. Myomatous and adenomyosis nodes are removed from the abdominal cavity by means of electromechanical morcellation Rotocut G1 of Karl Storz Company. Anticommissural gel is applied onto the suture line.
You can read about this technique in detail on the personal cite of Professor Puchkov Konstantin Viktorovich. To go to the link.
Laparoscopic myomectomy (intramural node 11 cm) with temporary occlusion of the arterial supply
Автор: Puchkov K.V.
Laparoscopic myomectomy (intramural node 11 cm) with temporary occlusion of the arterial supply
Professor Puchkov K.V. is performing an operation (2018)
The video presents a technique of laparoscopic myomectomy with a temporary occlusion of the arterial supply (internal iliac arteries) according to the author's method (2007 year patent). The operation is performed for a 29-year-old patient with an intramural uterine myoma, ~ 11 cm in diameter. At the first stage, in the area of bifurcation of the common iliac artery, the pelvic peritoneum is opened and the De Bekey vascular clamp is temporarily imposed on the internal artery. This trick reduce blood loss during the surgery. Then, using the J-hook RK Technology OLYMPUS, the muscular tissue is dissected up to the myoma node in the transverse direction and the fibroids are exfoliated from the surrounding tissues with two 10 mm rigid clamps. The wound is sutured with the V-lock system (MEDTRONIC COVIDIEN), made of a monofilament absorbable polydioxanone thread with notches oriented in space at a given angle. This system allows to close the uterus wound quickly and layers by layers with good hemostasis. The final line of stitches is made with Monocryl 2-0 thread on an atraumatic needle. Next, the clamp is removed from the internal iliac artery and blood flow is restored in the uterus. The myoma node is extracted from the abdominal cavity using the OLYMPUS bipolar PK MORCELLATOR tool.
You can read about this technique in detail on the personal cite of Professor Puchkov Konstantin Viktorovich. To go to the link.
Laparoscopic correction of direct inguinal hernia in a female
Автор: Puchkov K.V.
Laparoscopic correction of direct inguinal hernia in a female.Professor Puchkov K.V. is performing an operation (2017).
In this film the technique of laparoscopic correction of direct right inguinal hernia in a female is presented. Mobilization of hernial sac, lipoma and dissection of the round ligament is done with the help of a 5 mm Harmonic Scalpel Ethicon instrument. The exposure of the inguinal ligament, of connected tendineous aponeurosis, internal inferior epigastral artery, pubic tubercle and round uterine ligament is demonstrated. Plasty of hernial ports is done by means of Bard 3d Max LIGHT Mesh, that is the facilitated analogue of 3DMaxmesh, it has 50% lesser weight, provides bigger scope of vision of the surgical site without losing firmness of the implant. The unique 3D design of this prosthesis has been elaborated specially for laparoscopic hernioplasty. The material of mesh implant is non-covered polypropylene. The shape and contours of the implant completely correspond to this anatomic area, that provides maximum close-fitting and minimizes the probability of shifting of the prosthesis. Fixation of the prosthesis is done by a herniostapler ProTack MEDTRONIC COVIDIEN. Peritonization of abdomen is done by ‘Monocril” thread. Operation duration is 24 minutes.
You can read about this technique in detail on the personal cite of Professor Puchkov Konstantin Viktorovich. To go to the link.
Laparoscopic radical hysterectomy with aortoileac and pelvic lymphadenectomy (operation according to Wertheim) with the resection of rectum
Автор: Puchkov K.V.
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.
Laparoscopic myomectomy (intraligament node is 12 cm) with the temporary occlusion of the arterial stream
Автор: Puchkov K.V.
Laparoscopic myomectomy (intraligament node is 12 cm) with the temporary occlusion of the arterial stream. Professor Puchkov K.V. is performing an operation (2017)
In this video the technique of laparoscopic myomectomy with the temporary occlusion of the arterial stream (the internal iliac arteries) according to the author’s own method (the patent, dated 2007) is presented. A 36 year-old patient is operated on for intraligament myoma of uterus-12 cm and 4 cm nodes are on the posterior wall. At the first stage, immediately after the bifurcation of the common iliac artery, the pelvic abdomen is opened, and De Bekey vascular forceps are temporarily applied onto the internal artery. It gives a possibility to exclude blood loss during the operation. Then, using a monopolar electrode, the muscle tissue is dissected up to the myomatous node, and using two 10 mm hard forceps the myoma is enucleated from the surrounding tissues, and one should take a visual control of the right ureter. The pelvic fascia is not opened. The wound is stitched by V-lock (MEDTRONIC COVIDIEN) system, made of the monofilament absorbable polydioxanone thread, oriented in space with the set angle. This system gives a possibility to stitch the wound fast and layer by layer with the proper hemostasis. Abdomen is stitched by atraumatic suture, using “Monocril” 2-0 thread, in the area of broad and sacrouterine ligament. Then, the forceps are removed from the internal iliac artery, and bloodstream is restored in the uterus. The myomatous nodes are removed from the abdomen cavity by means of electromechanical Rotocut G1 morcellation (Karl Storz COMPANY). Anticommisural gel is applied onto the wound line.
You can read about this technique in detail on the personal cite of Professor Puchkov Konstantin Viktorovich. To go to the link.
Laparoscopic myomectomy (intraligamentary node is 6 cm)
Автор: Пучков К.В.
Laparoscopic myomectomy (intraligamentary node is 6 cm)Professor Puchkov K.V. is performing an operation (2017).
In this film the technique of laparoscopic myomectomy is presented. A 30 year-old patient is operated on for intraligamentary myoma of uterus-6 cm- on the right lateral wall and retrocervical endometriosis. At the first stage removal of endometrioid infiltrate of rectum by “shaving” is done, up to the submucous layer, with the further peritonization of operation zone by placing an atraumatic interrupted suture, using “Polysorb” 3-0 thread. Then, using a monopolar electrode, the broad ligament is dissected up to the myomatous node, and using two 10 mm hard forceps, myoma is enucleated out of surrounding tissues; visual control of the right ureter should be taken over. Pelvic fascia is not opened. The wound is stitched by V-lock system (MEDTRONIC COVIDIEN), having monofilament resorbable polydioxanone thread, oriented in space with the set angle. This system gives a possibility to stitch uterine wound fast and layer by layer with the proper hemostasis. Abdomen is stitched, by placing an atraumatic separate suture, using “Monocril” 2-0 thread, in the area of broad and sacrouterine ligaments. Myomatous node is removed from the abdominal cavity by means of electromechanical morcellation Rotocut G1 of Karl Storz Company. Anticommissural gel is applied onto the suture line. Operation duration is 50 minutes.
You can read about this technique in detail on the personal cite of Professor Puchkov Konstantin Viktorovich. To go to the link.
