Video of operations
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Laparoscopic resection
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 atypical liver resection
Автор: Puchkov K.V.
Laparoscopic atypical liver resection.
Professor Puchkov K.V. is performing an operation (2018).
The video demonstrates the technique of laparoscopic resection of the left hepatic lobe with 6 cm adenoma. Mobilization of the left hepatic lobe and dissection of the hepatic parenchyma is performed using the 5 mm Thunderbeat Olympus instrument, which implements the concept «one operation - one instrument». Dissection of tissues is carried out quickly and bloodless. The final hemostasis is carried out with bipolar coagulation. The tumor is immersed in a special plastic container (MEDTRONIC COVIDIEN), which is removed through umbilical access. Drainage was placed in the operative zone for a day. The operation time is 25 minutes.
You can read more about the techniques on the personal site of Professor Konstantin Viktorovich Puchkov.
Laparoscopic dissection of the right lower hypogastric nerve during excising retrocervical endometriosis
Автор: Puchkov K.V.
Laparoscopic dissection of the right lower hypogastric nerve during excising retrocervical endometriosis Professor Puchkov K.V. is performing an operation (2017).
The patient was 28 years old, she had a painful syndrome on the background of the infiltrating endometriosis, invading to the wall of rectum, vagina and the right inferior hypogastric nerve. In this video the technique of exposure of the right inferior hypogastric nerve by a 5 mm monopolar electrode was presented, as well as the further resection of it alongside with the infiltrate, using a 5 mm LigaSure («MEDTRONIC COVIDIEN») instrument.
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
Автор: Puchkov K.V.
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 obstructive anterior resection of rectum with the formation of temporary terminal sigmostoma with the further reconstructive-restorative operation with formation of colorectal anastomosis
Автор: Puchkov K.V.
Laparoscopic obstructive anterior resection of rectum with the formation of temporary terminal sigmostoma with the further reconstructive-restorative operation with formation of colorectal anastomosis Professor Puchkov K.V. is performing an operation (2016).
A 65 year-old female patient was treated, having the diagnosis: Cancer of the upper third of rectum fT4N0M0. She was admitted to hospital with subcompensated tumourous stenosis of the large colon, microcytic hypochromic anemia (Hb-79g/L), tumourous intoxication, cachexia. During preoperation investigation of abdominal cavity organs due to RCT the single increased up to 1.0 cm lymphatic node along the superior rectal artery has been found out. The “classical” scheme of positioning of trocars was used: in the right and left iliac area, and to the left in the mesogastric area. The operation was started with dissection of peritoneum to the right of rectum, exposure of rectum along the posterior wall with the identification of the left ureter. Transection of the inferior mesenteric artery was done near the origin with applying two titanic clips. The next stage was dissection of peritoneum of the left lateral canal and mobilization of the descending part of the colon. Exposure of rectum was done in 5 cm lower than distal border of tumour along the posterior wall, then along the right and left semicircumference, and only then-along the anterior wall. Transection of the large colon in its distal part was done with EndoGIA-45 (green and blue reload) device («MEDTRONIC COVIDIEN»). Removal of specimen was done by performing a minilaparotomy. In the left mesogastric area sigmostoma was created. The operation was finished by placing drainage transabdominally via a trocar wound in the right iliac area. Operation time was 115 minutes. After a radical operation, a specimen was sent for histological investigation. Histological conclusion was: highly and moderately differentiated adenocarcinoma of rectum with invasion to the muscle layer of the large colon (without invading to the serous membrane), with invasion to the muscle layer of the loop of the sigmoid colon (without invading to the mucous membrane). In lymphatic nodes, there were no symptoms of tumour growth. Molecular-genetic investigations (NRAS, BRAF, KRAS): the symptoms of mutations had not been found out. A chemotherapeutic specialist had consulted her and recommended to have adjuvant polychemotherapy according to XELOX scheme (oxalaplatin+xelode). The patient had 8 courses of chemotherapy.
