Olympus

Laparoscopic organ preserving resection of two pheochromocytes from a single left adrenal gland

Laparoscopic organ preserving resection of two pheochromocytes from a single left adrenal gland.

Professor Puchkov K.V. is performing an operation (2019).

Patient 24 years old, in the single left adrenal gland were found two tumors about 2 cm each in diameter, they located in the medial pedicle and in the body of the organ. At the age of 20, he was examined about hypertensive crises. In 2015, bilateral adrenal lesions were diagnosed: on the right a tumor - up to 5 cm, on the left side - 2 lesions: 1 and 1.5 cm. Right-sided adrenalectomy was performed, the histological conclusion was: malignant pheochromocytoma. The patient refused bilateral adrenalectomy. In the future, according to CT data, the growth of lesions of the left adrenal gland is noted. In the analyzes: daily urine metanephrins: maximum metanephrine 8.897 mg/day, normetanephrine 319.3 mg/day. In the preoperative period, he received «Cardura». A laparoscopic organ-sparing surgery was performed - removal of two formations with full preservation of the adrenal tissue. Access to the adrenal gland was done by mobilising the splenic angle of the colon and dissecting the tissue between the Tolds fascia and Herota fascia. The intersection of the vascular structures and adrenal tissue is performed by alternating ligation systems — 5 mm Thunderbeat Olympus instrument and 5 mm LigaSure MEDTRONIC COVIDIEN instrument. The operation is carried out quickly and bloodless. The tumor is cut off from the body of the adrenal gland and placed in a plastic container in which was removed from the abdominal cavity. For the hemostasis «Tachocombe» was used at the sites of tumor removal. The operation time was 40 minutes. Histology - pheochromocytoma of solid-alveolar structure with polymorphoncellular composition.

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

Laparoscopic ischemic resection of the left kidney

Laparoscopic ischemic resection of the left kidney
Professor Puchkov K.V. is performing an operation (2019).

The film shows the technique of left-sided laparoscopic resection of the kidney in a malignant tumor (4 cm) located in the lower pole. Mobilization of the kidney and dissection of the renal artery and vein is performed using 5 mm instruments using the Thunderbeat (Olympus) and LigaSure system (MEDTRONIC COVIDIEN). A De Bekey vascular clamp (AESCULAP) is temporarily superimposed on the renal artery. Kidney resection is performed with a 5 mm Thunderbeat (Olympus) instrument within healthy tissue. Hemostasis in the area of the bed is carried out by the bipolar instrument of the Karl Storz Company. For the purpose of additional hemostasis, the wound is covered with a hemostatic plate Tachocomb (Austria). Next, the clamp is removed from the renal artery and blood flow is restored in the kidney. The time of thermal ischemia is 24 minutes. The tumor is immersed in a special plastic container MEDTRONIC COVIDIEN, which is removed through umbilical access. Operation time 1 hour 5 minutes.

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 the kidney with ZERO ischemia

Laparoscopic resection of the kidney with ZERO ischemia
Professor Puchkov K.V. is performing an operation (2019).

Laparoscopic resection of the kidney with ZERO ischemia

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

Laparoscopic right-sided enucleation of adrenal tumor for pheochromocytoma

Laparoscopic right-sided enucleation of adrenal tumor for pheochromocytoma.

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

Patient 53 years old was admitted to the hospital, it was found a 3 cm tumor of the right adrenal gland, located in the medial pedicle. The patient noted a history of hypertensive crises. A laparoscopic organ-sparing surgery was performed - right-sided enucleation of the tumor. Access to the adrenal gland was done by dissecting the tissue between the Tolds fascia and Herota fascia. The intersection of the vascular structures and adrenal tissue was performed by alternating the ligation systems — 5 mm Thunderbeat Olympus instrument and 5 mm LigaSure MEDTRONIC COVIDIEN instrument. The tumor was cut off from the body of the adrenal gland and placed in a plastic container in which was removed from the abdominal cavity. The operation time was 30 minutes.
The operation was carried out quickly and bloodless. Additional hemostasis was carried out by the PerClot system (Italy). At the end of the film, the removed specimen is shown - adrenal pheochromocytoma (3 cm).
Histology - adrenal pheochromocytoma.

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

Laparoscopic right-side partial adrenalectomy for pheochromocytoma

Laparoscopic right-side partial adrenalectomy for pheochromocytoma.
Professor Puchkov K.V. is performing an operation (2018).

Patient 44 years old, was admitted with a tumor of the right adrenal gland about 6 cm in size located in its body. In the analyzes, was found out the increase of urine metanephrine: metanephrine 429 µg / day (up to 320), normetanephrine 695 µg / day (up to 390), cortisol and aldosterone were within normal limits. In the preoperative period she received «Cardura». Concomitant chronic calculous cholecystitis. A laparoscopic organ-sparing surgery was performed - partial adrenalectomy and cholecystectomy. Access to the adrenal gland was performed by dissecting the tissue between the fascia of Tolda and Gerot. The intersection of the vascular structures and adrenal tissue was performed by alternating the ligation systems — 5 mm Thunderbeat Olympus instrument and 5 mm LigaSure MEDTRONIC COVIDIEN instrument. The tumor was cut off from the body of the adrenal gland and placed in a plastic container in which it was removed from the abdominal cavity. Operation time 45 minutes.
The operation was carried out quickly and bloodless. Additional hemostasis was carried out by the PerClot system (Italy). At the end of the film, a removed specimen is shown - the adrenal pheochromocytoma (6 cm). Histology - the adrenal pheochromocytoma.

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

Laparoscopic left-sided partial adrenalectomy for pheochromocytoma

Laparoscopic left-sided partial adrenalectomy for pheochromocytoma.
Professor Puchkov K.V. is performing an operation (2018).

Patient 37 years old, was admitted with a tumor of the left adrenal gland, 4 cm in diameter, located in the lateral pedicle. BMI - 32.3. In the analyzes was found out the increase of urine metanephrine: metanephrine 460 mcg / day (up to 320), normetanephrine 595 mcg / day (up to 390), cortisol and aldosterone were within normal limits. In the preoperative period she received «Cardura». A laparoscopic organ-sparing surgery was performed - left partial adrenalectomy. Access to the adrenal gland is accomplished by dissecting the splenic angle of the colon and dissecting the tissue between the fascia of Toldt and Herot. The intersection of the vascular structures and adrenal tissue was performed by alternating the ligation systems — 5 mm Thunderbeat Olympus instrument and 5 mm LigaSure MEDTRONIC COVIDIEN instrument. The operation was carried out quickly and bloodless. The tumor was cut off from the body of the adrenal gland and placed in a plastic container in which it was removed from the abdominal cavity.
Additional hemostasis was carried out by the PerClot system (Italy). The operation time was 40 minutes.
Histology - adrenal pheochromocytoma

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

Laparoscopic atypical liver resection

Laparoscopic atypical liver resection.
Professor Puchkov K.V. is performing an operation (2018).

The video demonstrates the technique of laparoscopic resection of the left hepatic lobe with 6 cm adenoma. Mobilization of the left hepatic lobe and dissection of the hepatic parenchyma is performed using the 5 mm Thunderbeat Olympus instrument, which implements the concept «one operation - one instrument». Dissection of tissues is carried out quickly and bloodless. The final hemostasis is carried out with bipolar coagulation. The tumor is immersed in a special plastic container (MEDTRONIC COVIDIEN), which is removed through umbilical access. Drainage was placed in the operative zone for a day. The operation time is 25 minutes.

You can read more about the techniques on the personal site of Professor Konstantin Viktorovich Puchkov.