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Adenomyosis

Laparoscopic excision of nodular adenomyosis and myomectomy with transient occlusion of arteries

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

In this video the technique of laparoscopic excision of nodular adenomyosis ( 9 cm), located on the posterior wall of uterus and myomectomy with the transient occlusion of arteries (internal iliac arteries) according to the author’s method of Professor Puchkov K.V. is demonstrated. A 34 year-old patient is operated on for mentioned above problems. At the first stage, immediately after bifurcation of the common iliac artery, pelvic abdomen is opened, and De Bekey vascular forceps are transiently applied onto the internal artery. It gives a possibility to avoid blood loss during the operation. Then nodular adenomyosis is dissected by a monopolar electrode within the boundaries of healthy tissues, without opening uterine cavity. The wound is stitched by V-lock system (MEDTRONIC COVIDIEN), having monofilament resorbable polydioxanone thread, oriented in space with the set angle. It gives a possibility to thread to slide freely in one direction and not to be shifted in the opposite direction. This system gives a possibility to stitch uterine wound fast and layer by layer with the proper hemostasis. Additionally the wound is strengthened by three interrupted Z-shaped stitches, using “Monocril” thread. At the second stage myomectomy is performed with stitching uterine wound, using interrupted suture. Then the forceps are removed from the internal iliac artery; and blood circulation is restored in uterus. Myomatous and adenomyosis nodes are removed from the abdominal cavity by means of electromechanical morcellation Rotocut G1 of Karl Storz Company. Anticommissural gel is applied onto the suture line.

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

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 supracervical hysterectomy without appendages. With no mounting of the video

Laparoscopic supracervical hysterectomy without appendages. With no mounting of the video
The operation is performed by Professor Puchkov K.V. (2017).

In this video the classic technique of removal of uterus without appendages, using a 5 mm MEDTRONIC COVIDIEN instrument, is presented; it is performed laparoscopically, without cutting and on-line. The operation is performed fast and without bloodloss. Attention should be paid to the consecutive transsection of the round ligaments of uterus, fallopian tubes and uterine vessels. Vascular fascicle handling is done strictly at the level of the ascending branch of the uterine artery. Uterus dissection from the cervix is performed with the help of a special monopolar loop, produced by KARL STORZ Company, that gives a possibility to transsect the tissue fast. A special attention should be paid to the closure of uterine cervix and stitching of sacrouterine ligaments for the sake of prevention of cervix prolapse. The duration of the operation is 19 minutes.

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

Laparoscopic dissection of the nodular adenomyosis (the node is 7 cm) with the temporary occlusion of the arterial stream

Laparoscopic dissection of the nodular adenomyosis (the node is 7 cm) with the temporary occlusion of the arterial stream
Professor Puchkov K.V. is performing an operation (2015)

In this video the technique of laparoscopic dissection of the nodular adenomyosis with the temporary occlusion of the arterial stream (the internal iliac arteries) according to the author’s own method (the patent, dated 2007) is presented. A 32 year-old patient is operated on for the nodular adenomyosis (the node is 7 cm) on the left lateral wall. On the MRT image the endometrioid cavity, having the diameter 5 cm with the fluid contents, has been found out in the centre of the node. At the first stage, immediately after the bifurcation of the common iliac artery the pelvic abdomen is opened, and De Bekey vascular forceps are temporarily applied onto the internal artery. It gives a possibility to exclude blood loss during the operation. Then, using a monopolar electrode, the muscular tissue is dissected up to the node, and by means of two 10 mm hard forceps and the monopolar electrode resection of the node from the surrounding tissues is performed. The wound is stitched by separate П- shaped stitches and the additional V-lock system (MEDTRONIC COVIDIEN). Then, the forceps are removed from the internal iliac artery, and blood flow is restored in the uterus. The adenomyous node is removed from the abdominal cavity with the help of Rotocut G1 electromechanical morcellation (Karl Storz Company). It is seen, that the node has a cavity, and ”Chocolade colour” contents are pouring out from it. The anticommisural gel is applied on the wound line.

