Endo GIA

Laparoscopic abdominal perineal resection (APR) of rectum, using a monopolar hook

Laparoscopic abdominal perineal resection (APR) of rectum, using a monopolar hook
Professor Puchkov K.V. is performing an operation (2018).

In this film the technique of performing of abdominal perineal resection (APR) of rectum with the expanded lymphadenectomy, using a monopolar “hook” electrode is presented. A 59 year-old female patient was treated with the diagnosis: Low rectal cancer fT3N1M0, G1. She had a course of neoadjuvant chemotherapy (CLT) with preoperative radiotherapy.
Exposure of rectum had done within the injuring of mesorectal fascia, with preserving the structures of upper and lower hypogastral plexus (sympatic and parasympatic nerves) laparoscopically. The “classical” positioning of trocars had been used: in the right and left iliac area, and in the mesogastric area to the left. The operation was started with dissection of pelvic in the right side of rectum, then exposure of rectum along the posterior wall with identification of the left ureter. Lymphodissection was performed in the area of origin of the inferior mesenteric artery, transection of superior rectal artery (with preserving of the left colic artery) was done with a 5 mm “LigaSure” («MEDTRONIC COVIDIEN») instrument. The next stage was dissection of the left lateral canal and mobilization of the descending part of the colic colon. Exposure of rectum up to pelvic floor along the posterior semicircumference took place within the injuring of the mesorectal fascia, then along the right and left semicircumference, and only at the end-along the anterior wall. Transection of the large colon in its proximal part had performed with EndoGIA-60 (a blue reload) device («MEDTRONIC COVIDIEN»).
The perineal stage had done in a classical approach. Stoma was created in the left iliac area. The drainage was placed via perineal wound. Operation duration was about 150 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 hemihepatectomy

Laparoscopic left hemihepatectomy.
Professor A.Forgione (Italy) is performing an operation (2017).

Operation is performed for metastasia into the left lobe of the liver. In this video the technique of laparoscopic left hemihepatectomy with the help of a 5 mm Harmonic Scalpel Ethicon instrument, bipolar, clipping of the vascular structures and bile ducts, stitching and transecting of the vein by Endo GIA MEDTRONIC COVIDIEN apparatus with a 45 mm white cassette, is presented. The preparation is placed into a special plastic container MEDTRONIC COVIDIEN, that is removed at the end of operation through the expanded access.

Laparoscopic radical hysterectomy with aortoileac and pelvic lymphadenectomy (operation according to Wertheim) with the resection of rectum

Laparoscopic radical hysterectomy with aortoileac and pelvic lymphadenectomy (operation according to Wertheim) with the resection of rectum.
Professor Puchkov K.V. is performing an operation (2017).

The patient was 48 years old, had retrocervical infiltrating endometriosis, invading to the uterine cervix, sacroiliac ligament on the left side, vaginal wall and rectum, with the development of moderately differentiated adenocarcinoma of an endometrioid type with the focus of planocellular metaplasia of fornix of vagina, invading to the cervix and vaginal wall (in rectum the tumor had not been found out). In this video the technique of radical hysterectomy with aortoileac and pelvic lymphadenectomy with transsection of sacrouterine and cardinal ligaments near the pelvic wall and removal of the upper one-third of vagina is demonstrated. Hysterectomy was performed with the help of a 5 mm LigaSure («MEDTRONIC-COVIDIEN») instrument. When performing aortoileac and pelvic lymphadenectomy, the technique of removing of nodes simultaneously by a 5 mm ultrasonic dissector, called Harmonic Scalpel, produced by Ethicon Company, was demonstrated. The use of ultrasound gives a possibility “to weld” thin lymphatic ducts, it is a kind of prophylaxis to prevent development of lymphatic cysts. This technique of operation gives a possibility not to use the drainage system. Lymphatic nodes were placed in separate plastic bags and were removed from the abdominal cavity alongside with the uterus. The author had shown a safe technique of exposure of tumorous infiltrate and exposure of ureter until the area where it confluences into the urinary bladder by means of a 5 mm thin hook. The zone of rectum exposure was 2/3 of its circumference, then the edge resection of colon was performed with using of a 45 mm EndoGIA («MEDTRONIC COVIDIEN») intestinal reloads, leaving the affected area in the tumorous infiltrate. Vagina was exposed as low as possible in the caudal direction and was transected at the distance of 4 cm from the cervix within the limits of healthy tissues (1/3 of it was removed). In this video a special attention is paid to the restorative stage-stitching of vagina, that was done by the interrupted suture, using “Monocril” thread. The operation time was 2 hours 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 appendectomy in case of myxoma of the vermiform appendix

Laparoscopic appendectomy in case of myxoma of the vermiform appendix.
Professor Puchkov K.V. is performing an operation (2017).

