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Diseases of gallbladder

Laparoscopic cholecystectomy in case of massive adhesions (calculus 5.5 cm, volume of content 400 ml)

Laparoscopic cholecystectomy in case of massive adhesions (calculus 5.5 cm, volume of content 400 ml)
Surgeon: professor K.V. Puchkov (2018).

The film shows the technique of laparoscopic cholecystectomy for chronic calculous cholecystitis and massive adhesions. The size of the gallbladder is 22cm x 4 cm (volume 400 ml), the size of the stone is about 5.5 cm. A technique for isolating the gallbladder from adhesions using a 5 mm instrument (LigaSure MEDTRONIC COVIDIEN) and a monopolar electrode is shown. Only the bottom of the gallbladder was free from adhesions. Careful extraction of the cystic duct and artery of 5 mm with a monopolar hook and mini retract tool COVIDIEN and clipping of these structures with a 10 mm Aesculap DS applicator with titanium latch clips was performed. 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.

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 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 cholecystectomy, using the single access (S.I.L.S.Port COVIDIEN)

Laparoscopic cholecystectomy, using the single access (S.I.L.S.Port COVIDIEN).
Professor Puchkov K.V. is performing an operation (2018).

In this video the technique of laparoscopic cholecystectomy for chronic calculous cholecystitis, using the single port (SILS port COVIDIEN), is presented. The sizes of the gallbladder are as follows: 14x7 cm. The doctor is commenting on positioning of the port. Taking into consideration big sizes of the gallbladder, its puncture is being done and evacuation of 100 mL of thick bile is taking place. The technique of transcutaneous fixing stitches, a careful exposure of the cystic duct and artery by a 5 mm monopolar hook and mini retract COVIDIEN instrument and clipping of all these structures by a 5 mm automatic applicator is presented. The dissected 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 cholecystectomy for rare version of positioning of cystic artery

Автор: Пучков К.В.

Теги: Puchkov K.V. Cholecystectomy Diseases of gallbladder

Laparoscopic cholecystectomy for rare version of positioning of cystic artery.
Professor Puchkov K.V. is performing an operation (2017)

In this film the technique of laparoscopic cholecystectomy in case of rare version of positioning of cystic artery is presented. The cystic artery originates from the common hepatic artery (it is marked in 2 % of cases), and both the common hepatic artery and the right hepatic artery are near the wall of the gallbladder. That is why it is necessary to perform a careful dissection of tubular structures near Calot’s triangle before their transection. This technique of operation is a kind of prophilaxis to prevent from severe complications-clipping and transection of the common hepatic artery.

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

Laparoscopic cholecystectomy, using the single access-SILS (concrement is 6 cm, contents volume 400 mL)

Laparoscopic cholecystectomy, using the single access-SILS (concrement is 6 cm, contents volume 400 mL)
Professor Puchkov K.V. is performing an operation (2017).

The technique of laparoscopic cholecystectomy, using the single port (SILS port COVIDIEN) for chronic calculous cholecystitis and gallbladder hydrops, is presented. The sizes of the gallbladder are as follows: 20x10 cm (the volume is 400 mL), the size of a stone is 6 cm. Taking into consideration big sizes of the gallbladder, its preliminary puncture is done, as well as evacuation of its 400 mL contents. The technique of transcutaneous fixing stitches is shown, as well as a careful exposure of the cystic duct and artery by a 5 mm monopolar hook and by mini retract COVIDIEN instrument, and clipping of these structures by means of a 5 mm automatic applicator. The removed gallbladder is pulled out from the abdominal cavity in a plastic container. The way the removed gallbladder and concrements look like is shown in this video.

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

Simultaneous laparoscopic cholecystectomy and resection of hepatic cyst

Simultaneous laparoscopic cholecystectomy and resection of hepatic cyst.
Professor Puchkov K.V. is performing an operation (2016).

In this film the technique of classical laparoscopic cholecystectomy in case of calculous cholecystitis, using 4 ports, is presented. The author is demonstrating the virtuosity when showing the technique of working with a 5 mm monopolar electrode in the area of Calot’s triangle. Dissection of the cystic duct and artery is performed without blood loss. The duration of cholecystectomy stage is 6 minutes. Then, using these ports, and a 5 mm Ligasure MEDTRONIC COVIDIEN instrument, resection of the cyst of the right lobe of liver (8 cm) is done. The cyst is opened by a monopolar electrode, and its contents (350 mL) is evacuated with the help of electroejection. Then, on the boundary with the hepatic tissue resection of walls of the cyst is done by means of a 5 mm LigaSure MEDTRONIC COVIDIEN instrument. Destruction of the cystic wall near its bed is done with the help of a 5 mm monopolar instrument in the mode of non-contact coagulation “spray” of the Company Karl Storz. The gallbladder and cystic walls are placed into a special plastic container MEDTRONIC COVIDIEN, then are removed through the umbilical access. Operation time is 20 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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