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Laparoscopic anterior resection with D3 - lymphadenectomy, preserving of the left colic artery, transvaginal specimen extraction (N.O.S.E.S. technique)

Автор: Puchkov D. K.

Теги: Puchkov D.K. NOTES Resection of the colon Colon cancer

Laparoscopic anterior resection with D3 - lymphadenectomy, preserving of the left colic artery, transvaginal specimen extraction (N.O.S.E.S. technique)
Surgeon D.K. Puchkov (2020y.)

This film shows the technique of performing laparoscopic anterior resection with D3 - lymphadenectomy, preserving of the left colic artery, transvaginal specimen extraction (N.O.S.E.S. technique).

Patient B., 49 years old, was treated with the diagnosis: Cancer of the upper third part of the rectum fT2N2M0, G2. During the preoperative examination, according to MRI of the small pelvis in the rectum about 11 cm from the anal verge was found a formation 2 cm in diameter. According to CT-scans along the upper rectal artery, in the area of the origin of the inferior mesenteric artery were found a few enlarged lymph nodes.

A 10 mm trocar, endoscope were introduce above the umbilicum. In the right and left mesogastrium region 5 mm trocars were introduced; in the right iliac region a 10 mm trocar was introduced. Firstly, the patient was transferred to the Trendelenburg position. The tumor was not visually defined; intraoperative colonoscopy was performed to determine the border of the resection.

The parietal peritoneum was dissected along the IMA, medial-to-lateral mobilization was performed, the left ureter was visualized, then the IMA was mobilized, the superior rectal artery and the first sigmoid artery were selectively crossed with the 5mm LigaSure device. The left part of the colon was mobilised using a Harmonic scalpel (Ethicon).

The mobilisation of the rectum to the level of resection within the mesorectal fascia was performed.

A colpotomy was performed, a plastic sleeve was inserted into the abdominal cavity to prevent tumor contamination of the vagina. The colon was removed, the proximal resection border was visualised (the demarcation line), the specimen was cut off extracorporeally. The head of the CDH-29 device was inserted into the proximal part of the colon and fixed with a purse string suture (thread “Vicryl 2.0”), immersed in the abdominal cavity. The colpotomy opening was intracorporeally sutured. Leak control - no air intake.

The CDH-29 device was transanally introduced. The head was adapted with the device; the device was removed. The trocar wounds were sutured and the skin was trimmed with OmniStrip stripes. Operation time 145 minutes.

Transvaginal hybrid minilaparoscopy-assisted cholecystectomy (N.O.T.E.S. technique)

Transvaginal hybrid minilaparoscopy-assisted cholecystectomy (N.O.T.E.S. technique).
Professor Puchkov K.V. is performing an operation (2015).

In this film a simple technique of removal of a gallbladder, using the transvaginal access with laparoscopic assistance, is presented. The instruments that are used, are as follows: 3 troacars-10 mm, 3 mm, 5 mm and instruments of Karl Storz Company. The technique of transvaginal introduction of the first troacar, under the visual guidance of a laparoscope, is presented. Visualization of the surgical site is done due to a 10 mm (the length is 55cm) hard laparoscope. Attention is paid to the consecutive and safe dissection of the structures of Calot’s triangle, using Endo Mini-Retract COVIDIEN instrument with clipping by means of a 5 mm MEDTRONIC COVIDIEN applicator via a 5 mm umbilical access. Removal of the gallbladder is done transvaginally with the closure of vaginal wound by one stitch, where synthetic resorbable thread has been used.

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

Transvaginal hybrid minilaparoscopy-assisted cholecystectomy

Transvaginal hybrid minilaparoscopy-assisted cholecystectomy.
Professor Puchkov K.V. is performing an operation (2008).

In this film a simple technique of removal of gallbladder transvaginally is presented. The instruments that have been used are the following: a 10 mm long troacar, a 3 mm troacar, and a 5 mm troacar. Duration of the operation is 25 minutes. Attention is paid to the consecutive and safe dissection of the structures of Calot’s triangle with clipping by means of a 5 mm MEDTRONIC COVIDIEN applicator. Visualization of the operation field is done with the help of a hard laparoscope (the length is 55 cm), 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.

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