Endometriosis

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.

Laparoscopic dissection of the external genital endometriosis of the pelvic abdomen. Ureterolysis. Ureter duplication on the left

Laparoscopic dissection of the external genital endometriosis of the pelvic abdomen. Ureterolysis. Ureter duplication on the left.
Professor Puchkov K.V. is performing an operation (2017).

A 25 year-old patient is operated on for the external genital endometriosis, stage 3. In this video the technique of dissection of centres on the abdomen, using instruments of Karl Storz Company, is presented. Attention should be paid to the preliminary opening of the abdomen by means of a monopolar electrode near the centre, giving a possibility to carbonic acid gas to penetrate into the retroperitoneal space. Gas presence gives a possibility to perform more safe dissection of affected tissues. Simultaneously traction of the endometrioid centre in opposite direction is performed, giving a possibility to see clearly the structures of the retroperitoneal space. Using the soft forceps, the exposure of the tubular structures is done subperitoneally, they are moved aside from the endometrioid centre. During the tissue dissection the ureter duplication has been found out. One should bear in mind the variants of anatomy to prevent the injury of ureters during the dissection of the endometrioid centres. Antiсommisural “Mesogel” barrier is introduced into the pelvic area. The operation duration is 50 minutes.

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 dissection of the right lower hypogastric nerve during excising retrocervical endometriosis

Laparoscopic dissection of the right lower hypogastric nerve during excising retrocervical endometriosis
Professor Puchkov K.V. is performing an operation (2017).

The patient was 28 years old, she had a painful syndrome on the background of the infiltrating endometriosis, invading to the wall of rectum, vagina and the right inferior hypogastric nerve. In this video the technique of exposure of the right inferior hypogastric nerve by a 5 mm monopolar electrode was presented, as well as the further resection of it alongside with the infiltrate, using a 5 mm LigaSure («MEDTRONIC COVIDIEN») instrument.

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

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 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 resection of vaginal wall and rectal wall in case of endometriosis infiltration

Laparoscopic resection of vaginal wall and rectal wall in case of endometriosis infiltration
The operation is performed by Professor Puchkov K.V. (2017).

The patient was admitted with the infiltrating endometriosis that invades to the anterior wall of rectum without deformity of the lumen, it also invades to the posterior fornix of vagina. In this video the technique of exposure of endometriosis infiltrate from the surrounding tissues with using of the monopolar electrode and Liga Sure instrument («MEDTRONIC COVIDIEN») has been demonstrated. The affected area of vagina was resected and removed with the infiltrate. The anterior intestinal wall alongside with the vaginal area and infiltrate were resected by the linear endoscopic («MEDTRONIC COVIDIEN») stitching device in the transverse direction. The specimen was removed from the abdominal cavity through the vagina. The wound was stitched by the single-knot suture, using Monocril 2-0 thread.

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