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Dermoid cyst
Excision of retroperitoneal dermoid cyst (mature teratoma 15 cm) by laparoscopic approach
Автор: Puchkov K.V.
Excision of retroperitoneal dermoid cyst (mature teratoma 15 cm) by laparoscopic approach Professor Puchkov K.V. is performing an operation (2019).
The patient is 21 years old. Complaints of arching pain in the right hypochondrium and lumbar region. The video shows a cross-sectional CT scan, where a large cyst with dense walls and fragments bone inside was determined, which was located between the inferior vena cava and aorta. During the laparoscopy, topographic anatomy is shown. Areas of surgical intervention: hepatoduodenal ligament, right kidney, duodenum, left renal vein, inferior vena cava. Clearly visible front wall of the cyst under the IVC, duodenum and hepatoduodenal ligament. The operation was started with dissection of the parietal peritoneum at the lower pole of the cyst between Toldi’s fascia and Gerota fascia. Next step - with 5 mm Thunderbeat Olympus device the dissection of the retroperitoneal cyst was performed. Cyst wall capsule was tightly soldered to the rear wall of the IVC. In this regard, the peritoneum was dissected medially to the IVC and the inferior vena cava was maximally separated from the cyst wall. Further cyst was opened with a monopolar electrode and contents (800 ml) aspirated. Fat, hair and bone fragments were founded in the lumen. After aspiration, the separation of IVC and anterior cyst wall in a "blunt" way. Further visualized the right renal artery that was intimately soldered from a cyst capsule. The medial margin of the cyst was separated from the anterior walls of the aorta and surrounding tissues. The lumbar artery was clipped and crossed. The base of the cyst in the lumbar muscles was coagulated. The cyst was placed in a plastic container and removed from abdomen. The duration of the operation was 1 hour and 50 minutes. Histological examination - the wall of the tumor consists of well differentiated germline derivatives with predominance of ectodermal derivatives: the elements are determined skin with all its components (epidermis, fibrous layer), elastic and fatty tissues, sweat and sebaceous glands, hair follicles), elements of fibrous and bone tissue. Mature teratoma (dermoid cyst).
You can read about this technique in detail on the personal cite of Professor Puchkov Konstantin Viktorovich. To go to the link.
Laparoscopic cystadnexectomy on the left
Автор: Puchkov K.V.
Laparoscopic cystadnexectomy on the left.
Professor Puchkov K.V. is performing an operation (2015).
In this video the technique of removing uterine appendages with the cyst laposcopically, using a 5 mm Liga Sure MEDTRONIC-COVIDIEN instrument, is presented. A 46 year-old patient is operated on for the dermoid cyst, having the size 20 cm. Before that the cyst has been dotted by means of a 10 mm ribbed troacar MEDTRONIC COVIDIEN, 800 mL of thick contents have been evacuated from it. The orifice is stitched by the interrupted suture. Then, using Liga Sure instrument, the consecutive coagulation and transsection of infundibulopelvic and ovarian ligaments are performed, as well as that of the fallopian tube. The operation is done fast and without bloodloss. The dissected preparation should be removed in a special plastic container. At the end of the procedure the removed cyst has been shown. 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.
