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Laparoscopic salpingostomy according to M. Bruat with manual stitching

Laparoscopic salpingostomy according to M. Bruat with manual stitching.
Professor Puchkov K.V. is performing an operation (2017).

A 29 year-old patient is operated on for the secondary infertility on the background of chronic salpingitis and left hydrosalpinx. During operation chromosalpingoscopy has been performed, and during this procedure obstruction of the left fallopian tube in its terminal part has been found out, the same thing in the right tube as peritubary adhesion has been present. Salpingoovariolysis has been performed both sides. The video presents the technique of salpingostomy according to M. Bruat. Fixation of fibrial part of fallopian tube is done by placing an atraumatic suture, using resorbable “Polysorb” 4-0 thread, forming an intracorporeal knot. Then a careful washing of operation zone is done by saline solution and introduction of anticommissural gel. Operation time is 40 minutes.

Laparoscopic creation of anastomosis of the fallopian tube

Laparoscopic creation of anastomosis of the fallopian tube.
Professor Puchkov K.V. is performing an operation (2017).

The video demonstrates the technique of laparoscopic creation of the «end-to-end» anastomosis of the left fallopian tube after sterilization. The patient underwent ligation of the single uterine tube at caesarean section in 2012. Surgical intervention was performed at the insistent request of the patient due to the impossibility of IVF on religious grounds. At the first stage, hysteroscopy was performed, in which the uterine cavity and the proximal part of the left fallopian tube were found to be satisfactory. Further, during laparoscopy, a stump of a tube about 2 cm long and a defect of a wall about 1.5 cm was revealed. Single planar adhesions around the tube, fimbria was absolutely free. Tubal stumps are dissected with sharp endoscopic scissors. When checking the functionality of the distal tube, free flow of contrast into the abdominal cavity is noted. An «end to end» anastomosis was created with interrupted sutures with atraumatic Polysorb 5/0 thread without taking of the mucous membrane. Next, excised retrocervical invasive endometriosis from sacral ligaments. The operation time is 55 minutes.
1 year after surgery, the patient reported about 16 week uterine pregnancy.

You can read more about the techniques on the personal site of Professor Konstantin Viktorovich Puchkov.

The alternative version of gastric shunting with one anastomosis. Totally manual anastomosis, using EndoStitch apparatus, behind the stomach and behind the colon

Автор: Evdoshenko V.V and Fedenko V.V.

Теги: Evdoshenko V.V Fedenko V.V. Gastric Shunting EndoStitch device Manual suture

The alternative version of gastric shunting with one anastomosis. Totally manual anastomosis, using EndoStitch apparatus, behind the stomach and behind the colon.
D-r Evdoshenko V.V. and D-r Fedenko V.V. are performing an operation (2017).

In standard gastric shunting with one anastomosis the operation is performed so that the small colon is in front of the colon and in front of the stomach. In case of extreme obesity and extensive size of omentum this way of performing an operation presents difficulties, problems can develop because omentum will interfere with anastomosis-it can be stretched by omentum. Suggested alternative technique implies that the small colon and “small stomach” should come closer, using the shortest way, and, thus, complete absence of any stretching.

Laparoscopic supracervical hysterectomy without appendages

Laparoscopic supracervical hysterectomy without appendages
Professor Puchkov K.v. is performing an operation (2017).

A 52 year-old patient has been operated on. The diagnosis is as follows: multiple myomas of uterus, adenomyosis, metrorrhagia. In this video the technique of uterus removal without appendages, is demonstrated, using laparoscopic way, by means of a 5 mm Ligasure MEDTRONIC COVIDIEN instrument. Due to this instrument the operation is performed fast and without blood loss. Attention is paid to the consecutive transsection of the round ligaments, fallopian tubes and urinary vessels. Dissection of uterus from the cervix is performed with the help of a special monopolar loop, produced by Karl Storz Company, that gives a possibility to dissect the tissue fast. A special attention is paid to the technique of closure of the uterine cervix and stitching of sacrouterine ligaments by manual stitching to prevent the prolapse of the uterine cervix. The body of the uterus is removed from the abdominal cavity by means of electromechanical Rotocut G1 morcellation, produced by Karl Storz Company.

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

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 “shaving” of the rectal wall in case of retrocervical endometriosis

Laparoscopic “shaving” of the rectal wall in case of retrocervical endometriosis
The operation is performed by Professor Puchkov K.V. (2017).

The 29 years old patient with the deep infiltrating endometriosis. According to MRT investigation there is the invasion of endometriosis focus in the rectal wall, without the involvement of the submucous layer into the process. In this video the technique of exposure of the endometriosis infiltrate from the surrounding tissues with using of 5 mm monopolar electrode is demonstrated. A careful dissection of ureters was done, and they were led aside laterally. An affected area of the colon was dissected within the submucous layer and was stitched by the interrupted manual suture, using “Polysorb” 3-0 thread. The operation duration was 110 minutes.

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 the treatment of retrocervical endometriosis with the affected iliac colon

Laparoscopic approach in the treatment of retrocervical endometriosis with the affected iliac colon.
Professor Puchkov K.V. is performing an operation (2016).

A 34 year-old patient was operated for deep infiltrating retrocervical endometriosis and affected iliac colon. In her anamnesis it is mentioned that she has had two cesarean sections. During laparoscopy it had been found out that the patient has a massive adhesions of organs of small pelvis with the involvement of greater omentum, sigmoid colon, uterus and the urinary bladder. In this video the technique of adhesion dissection by a 5 mm monopolar electrode and a 5 mm LigaSure («MEDTRONIC COVIDIEN») instrument is presented. During revision the lesion of the iliac colon by the invasive endometriosis at the distance of 4 cm from the ileocecal angle had been found out. The length of lesion was 6 cm. The focus invaded to all layers of the intestinal wall, and stenosis of organ lumen had been formed. Trocar port was expanded up to 4 cm, and an affected area of the colon was exteriorized onto the abdominal wall. Resection of some area of small colon was done with the dissection of the mesentery near the wall of colon, preserving the branches of a.ileocolica. It has given a possibility to form “end-to-end” anastomosis near the large colon, placing an atraumatic suture, using manual stitching and “Polysorb” thread 4-0. Suture line was additionally strengthened by a hemostatic patch TachoComb (Austria). Anastomosis was immersed into the abdominal cavity. Operation duration 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.

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