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

Simultaneous laparoscopic hysterectomy, right hemicolectomy with intracorporeal anastomosis creation and extraction of specimen via vagina (N.O.S.E. technique)

Simultaneous laparoscopic hysterectomy, right hemicolectomy with intracorporeal anastomosis creation and extraction of specimen via vagina (N.O.S.E. technique)
Professor Puchkov K.V. is performing an operation (2013).

A 51 year-old woman was operated for myoma of uterus in combination with adenomyosis and hyperplasia of endometrium, carcinoid of the ascending colon, stage 2. In this film the technique of hysterectomy and ligation of the ascending branch of the uterine artery with a 10 mm LigaSure («MEDTRONIC COVIDIEN») instrument and «Karl Storz Company» instruments was demonstrated. Hemicolectomy was performed in lateral to medial approach with a 5 mm Harmonic Scalpel Ethicon instrument, with dissection of mesocolon along the superior mesenteric vein. Transection of the iliac colon and ascending colon was performed with Endo GIA («MEDTRONIC COVIDIEN») device with a 60 mm length. Anastomosis was performed intracorporeally, “side-to-side” by mechanic and manual stitching. Then the affected part of the colon was removed from the abdominal cavity through the colpotomic opening. The final stage – vagina was stitching by interrupted resorbable suture.

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

Laparoscopic supracervical hysterectomy, using the single access (S.I.L.S. Port COVIDIEN)

Laparoscopic supracervical hysterectomy, using the single access (S.I.L.S. Port COVIDIEN).
The operation is performed by Puchkov K.V. (2010).

In this video the technique of laparoscopic supracervical hysterectomy, using the single port (SILS port COVIDIEN), in case of the multiple myomas of uterus and adenomyosis, is demonstrated. The port is located in the umbilical area (the area for the further morcellation and evacuation of the uterus). The technique of ligation and transsection of the round uterine ligaments, ovarian ligaments and the uterine artery by means of a 5 mm instrument (LigaSure MEDTRONIC COVIDIEN) and a monopolar electrode (Karl Storz Company) are presented. To make the work in the area of the small pelvis easier, a uterine manipulator is inserted into the uterine cavity. Excision of body of uterus from the cervix is done by means of a monopolar loop (Karl Storz Company). Abdomen peritonizatuion and stitching of the sacrouterine ligaments are done with the help of Endo Stitch (MEDTRONIC COVIDIEN) instrument. The body of uterus is grasped by the bullet forceps and is removed from the umbilical access by means of mechanical morcellation. Duration of the operation is 35 minutes.

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

Laparoscopic panhysterectomy, using the single access (S.I.L.S. Port COVIDIEN)

Laparoscopic panhysterectomy, using the single access (S.I.L.S. Port COVIDIEN).
Professor Puchkov K.V. is performing an operation (2010).

In this video the technique of laparoscopic panhysterectomy, using the single port (SILS port COVIDIEN), in case of multiple myomas of uterus and adenomyosis, is presented. The port is placed in the umbilical area (the area for further morcellation and evacuation of uterus). The technique of ligation and transsection of the round ligaments of uterus, ovarian ligaments and the uterine artery by means of a 10 mm instrument (Liga Sure COVIDIEN) and a monopolar electrode (produced by Karl Storz Company) is presented here. To make the work in the area of small pelvis easier, a uterine manipulator is inserted into the uterine cavity. Excision of the body of uterus from the cervix is done by a monopolar loop (Karl Storz Company). The body of uterus is grasped by the bullet forceps and is removed via vagina. Vagina stitching, stitching of the sacrouterine ligaments and peritonization of the pelvic abdomen are done with the help of Endo Stitch (MEDTRONIC COVIDIEN) instrument, using “Polysorb” 2-0 thread. At the end of the operation the way the apparatus looks like and the stitched umbilical wound are shown. The duration of the operation is 55 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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