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Laparoscopic excision of nodular adenomyosis and myomectomy with transient occlusion of arteries

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

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 myomectomy (intraligamentary node is 6 cm)

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.

Laparoscopic myomectomy (intraligament node is 12 cm) with the temporary occlusion of the arterial stream

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 (cervical node is 10 cm) with the temporary occlusion of the arterial stream

Laparoscopic myomectomy (cervical node is 10 cm) with the temporary occlusion of the arterial stream.
Professor Puchkov K.V. is performing an operation (2016)

In this video the technique of laparoscopic myomectomy with the temporary occlusion of the arterial stream (internal iliac arteries) according to the author’s own method (the patent, dated 2007) is demonstrated. A 30 year-old patient is operated on for uterine cervix myoma-10 cm. At the first stage, immediately after bifurcation of the common iliac artery 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 muscular tissue is dissected in the longitudinal direction up to the myomatous node, and, using two 10 mm hard forceps, the myoma is enucleated from the surrounding tissues. 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 uterine wound fast and layer by layer with the proper hemostasis.

The abdomen near the cervix and sacrouterine ligaments is stitched by placing an atraumatic suture, using “Monocril” 2-0 thread. Then the forceps are removed from the internal iliac artery, and bloodstream is restored in the uterus. Myomatous node is removed from the abdominal cavity with the help of electromechanical Rotocut G1 morcellation (Karl Storz Company). Anticommissural gel is applied on 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 left resection of kidney

Laparoscopic left resection of kidney.
Professor Gallyamov E.A. is performing an operation (2013).

In this video the technique of laparoscopic left resection of kidney for malignant tumour, located in the lower pole, is demonstrated. Kidney mobilization and dissection of the renal artery and vein are done with the help of a 5mm Harmonic Scalpel Ethicon instrument. Hemostasis by means of manual stitching of the branch of the renal artery is demonstrated. Temporary ischemia is due to applying forceps onto the artery. Kidney resection is performed by means of 5 mm scissors by a “cold method” within the boundaries of healthy tissues. Kidney wound is stitched by V-lock system (MEDTRONIC COVIDIEN). Then the forceps are removed from the renal artery, and blood flow is restored in kidney. The tumour is placed into a special plastic container MEDTRONIC COVIDIEN, and is removed through the umbilical access.

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 for malignant tumour (4 cm)

Laparoscopic right resection of kidney for malignant tumour (4 cm)
Professor Puchkov K.V. is performing an operation (2012).

In this video the technique of laparoscopic right resection of kidney for malignant tumour (4 cm) is demonstrated. Kidney mobilization and dissection of the renal artery and veins are done by means of a 5 mm Thunderbeat Olympus instrument, when the conception “one operation-one instrument” has been realized. Tissue dissection is performed fast and without blood loss. Then De Bekey vascular forceps are transiently applied onto the renal artery. Kidney resection is performed by means of a 5 mm Thunderbeat Olympus instrument within the boundaries of healthy tissues. The wound is stitched by V-lock (MEDTRONIC COVIDIEN) system, using monofilament resorbable polydioxanone thread, that is 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 the kidney wound layer by layer and fast with the proper hemostasis. Then the forceps are removed from the renal artery, and blood supply is restored in the kidney. Ischemia time is 25 minutes. The tumour is placed into a special plastic container MEDTRONIC COVIDIEN, that is removed through the umbilical access. Operation duration is 45 minutes.

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

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