Operation is performed for myxoma of the vermiform appendix, the size is as follows; 8x4 cm. In the film the technique of dissection of mesentery of the vermiform appendix by a 5 mm LigaSure MEDTRONIC COVIDIEN instrument and Karl Storz Company instruments is presented. Then the appendix is dissected in the transverse direction by a linear stitching Endo GIA MEDTRONIC COVIDIEN apparatus, the length of the cassette is 45 mm. The preparation is placed into a special plastic container MEDTRONIC COVIDIEN, then it is removed through the umbilical access. Operation duration is 10 minutes.

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 resection of the sigmoid colon for acute diverticulitis

Laparoscopic resection of the sigmoid colon for acute diverticulitis
Professor Puchkov K.V. is performing an operation (2017).

In this film the technique of laparoscopic resection of sigmoid colon with end colostomy exteriorization is presented. A 64 year-old female patient was treated with the diagnosis: Diverticular disease of sigmoid colon with phlegmonous peridiverticulitis. The patient was admitted in hospital in 4 days after the beginning of the disease with the clinical presentation of acute diverticulitis of the sigmoid colon. During preoperation investigation according to RCT of the abdominal cavity, shown multiple diverticula, having the sizes 0.4—2 cm had been found out in her sigmoid colon, in the middle one-third of sigmoid colon, infiltrate (d~6 cm) had been found out, in mesentery of the sigmoid colon fluid formation with 2 cm in diameter with non-homogenous contents had been found out. Within the period from 2012 to 2016 twice a year the patient had attacks of acute diverticulitis, accompanied by temperature increase up to 39 degrees, abrupt pain in the lower abdomen; it required admitting to the surgical department of hospital. During the last 12 months the patient was thrice delivered to hospital for exacerbation of diverticular disease.
Then it was decided to perform an urgent operation. The “classic” scheme of positioning of troacars had been used: in the right and left iliac area, in the left mesogastric area. The operation was started with adhesiolysis, opening of the small pelvic on the right side of rectum, exposure of rectum along the posterior wall within the boundaries of mesorectal fascia with the identification of the left ureter with “Harmonic” scalpel (“Ethicon”) device. The next stage is separation of inflammated wall of the sigmoid colon from the lateral wall of pelvis in a “blunt” way, opening the left lateral canal, mobilization of sigmoid and descending colon within the boundaries of mesocolic fascia with “LigaSure” instrument (“Medtronic Covidien”). After transection of mesentery of descending colon transection of the large colon in its distal part was done with “EndoGIA-60” device (a blue cassette) (“Medtronic Covidien”). Specimen was removed throught the minilaparotomic access. In the left mesogastric area stoma was created. Operation was finished by draining the small pelvis. The duration of operation was 145 minutes.
Histologic conclusion: Diverticular disease of the large colon with perforation of one of diverticula with formation of mesenteric abscess. In postoperation period complex antibacterial, anti-inflammatory therapy was done. The patient had been discharged from hospital on the 6 days after operation.

Laparoscopic elective resection of the sigmoid colon for divertucular disease

Laparoscopic elective resection of the sigmoid colon for divertucular disease.
Professor Puchkov K.V. is performing an operation (2017).

In this video the technique of performing laparoscopic resection of the sigmoid colon with formation of circular stapler anastomosis is presented. A 62 year-old male patient was treated, having the diagnosis: Diverticular disease of the sigmoid colon. Chronic diverticulitis with relapses. The patient was admitted to hospital in 3 months after the ending of his therapeutic conservative course of treatment for acute diverticulitis of the sigmoid colon. During the last 16 months the patient 4 times was taken to hospital because of exacerbation of his diverticular disease. It was decided that a patient should be operated. Preoperation investigations have been done. According to FCS values and investigations with contrast enhancement multiple diverticula, having the sizes 0.4-1.2 cm, have been found out in his sigmoid colon.
The “classic” scheme of positioning of troacars had been used: in the right and left iliac area, and on the left in the mesogastric area. The operation was started with the dissection of peritoneum of the left lateral canal, mobilization of the sigmoid colon and descending colon within trauma of the mesocolic fascia with the “LigaSure” instrument (MEDTRONIC COVIDIEN). The next stage - opening of the peritoneum in the right of rectum, dissecting of rectum along the posterior wall within damaging of mesorectal fascia with the identification of the left ureter. The mandatory condition of performing the “correct” operation, according to our point of view, is preserving of the superior rectal artery and the left colic artery. Transection of the large colon in the distal part was done with EndoGIA-60 device (a violet cassette) (MEDTRONIC COVIDIEN).
Specimen was removed throught the minilaparotomic access Circular apparatus was introduced transanally and anastomosis was created. The second layer of single interrupted suture was placed in the anastomosis line. Operation was finished by placing transabdominal drainage. Duration of operation was 120 minutes.