In 10 months after resection of the primary tumour reconstructive-restorative operation was performed for restoration of intestinal continuity with the formation of colorectal anastomosis, creation of temporary ileostoma. The “classical” scheme of positioning of trocars was used: in the right and left iliac area, and to the left of mesogastric area. The operation was started with stitching stoma on the anterior abdominal wall, exposure out of tissues of the anterior abdominal wall. CEEA-29 («Medtronic-Covidien») device head was inserted into the proximal part and fixed by purse-string suture, using “Vicryl” 2-0 thread, was immersed into the abdominal cavity. Then adhesyolisis was performed; exposure of descending colon along the left lateral canal with 5 mm LigaSure («Medtronic-Covidien») device took place. The mandatory condition of successful performing an operation by laparoscopic approach is separation of all possible adhesions between colon and surrounding tissues, dissection of abdomen along the posterior
semicircumference with the identification of the left ureter. After handling of the proximal part of the colon the stump of rectum was exposed with a monopolar “hook” electrode. CEEA-29 device was introduced transanally, adjustment of the head and apparatus was done, then stitching and removal of the device. At the end of operation single interrupted suture was placed between the proximal and distal parts of anastomosis. Operation was finished by placing drainage transabdominally through a trocar wound in the right iliac area, creation a temporary loop ileostoma in the right iliac area. Operation time was 120 minutes. In 3 months a new operation was performed for intraabdominal closure of ileostoma.
You can read about this technique in detail on the personal cite of Professor Puchkov Konstantin Viktorovich. To go to the link.
Laparoscopic resection of hepatic cyst
Автор: Puchkov K.V.
Laparoscopic resection of hepatic cyst.
Professor Puchkov K.V. is performing an operation (2015).
In this film the technique of laparoscopic resection of the cyst of the right lobe of liver (12 cm) is presented. The cyst is opened by a monopolar electrode, and its contents (600 mL) are evacuated by an electroejector. Then, on the border on the hepatic tissue resection of cystic walls is done by means of a 5 mm LigaSure MEDTRONIC-COVIDIEN instrument. Destruction of the cystic wall near its bed is done with the help of a 5 mm monopolar instrument in the mode of non-contact “spray” coagulation, manufactured by Karl Storz Company. The cyst is placed into a special plastic container MEDTRONIC COVIDIEN, that is removed via the umbilical access. Operation duration is 25 minutes.
You can read about this technique in detail on the personal cite of Professor Puchkov Konstantin Viktorovich. To go to the link.
Laparoscopic anterior resection of rectum with aortocaval lymphadenectomy
Автор: Puchkov K.V.
Laparoscopic anterior resection of rectum with aortocaval lymphadenectomy Professor Puchkov K.V. is performing an operation (2015).
A 59 year-old female patient was treated, having the diagnosis: Cancer of the upper third part of rectum fT3N1M0, G2. During preoperation investigation of abdominal cavity due to RCT, multiple increased up to 1.5-2 cm lymphatic nodes along the inferior mesenteric artery, aorta until the area of aorta bifurcation have been found out. The “classical” scheme of positioning of trocars was used: in the right and left iliac area and to the left of mesogastric area. The operation was started with performing an aortocaval lymphadenectomy with a 5 mm Harmonic Scalpel instrument (“Ethicon”). Transection of the inferior mesenteric artery was at the origin with applying two titanic clips. Then dissection of peritoneum to the right of rectum was done, exposure of rectum along the posterior wall with the identification of the left ureter. The next stage was dissection of peritoneum of the left lateral canal and mobilization of the descending part of the colic colon. Exposure of rectum was done in 5 cm lower from the distal border of the tumour along the posterior wall and then along the right and left semicircumference, and only at the end-along the anterior wall. Transection of the large colon in its distal part was done with Endo GIA-45 (a violet reload) device («MEDTRONIC COVIDIEN»). Extraction of specimen was done via minilaparotomy. At the end of operation, continuous suture was placed between peritoneum and the proximal part of rectum, higher then anastomosis level. Operation time was 120 minutes.
You can read about this technique in detail on the personal cite of Professor Puchkov Konstantin Viktorovich. To go to the link.
