“Shaving”

Surgical treatment of retrocervical endometriosis with the lesion of sigmoid colon, rectum, caecum and iliac colon, using laparoscopic access

Professor Puchkov k.V. is performing an operation (2018).

A 32 year-old patient was operated laparoscopically for deep infiltrative retrocervical endometriosis of sacrouterine ligaments and lesion of sigmoid colon, rectum, caecum and iliac colon. A repeated laparoscopy to evaluate the result had been performed in a year after surgery.
During the first operation was found out an invasion of the sigmoid colon in two areas, with stenosis of lumen more than 50%. Lesion of rectum and iliac colon with invading to the wall up to the submucous layer was identified. The whole of the wall thickness of caecum had been affected. For the better visualization of the surgical site temporary fixation of ovaries by transabdominal stitching was done. In the video safe technique of removing of endometriosis of sacrouretal ligaments and “shaving” of rectum with using of 5 mm monopolar electrode is demonstrated.
A 5 mm LigaSure («MEDTRONIC COVIDIEN») instrument was used for dissection of mesentery of the sigmoid colon, transection of the distal part by a linear endoscopic stitching device took place. The affected part of colon was removed through the minilaparotomy, the dissection of proximal part of colon was near infiltrate. Then the head of stitching device was inserted into the proximal part to form circular “end-to-end” anastomosis using a 31 mm device («MEDTRONIC COVIDIEN») laparoscopically.
At the second stage, resection of caecum with endometriosis focus with a linear endoscopic stitching device was done. Trocar wound in the right iliac area was expanded up to 3 cm, and an affected area of the iliac colon is exteriorized onto the abdominal wall. Then “shaving” of endometrioid foci up to the submucous layer was done, using a monopolar electrode. An atraumatic manual suture was placed on defects of the intestinal wall, using “Polysorb” 4-0 thread. The colon was immersed into the abdominal cavity. Anti-adhesive gel was applied to the operation area. Postoperative therapy was performed with Diferiline-3.75 mg intramuscularly within 6 months. The repeated laparoscopy to evaluate the result of treatment was performed in a year after surgery. In the abdomen cavity there was no any sings of adhesions, zones of excised infiltrates was covered by peritoneum. In the area of anastomosis on the large colon and in the area of suture on the blind gut thin scars were found out. At the area of “shaving” on the iliac colon soft scar was found out. The result of treatment is excellent.

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

Laparoscopic reimplantation of the ureter in surgical treatment of endometriosis infiltration

Laparoscopic reimplantation of the ureter in surgical treatment of endometriosis infiltration.
Professor M.Malzoni (2018) is performing an operation

The patient, aged 30, has infiltrating endometriosis, invading to the anal wall and the right ureter. In this video the technique of the exposure of endometrioid infiltrate by means of the bipolar forceps and endoscopic scissors with the preliminary exposure of the right ureter up to the stenosis level is presented. Then the transection of the colon by the linear endoscopic stitching apparatus is immediately performed when infiltration is noticed. Then, using a 5-mm Thunderbeat Olympus instrument, dissection of the urinary bladder is performed. When the urinary bladder is inflated, the right wall of it is fixed to the lumbar muscle. The ureter and the urinary bladder are opened, and the ureter stent is inserted into the lumen. Then anastomosis is performed between the urinary bladder and the ureter by the interrupted suture, using “Polysorb” thread.

Laparoscopic “shaving” of the walls of urinary bladder in case of infiltrative endometriosis

Laparoscopic “shaving” of the walls of urinary bladder in case of infiltrative endometriosis.
Professor Puchkov K.V. is performing an operation (2017).

A patient is operated on for infiltrative endometriosis, invading the walls of urinary bladder. MRT images have shown it. During cystoscopy they have not found out the involvement of mucous membrane. The film demonstrates the technique of exposure of endometrioid infiltrate out of the surrounding tissues by means of a 5 mm monopolar electrode. An affected part of urinary bladder is dissected within the boundaries of submucous layer and is stitched by “Polysorb” 3-0 thread. Duration of this stage is 6 minutes.

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

Laparoscopic myomectomy (intraligamentary node is 6 cm)

Laparoscopic myomectomy (intraligamentary node is 6 cm)
Professor Puchkov K.V. is performing an operation (2017).

In this film the technique of laparoscopic myomectomy is presented. A 30 year-old patient is operated on for intraligamentary myoma of uterus-6 cm- on the right lateral wall and retrocervical endometriosis. At the first stage removal of endometrioid infiltrate of rectum by “shaving” is done, up to the submucous layer, with the further peritonization of operation zone by placing an atraumatic interrupted suture, using “Polysorb” 3-0 thread. Then, using a monopolar electrode, the broad ligament is dissected up to the myomatous node, and using two 10 mm hard forceps, myoma is enucleated out of surrounding tissues; visual control of the right ureter should be taken over. Pelvic fascia is not opened. The wound is stitched by V-lock system (MEDTRONIC COVIDIEN), having monofilament resorbable polydioxanone thread, oriented in space with the set angle. This system gives a possibility to stitch uterine wound fast and layer by layer with the proper hemostasis. Abdomen is stitched, by placing an atraumatic separate suture, using “Monocril” 2-0 thread, in the area of broad and sacrouterine ligaments. Myomatous node is removed from the abdominal cavity by means of electromechanical morcellation Rotocut G1 of Karl Storz Company. Anticommissural gel is applied onto the suture line. Operation duration is 50 minutes.

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 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 “shaving” of the wall of the urinary bladder in case of the infiltrating endometriosis

Laparoscopic “shaving” of the wall of the urinary bladder in case of the infiltrating endometriosis.
Professor Puchkov is performing an operation (2015).

The patient has an infiltrating endometriosis, invading the wall of the urinary bladder. In this video the technique of exposure of the endometrioid infiltrate from the surrounding tissues by means of a 5 mm monopolar electrode is demonstrated. The infiltrate is localized closer to the orifice of the left ureter. Because of it the temporary stenting of the left ureter has been done. The affected area of the urinary bladder is dissected within the limits of the submucous layer. Through non-opened mucous membrane urinary catheter is seen. The wall of the urinary bladder is stitched by “Monocril” 3-0 thread. Operation duration is 16 minutes.

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