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Removal of endometriosis

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 resection of vaginal wall and rectal wall in case of endometriosis infiltration

Laparoscopic resection of vaginal wall and rectal wall in case of endometriosis infiltration
The operation is performed by Professor Puchkov K.V. (2017).

The patient was admitted with the infiltrating endometriosis that invades to the anterior wall of rectum without deformity of the lumen, it also invades to the posterior fornix of vagina. In this video the technique of exposure of endometriosis infiltrate from the surrounding tissues with using of the monopolar electrode and Liga Sure instrument («MEDTRONIC COVIDIEN») has been demonstrated. The affected area of vagina was resected and removed with the infiltrate. The anterior intestinal wall alongside with the vaginal area and infiltrate were resected by the linear endoscopic («MEDTRONIC COVIDIEN») stitching device in the transverse direction. The specimen was removed from the abdominal cavity through the vagina. The wound was stitched by the single-knot suture, using Monocril 2-0 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, stage IV. Nerve-preserving resection of rectum with the circular “end-to-end” anastomosis

Laparoscopic approach in the treatment of retrocervical endometriosis, stage IV. Nerve-preserving resection of rectum with the circular “end-to-end” anastomosis
Professor Puchkov K.V. is performing an operation (2017).

The patient was admitted with endometriosis infiltration, it invades to the rectal wall in three areas, the lumen stenosis that more than 50 %. In this video the safe technique of exposure of the right and left lower hypogastric nerves with using of 5 mm monopolar electrode is presented. Using a 5 mm Liga Sure («MEDTRONIC COVIDIEN») instrument, dissection of the rectum and vaginal dome was performed. For the better visualization of the surgical site the temporary fixation of ovaries was created with transabdominal sutures. We recommend performing a transsection of colon with the linear endoscopic stitching device right behind the infiltrate. We remove the specimen out of the abdomen and the head of the stitching device was inserted into the proximal part of colon. Final stage- creation of the circular ”end-to-end” anastomosis, using a 31 mm («MEDTRONIC COVIDIEN») stapler.

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.

Laparoscopic approach in treatment of retrocervical endometriosis with the lesion of the iliac colon

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

A 38 year-old patient was operated for deep infiltrative retrocervical endometriosis and lesion of the iliac colon. In her anamnesis there were 2 cesarean sections. During laparoscopy massive adhesions of organs of small pelvis had been found out, with involvement of greater omentum, sigmoid colon, uterus, and urinary bladder. The technique of dissection of adhesion by a 5 mm monopolar electrode and a 5 mm LigaSure instrument («MEDTRONIC COVIDIEN») had been demonstrated. During revision the lesion of the iliac colon by invasive endometriosis had been found out. Infiltrates were found out at the length of 5 cm (2 foci within the range 3-9 mm) with the deformation of intestinal wall, without involvement of the submucous layer. Trocar wound was expanded up to 3 cm, and an affected part of the colon was exteriorized onto the abdominal wall. Then “shaving” of foci was performed up to the submucous layer of the small colon by a thin monopolar electrode. An atraumatic manual suture was placed on the defects of the intestinal wall, using “Polysorb” 4-0 thread. The colon was immersed into the abdominal cavity. Anti-adhesion gel was applied on the operation zone.

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 endometriosis cysts of ovaries with extensive lesion of the small colon (“shaving“ of foci)

Laparoscopic approach in treatment of endometriosis cysts of ovaries with extensive lesion of the small colon (“shaving“ of foci)
Professor Puchkov K.V. is performing an operation ( 2015).

A 32 year-old patient has endometriosis cyst of ovaries, external genital endometriosis and extensive lesion of the iliac colon. In this video it is shown that during laparoscopy lesion of the iliac colon had been found out. Infiltration was determined at the length of 25 cm (10 foci within the range 3-8 mm) with the deformation of the intestinal wall without involvement of the submucous layer. Trocar wound in the right iliac area was enlarged up to 4 cm, and an affected area of the colon was exteriorized onto the abdominal wall. Then “shaving” of all foci up to the submucous layer of the small colon by a thin monopolar electrode was done. An atraumatic manual suture was placed on the defects of the colon wall,“Polysorb” thread 4-0 had been used. The colon was immersed into the abdominal cavity. Anti-adhesion gel was applied onto the area of operation. Operation duration was 90 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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