Monopolar electrode

Da Vinci surgical system Laparoscopic approach in the treatment of recurrent genital prolapse. Redo promontofixation procedure.

Da Vinci surgical system Laparoscopic approach in the treatment of recurrent genital prolapse. Redo promontofixation procedure.
Professor Puchkov K.V. is performing an operation (2019).

The film shows the technique of redo promontofixation procedure for genital prolapse III stage. In 2017, the patient underwent a robotic (da Vinci) hysterectomy without appendages and promontofixation with a mesh implant fixation to the anterior wall of the vagina. After 5 months, relapse developed. At the first stage, the pararectal space on the right was dissected with a 5 mm monopolar electrode and the dissection of the right lower hypogastric nerve. An excess mesh length was detected (stretching or inadequate selection of its length during the first operation). The fixation of the proximal edge to the promontory is reliable. In this regard, it was decided not to cut off its proximal part, but to cross the implant in the middle part. Next, lightweight promontofixation with a soft mesh implant MEDTRONIC COVIDIEN was performed according to the author's methodology (patent from 2015). The new implant was fixed to the distal part of the mesh in the area of the dome of the vagina and its proximal part, with adequate tension. The suture material was non-absorbable V-lock (MEDTRONIC COVIDIEN) and Prolen thread. Peritoneum was closed with Monocryl thread. The anterior and posterior colporrhaphy with levatoroplasty was also performed. The duration of the laparoscopic phase of the operation was 40 minutes. The patient was examined after 3 months, no complaints.

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

Laparoscopic partial Toupet fundoplication (270 gr.) with recurrent HH after Nissen fundoplication with an additional prosthetic mesh implant

Laparoscopic partial Toupet fundoplication (270 gr.) with recurrent HH after Nissen fundoplication with an additional prosthetic mesh implant
Surgeon: professor K.V. Puchkov (2019).

The patient is 49 years old; a year ago he underwent laparoscopic Nissen fundoplication on HH. After 4 years there was a recurrence of the HH over the esophagus, the place of cruroraphy is wealthy.
The video shows a reoperation technique for relapsed HH by laparoscopic approach. Mobilization of the gastroesophageal junction is performed with a 5 mm monopolar electrode and LigaSure MEDTRONIC COVIDIEN instrument. There is marked adhesions in the area of operation. The Nissen cuff is untenable. Particular attention is paid to the careful separation of the esophagus and the upper part of the stomach from adhesions, the elimination of the fundoplication cuff. Surgery is carried out quickly and bloodless. Next step - the top cruroraphy and partial Toupet fundoplication (270 gr.). The line of stitches is strengthened with the help of additional prosthetics of this zone with a special 3D with the Parietex Composite mesh and its fixation according to the author's safe technique with a flexible Relia Tack MEDTRONIC COVIDIEN bend hernia stapler. Implant fixation is performed by absorbable takers. The duration of the operation is 1 hour and 40 minutes.

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

Simultaneous laparoscopic cardiomyotomy with partial fundoplication and cholecystectomy

Simultaneous laparoscopic cardiomyotomy with partial fundoplication and cholecystectomy
Surgeon: professor K.V. Puchkov (2018).

The operation is performed for achalasia cardia and chronic calculous cholecystitis. The film shows the technique of dissecting of esophageal-gastric junction with the 5 mm LigaSure (MEDTRONIC COVIDIEN) instrument. Cardiomyotomy was performed by the original method with a thin monopolar electrode in a reduced power mode. Attention is paid to the dissection of all muscle layers up to the submucosal layer at a distance of at least 8 cm. The defect is covered by the anterior wall of the stomach with fixation with a continuous intracorporal suture. At the end of this stage, the anterior crurography is performed. Then, in the video shows the technique of laparoscopic cholecystectomy in chronic calculous cholecystitis. At this stage, special attention is paid to careful dissection of tubular structures in the area of the Kahlo triangle. After dissection of the cystic duct and artery, as well as visualization of the lateral wall of the common bile duct, the selected structures cut between the clips. A 10 mm applicator is inserted from the working access in the left hypochondrium. The gallbladder is removed from the abdominal cavity in a plastic container.

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

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 cholecystectomy, Kalo triangle dissection

Laparoscopic cholecystectomy, Kalo triangle dissection.
Professor Puchkov K.V. is performing an operation (2018).

The video shows the technique of laparoscopic classical cholecystectomy for chronic calculous cholecystitis. At this stage, special attention is paid to careful dissection of tubular structures in the area of the Kahlo triangle with a monopolar electrode (this stage is specifically shown without mounting). After dissection of the cystic duct and artery, as well as visualization of the lateral wall of the common bile duct, the selected structures cut between the clips. A 10 mm applicator is inserted from the working port in the left hypochondrium (it was used to perform cardiomyotomy for achalasia cardia). The gallbladder is removed from the abdominal cavity in a plastic container. You can read more about the techniques on the personal site of Professor Konstantin Viktorovich Puchkov.

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

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 vaporization of the endometrioid foci of the diaphragm

Laparoscopic vaporization of the endometrioid foci of the diaphragm.
Professor Puchkov K.V. is performing an operation (2018).

The operation is being performed for the external genital endometriosis, stage 4, the patient is 32 years old. In this video the technique of vaporization of endometrioid foci of the diaphragm with the help of the monopolar ball-shaped electrode (Karl Storz Company) is presented. The removal is done by means of non-contact method in “spray” mode”. The duration of this stage of operation is 10 minutes.