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Renal cancer

Laparoscopic radical right nephrectomy with aortocaval lymphadenectomy

Laparoscopic radical right nephrectomy with aortocaval lymphadenectomy.
Professor Puchkov K.V. is performing an operation (2017).

In this film the technique of laparoscopic right nephrectomy for malignant tumour (7 cm) is presented. Before operation MSCT with water-soluble contrast agent has been done. And in the aortocaval space the increased lymphatic nodes up to 4 cm have been found out. Access to hilum of kidney is done by means of bringing down the hepatic angle of the large colon and tissue dissection between Toldt’s fascia and fascia Gerotae by means of a 5 mm LigaSure (MEDTRONIC COVIDIEN) instrument and Karl Storz Company instruments. Then mobilization of duodenum according to Kocher is performed, with exposure of the inferior vena cava and gonad vein. At the next stage aoptocaval lymphadenectomy is performed, using a 5 mm Harmonic Scalpel Ethicon instrument. Ureter is transected at the level of the common iliac artery. Then the renal artery is exposed and clipped. The renal vein is stitched and transected by a 45 mm Endo GIA MEDTRONIC COVIDIEN apparatus with vascular casette. The preparation and removed lymphatic nodes are placed into a special plastic container MEDTRONIC COVIDIEN, that is removed through the umbilical access. Operation time is 1 hour 20 minutes.

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

Laparoscopic right resection of kidney with wound stitching

Laparoscopic right resection of kidney with wound stitching.
Professor Puchkov K.V. is performing an operation (2017).

In this film the technique of the right laparoscopic resection of kidney for malignant tumour (2 cm), that is located on the anterior surface, is demonstrated. In the abdominal cavity there is an extensive adhesion process, developed after open cholecystectomy. Mobilization of kidney and dissection of the renal artery and vein are done with the help of a 5 mm LigaSure (MEDTRONOC COVIDIEN) instrument. De Bekey forceps are temporarily applied onto the renal artery. Kidney resection is performed by a 5 mm monopolar instrument within the limits of healthy tissues. An atraumatic interrupted suture is placed on the kidney wound, using “Polysorb” thread. For the sake of additional hemostasis the wound is covered by hemostatic PerClot (Italy). Then the forceps are removed from the renal artery, and blood circulation is restored in the kidney. The ischemia time is 25 minutes. The tumour is placed into a special container MEDTRONIC COVIDIEN and is removed through the umbilical access. Operation duration is 1 hour 30 minutes.

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

Laparoscopic left resection of kidney (the tumour is 2.5 cm in the kidney hilus)

Laparoscopic left resection of kidney (the tumour is 2.5 cm in the kidney hilus).
Professor Puchkov K.V. is performing an operation (2016).

In this film the technique of laparoscopic left resection of kidney for malignant tumour (2.5 cm), located in the kidney hilus, is presented , as well as excision of renal cyst (7 cm). Kidney mobilization and dissection of the renal artery are done with the help of a 5 mm LigaSure (MEDTRONIC COVIDIEN) instrument and Karl Storz Company instruments. At the first stage the renal cyst is exposed and resected –it is located along the external contour of the kidney. The bed is handled by a monopolar electrode in the mode of “spray” coagulation. Then a vascular De Bekey forceps are temporarily applied onto the renal artery. Kidney resection is performed by Harmonic Scalpel Ethicon instrument within the boundaries of healthy tissues. For the sake of additional hemostasis the wound is covered by Tachocomb plate (Austria) Then forceps are removed from the renal artery, and blood supply is restored in the kidney. Ischemia time is 18 minutes. The tumour is placed into a special plastic container MEDTRONIC COVIDIEN, that is removed from the umbilical access. 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 left nephrectomy (tumour size is 12 cm, overweight is 62)

Laparoscopic left nephrectomy (tumour size is 12 cm, overweight is 62 ).
Professor Puchkov K.V. is performing an operation (2015).

In this film the technique of laparoscopic left nephrectomy for renal cancer (tumour size is 12 cm) is demonstrated. Access to kidney hilum is by means of bringing down the splenic angle of the large colon and dissection of tissues between Toldt’s fascia and fascia Gerotae by a 5 mm LigaSure (MEDTRONIC COVIDIEN) instrument and Karl Storz Company instruments. For making dissection easier in kidney hilum the descending part of the large colon is moved medially by soft 10 mm forceps. Ureter is transected by a 5 mm LigaSure instrument. The renal vein and artery are stitched and transected by Endo GIA MEDTRONIC COVIDIEN apparatus with a 45 mm cassette. The preparation is placed into a special plastic container MEDTRONIC COVIDIEN, that is removed through the enlarged umbilical access. At the end of the film the removed preparation is shown (the sizes are as follows: 40x25 cm), and the way the abdominal wall looks like after the operation. Operation duration is 1 hour 30 minutes.

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

Laparoscopic left resection of kidney

Laparoscopic left resection of kidney.
Professor Gallyamov E.A. is performing an operation (2013).

In this video the technique of laparoscopic left resection of kidney for malignant tumour, located in the lower pole, is demonstrated. Kidney mobilization and dissection of the renal artery and vein are done with the help of a 5mm Harmonic Scalpel Ethicon instrument. Hemostasis by means of manual stitching of the branch of the renal artery is demonstrated. Temporary ischemia is due to applying forceps onto the artery. Kidney resection is performed by means of 5 mm scissors by a “cold method” within the boundaries of healthy tissues. Kidney wound is stitched by V-lock system (MEDTRONIC COVIDIEN). Then the forceps are removed from the renal artery, and blood flow is restored in kidney. The tumour is placed into a special plastic container MEDTRONIC COVIDIEN, and is removed through the umbilical access.

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

Laparoscopic left nephrectomy

Laparoscopic left nephrectomy.
Professor Gallyamov E.A. is performing an operation (2013).

The author is commenting on his operation. In the film the technique of laparoscopic left nephrectomy for renal cancer is presented. The access to kidney hilus is done by bringing down the splenic angle of the large colon and dissection of tissues between Toldt’s fascia and Fascia Gerotae by a 10 mm LigaSure (MEDTRONIC COVIDIEN) instrument and Karl Storz Company instruments. The renal vein and artery are ligated by the system Weck Hem-o-Lock and are transected by the endoscopic scissors. The preparation is placed into a special plastic container and is removed through the access according to Pfannenstil.

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

Laparoscopic right nephrectomy

Laparoscopic right nephrectomy
Professor Puchkov K.V. is performing an operation (2013).

This video presents the technique of laparoscopic right nephrectomy for benign tumour (6 cm). An access to kidney hillus is done due to bringing down the hepatic angle of the large colon and dissection of tissues between Toldt’s fascia and fascia Herotae by a 5 mm LigaSure instrument (MEDTRONIC COVIDIEN) and instruments of Karl Storz Company. The duodenum mobilization is performed according to Kocher, with the exposure of inferior vena cava and the gonadal vein. Ureter is transected. Then the renal artery is exposed and clipped. The renal vein is stitched and transected by Endo GIA1 apparatus MEDTRONIC COVIDIEN, using a 45 mm vascular casette. Preparation is placed into a special plastic container MEDTRONIC COVIDIEN, that is removed through the umbilical access. Operation time is 40 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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