Troacar

This film shows the technique of dissecting of the left parts of the colon, modified combined approach for splenic flexure mobilization for cancer of the descending colon.

This film shows the technique of dissecting of the left parts of the colon, modified combined approach for splenic flexure mobilization for cancer of the descending colon.
Surgeon D.K. Puchkov (2019y).

This film shows the technique of dissecting of the left parts of the colon, modified combined approach for splenic flexure mobilization for cancer of the descending colon.

Patient M., 62 years old, was treated with a diagnosis of cancer of the descending colon fT3N0M0, G2. During the preoperative examination, RCT of abdominal organs in the descending colon was found a volumetric formation ~ 4 cm in diameter, no enlarged lymph nodes in the abdominal cavity were detected.

A 10 mm trocar, camera were introduced in the umbilical area. In the mesogastrium, in the right and left iliac regions three 5 mm trocars were introduced. The tumor was located in the proximal third of the descending colon, mobile, dense, the serous layer was not involved.

The parietal peritoneum was dissected along the IMA, the IMA was mobilized at the origin of its bifurcation. IMA branches were skeletonized, the left colon artery was selectively cut with a 5mm Ligasure device, and then the IMV was transsected. The left parts of the colon were mobilized with the Harmonic device in medial-to-lateral (inframesocolic) approach in the interfascial layer with visualization of the pancreatic tail.

An entrance to the omental bursa was made through the mesentery of the transverse colon, the mesentery was separated from the pancreas to the splenic flexure. The peritoneum was dissected along the left lateral canal to the splenic flexure.

Dissection of the gastro-colon ligament was performed, the splenic flexure of the colon was mobilized. The operation stage time was 65 minutes.

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 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.

Sleeve gastrectomy for morbid obesity

Sleeve gastrectomy for morbid obesity.
Professor A.Forgione is performing an operation (2017).

In this video the technique of bariatric operation-standard sleeve gastrectomy-is demonstrated. The first stage presents the positioning of troacars. For dissection of gastroesophageal isthmus a 10 mm Liga Sure MEDTRONIC COVIDIEN instrument is used. Sleeve gastrectomy is performed by means of stitching and transection of stomach by a 60 mm Endo GIA MEDTRONIC COVIDIEN apparatus with blue casettes. Preparation is placed into a special plastic container MEDTRONIC COVIDIEN, that is removed at the end of operation through the expanded access.

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.

Laparoscopic placement of gastric bandage for morbid obesity

Laparoscopic placement of gastric bandage for morbid obesity.
Professor A.Forgione is performing an operation (2016).

In this video the technique of bariatric operation is presented-laparoscopic placement of gastric bandage for morbid obesity. At the first stage the positioning of troacars is presented. For omentum dissection 5 mm monopolar scissors are used. The tunnel under esophagus is performed by ligament preparation by a 5 mm dissector. Gastric bandage is placed on the upper one-third of the stomach and fixed by serous stitching for prophilaxis of shifting in the distal direction.

Laparoscopic resection of cecum and appendectomy for infiltrative endometriosis

Laparoscopic resection of cecum and appendectomy for infiltrative endometriosis.
Professor Puchkov K.V. is performing an operation (2016).

The operation was performed for infiltrative endometriosis of cecum and base of appendix. The right fallopian tube and ovary were involved in the infiltrate. In the video the technique of adhesiolysis between appendages of uterus and cecum with 5 mm monopolar electrode, was demonstrated. Dissection of the mesentery of vermiform process was performed with a 5 mm LigaSure (“MEDTRONIC COVIDIEN”) instrument and instruments of Karl Storz Company. After mobilization it should be determined whether the whole of the cecum was involved into the process or it was without involving of ileocecal valve. Then the intestinal wall, lower than infiltrate level, was stitched and transected by a linear stitching device (“MEDTRONIC COVIDIEN”). Revision of the wound suture was done-there was no deformity and narrowing of ileocecal isthmus. Specimen was removed through the abdominal cavity via a 12 mm troacar. Duration of this stage was 16 minutes.

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