“Polysorb” thread

Laparoscopic salpingostomy according to M. Bruat with manual stitching

Laparoscopic salpingostomy according to M. Bruat with manual stitching.
Professor Puchkov K.V. is performing an operation (2017).

A 29 year-old patient is operated on for the secondary infertility on the background of chronic salpingitis and left hydrosalpinx. During operation chromosalpingoscopy has been performed, and during this procedure obstruction of the left fallopian tube in its terminal part has been found out, the same thing in the right tube as peritubary adhesion has been present. Salpingoovariolysis has been performed both sides. The video presents the technique of salpingostomy according to M. Bruat. Fixation of fibrial part of fallopian tube is done by placing an atraumatic suture, using resorbable “Polysorb” 4-0 thread, forming an intracorporeal knot. Then a careful washing of operation zone is done by saline solution and introduction of anticommissural gel. Operation time is 40 minutes.

Laparoscopic creation of anastomosis of the fallopian tube

Laparoscopic creation of anastomosis of the fallopian tube.
Professor Puchkov K.V. is performing an operation (2017).

The video demonstrates the technique of laparoscopic creation of the «end-to-end» anastomosis of the left fallopian tube after sterilization. The patient underwent ligation of the single uterine tube at caesarean section in 2012. Surgical intervention was performed at the insistent request of the patient due to the impossibility of IVF on religious grounds. At the first stage, hysteroscopy was performed, in which the uterine cavity and the proximal part of the left fallopian tube were found to be satisfactory. Further, during laparoscopy, a stump of a tube about 2 cm long and a defect of a wall about 1.5 cm was revealed. Single planar adhesions around the tube, fimbria was absolutely free. Tubal stumps are dissected with sharp endoscopic scissors. When checking the functionality of the distal tube, free flow of contrast into the abdominal cavity is noted. An «end to end» anastomosis was created with interrupted sutures with atraumatic Polysorb 5/0 thread without taking of the mucous membrane. Next, excised retrocervical invasive endometriosis from sacral ligaments. The operation time is 55 minutes.
1 year after surgery, the patient reported about 16 week uterine pregnancy.

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

Laparoscopic reconstructive metroplasty with the temporary occlusion of the arterial stream in case of healing failure of the uterine scar

Laparoscopic reconstructive metroplasty with the temporary occlusion of the arterial stream in case of healing failure of the uterine scar.
The operation is performed by Professor Puchkov K.V. (2017).

In this video the technique of laparoscopic reconstructive metroplasty in case of healing failure of the uterine scar after the cesarean section is presented. The operation is performed according to the author’s method (the patent obtained in 2007) with the temporary occlusion of the arterial stream. At the first stage, immediately after the bifurcation of the common iliac artery the pelvic abdomen is opened, and De Bekey vascular forceps are temporarily applied onto the internal artery. It gives a possibility to avoid blood loss during the operation. Then the insolved scar is dissected in the transverse direction till the healthy tissue with the help of a monopolar electrode. The wound is stitched by separate atraumatic suture, using “Polysorb” 2-0 and “Monocril” 2-0 thread. Then the forceps are removed from the internal iliac artery, and bloodstream is restored in the uterus. The suture is covered by anticommisural gel.

The details of this technique you can read on the personal cite of Professor Puchkov K.V. To go to the link

Laparoscopic “shaving” of the walls of urinary bladder in case of infiltrative endometriosis

Laparoscopic “shaving” of the walls of urinary bladder in case of infiltrative endometriosis.
Professor Puchkov K.V. is performing an operation (2017).

A patient is operated on for infiltrative endometriosis, invading the walls of urinary bladder. MRT images have shown it. During cystoscopy they have not found out the involvement of mucous membrane. The film demonstrates the technique of exposure of endometrioid infiltrate out of the surrounding tissues by means of a 5 mm monopolar electrode. An affected part of urinary bladder is dissected within the boundaries of submucous layer and is stitched by “Polysorb” 3-0 thread. Duration of this stage is 6 minutes.

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

Laparoscopic myomectomy (intraligamentary node is 6 cm)

Laparoscopic myomectomy (intraligamentary node is 6 cm)
Professor Puchkov K.V. is performing an operation (2017).

In this film the technique of laparoscopic myomectomy is presented. A 30 year-old patient is operated on for intraligamentary myoma of uterus-6 cm- on the right lateral wall and retrocervical endometriosis. At the first stage removal of endometrioid infiltrate of rectum by “shaving” is done, up to the submucous layer, with the further peritonization of operation zone by placing an atraumatic interrupted suture, using “Polysorb” 3-0 thread. Then, using a monopolar electrode, the broad ligament is dissected up to the myomatous node, and using two 10 mm hard forceps, myoma is enucleated out of surrounding tissues; visual control of the right ureter should be taken over. Pelvic fascia is not opened. The wound is stitched by V-lock system (MEDTRONIC COVIDIEN), having monofilament resorbable polydioxanone thread, oriented in space with the set angle. This system gives a possibility to stitch uterine wound fast and layer by layer with the proper hemostasis. Abdomen is stitched, by placing an atraumatic separate suture, using “Monocril” 2-0 thread, in the area of broad and sacrouterine ligaments. Myomatous node is removed from the abdominal cavity by means of electromechanical morcellation Rotocut G1 of Karl Storz Company. Anticommissural gel is applied onto the suture line. 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 nerve-preserving resection of rectum

Laparoscopic nerve-preserving resection of rectum
Professor Puchkov K.V. is performing an operation (2017).

A patient was operated for infiltrative endometriosis, invading to the wall of rectum, and stenosis of lumen more than 50 %. In this film a safe technique of exposure of the left ureter, the right and left inferior hypogastric nerves with using of 5 mm electrode is demonstrated. For the better visualization of the surgical site, temporary fixation of ovaries by transabdominal stitching was done. Then carefully endometriosis infiltrate was exposed out of surrounding tissues, with dissecting the layer between the posterior wall of vagina and the anterior wall of colon. Then, using a 5 mm LigaSure instrument («MEDTRONIC COVIDIEN»), dissection of rectum was done. The technique of colon transection with a linear endoscopic stitching device right behind the infiltrate, is shown. The final stage - forming a circular ”end-to-end” anastomosis, using a 31 mm («MEDTRONIC COVIDIEN») device and strengthening of anastomosis zone by manual stitching, using “Polysorb” 3-0 thread.

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

Laparoscopic “shaving” of the rectal wall in case of retrocervical endometriosis

Laparoscopic “shaving” of the rectal wall in case of retrocervical endometriosis
The operation is performed by Professor Puchkov K.V. (2017).

The 29 years old patient with the deep infiltrating endometriosis. According to MRT investigation there is the invasion of endometriosis focus in the rectal wall, without the involvement of the submucous layer into the process. In this video the technique of exposure of the endometriosis infiltrate from the surrounding tissues with using of 5 mm monopolar electrode is demonstrated. A careful dissection of ureters was done, and they were led aside laterally. An affected area of the colon was dissected within the submucous layer and was stitched by the interrupted manual suture, using “Polysorb” 3-0 thread. The operation duration was 110 minutes.

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