Dissection of rectum

Laparoscopic nerve-preserving resection of rectum

Laparoscopic nerve-preserving resection of rectum
Professor Puchkov K.V. is performing an operation (2017).

A patient was operated for infiltrative endometriosis, invading to the wall of rectum, and stenosis of lumen more than 50 %. In this film a safe technique of exposure of the left ureter, the right and left inferior hypogastric nerves with using of 5 mm electrode is demonstrated. For the better visualization of the surgical site, temporary fixation of ovaries by transabdominal stitching was done. Then carefully endometriosis infiltrate was exposed out of surrounding tissues, with dissecting the layer between the posterior wall of vagina and the anterior wall of colon. Then, using a 5 mm LigaSure instrument («MEDTRONIC COVIDIEN»), dissection of rectum was done. The technique of colon transection with a linear endoscopic stitching device right behind the infiltrate, is shown. The final stage - forming a circular ”end-to-end” anastomosis, using a 31 mm («MEDTRONIC COVIDIEN») device and strengthening of anastomosis zone by manual stitching, using “Polysorb” 3-0 thread.

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

Laparoscopic approach in treatment of giant presacral teratoma (14 cm)

Laparoscopic approach in treatment of giant presacral teratoma (14 cm)
Professor Puchkov K.V. is performing an operation (2017).

This patient had 2 attempts to perform a laparotomic operation for presacral teratoma. During investigation presacral cyst, having the size 14 cm with wall thickness up to 4 cm, haв been found out. During MRT research, contrast substance had not been accumulated. Teratoma was located in the area of the sacral bone and promontorium, with compression of common iliac veins. In this video the technique of laparoscopic dissection of rectum and urinary bladder, exposure of the cyst out of the surrounding tissues by a 5 mm monopolar electrode and LigaSure («MEDTRONIC COVIDIEN») instrument is demonstrated. Taking into consideration the cyst size and wall thickness of the cyst, during the first stage the cyst was incised, without opening the lumen, with leaving its wall in the area of sacral vessels. Then carefully the remnants of the cyst were removed by a monopolar electrode. Hemostasis was performed by bipolar forceps and hemostatic PerClot (Italy). There was no need to place drainage. Operation duration was 1 hour 50 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 presacral teratoma (8 cm), complicated by fistula, using laparoscopic approach

Excision of presacral teratoma (8 cm), complicated by fistula, using laparoscopic approach
Professor Puchkov K.V. is performing an operation (2016).

This patient was operated for perineal fistula several times. During investigation presacral teratoma (the size is 8 cm) was found out, it had draining outside. Fistula was opened on the skin of the sacrococcygeal area. In this film the technique of laparoscopic dissection of rectum and exposure of the cyst out of the surrounding tissue by a 5 mm LigaSure («MEDTRONIC COVIDIEN») instrument is demonstrated. At the final stage excision of fistula by perineal access and its removal alongside with the cyst was performed. The cavity was drained from the perineal side, and pelvic abdomen was restored by continuous suture, using laparoscopic approach. The way the excised fistula and teratoma look like has been shown. Operation duration was 1 hour 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 coloproctectomy, using the single port access (S.I.L.S. Port Covidien) with creation a J-pouch ileoanal anastomosis with temporary loop ileostoma

Laparoscopic coloproctectomy, using the single port access (S.I.L.S. Port Covidien) with creation a J-pouch ileoanal anastomosis with temporary loop ileostoma
Professor Puchkov K.V. is performing an operation ( 2011).

In this film the technique of laparoscopic coloprotectomy, using the single port (SILS port COVIDIEN) for ulcerative colitis, fulminant course of the disease (intestinal bleeding, liquid stool up to 12 times a day), is presented. The port was placed in the right iliac area (the area for the temporary loop ileostoma). The technique of dissection of the large colon and rectum by a 5 mm LigaSure instrument («MEDTRONIC COVIDIEN») and a 5 mm Harmonic Scalpel («Ethicon») instrument is demonstrated. To make the work with rectum easier, while working with the single port, the technique of transcutaneous fixing stitches on the pelvic abdomen is presented. The exposed area of rectum was transected in the transverse direction with endoscopic stitching EndoGIA device («MEDTRONIC COVIDIEN»), using a 60 mm intestinal reload. Specimen was removed from the abdominal cavity, and the ileal colon was dissected at the distance of 5 cm from the ileocecal angle. J-pouch was formed extracorporeally, and the head of a 31 mm endoscopic stitching circular device («MEDTRONIC COVIDIEN») was inserted there. Pouch was immersed into the abdominal cavity, and under the guidance of a laparoscopic, ileoanal pouch anastomosis was formed. Then at the area of the single port, loop ileostoma was created.