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Retrocervical endometriosis
Surgical treatment of retrocervical endometriosis with the lesion of sigmoid colon, rectum, caecum and iliac colon, using laparoscopic access
Автор: Puchkov K.V.
Professor Puchkov k.V. is performing an operation (2018).
A 32 year-old patient was operated laparoscopically for deep infiltrative retrocervical endometriosis of sacrouterine ligaments and lesion of sigmoid colon, rectum, caecum and iliac colon. A repeated laparoscopy to evaluate the result had been performed in a year after surgery.
During the first operation was found out an invasion of the sigmoid colon in two areas, with stenosis of lumen more than 50%. Lesion of rectum and iliac colon with invading to the wall up to the submucous layer was identified. The whole of the wall thickness of caecum had been affected. For the better visualization of the surgical site temporary fixation of ovaries by transabdominal stitching was done. In the video safe technique of removing of endometriosis of sacrouretal ligaments and “shaving” of rectum with using of 5 mm monopolar electrode is demonstrated.
A 5 mm LigaSure («MEDTRONIC COVIDIEN») instrument was used for dissection of mesentery of the sigmoid colon, transection of the distal part by a linear endoscopic stitching device took place. The affected part of colon was removed through the minilaparotomy, the dissection of proximal part of colon was near infiltrate. Then the head of stitching device was inserted into the proximal part to form circular “end-to-end” anastomosis using a 31 mm device («MEDTRONIC COVIDIEN») laparoscopically.
At the second stage, resection of caecum with endometriosis focus with a linear endoscopic stitching device was done. Trocar wound in the right iliac area was expanded up to 3 cm, and an affected area of the iliac colon is exteriorized onto the abdominal wall. Then “shaving” of endometrioid foci up to the submucous layer was done, using a monopolar electrode. An atraumatic manual suture was placed on defects of the intestinal wall, using “Polysorb” 4-0 thread. The colon was immersed into the abdominal cavity. Anti-adhesive gel was applied to the operation area. Postoperative therapy was performed with Diferiline-3.75 mg intramuscularly within 6 months. The repeated laparoscopy to evaluate the result of treatment was performed in a year after surgery. In the abdomen cavity there was no any sings of adhesions, zones of excised infiltrates was covered by peritoneum. In the area of anastomosis on the large colon and in the area of suture on the blind gut thin scars were found out. At the area of “shaving” on the iliac colon soft scar was found out. The result of treatment is excellent.
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
Автор: Puchkov K.V.
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
Автор: Puchkov K.V.
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
Автор: Puchkov K.V.
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
Автор: Puchkov K.V.
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.
Laparoscopic “shaving” of the rectal wall in case of retrocervical endometriosis
Автор: Puchkov K.V.
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.
Laparoscopic disc-shaped resection of rectum with using of a linear stitching device
Автор: Puchkov K.V.
Laparoscopic disc-shaped resection of rectum with using of a linear stitching device
Professor Puchkov K/V. is performing an operation (2017).
A patient haв infiltrative endometriosis, invading to the anterior wall of rectum without deformation of lumen. In this situation “shaving “ was not efficient. In this film the technique of exposure of endometriosis infiltrate out of surrounding tissues by a 5 mm LigaSure instrument («MEDTRONIC COVIDIEN») was demonstrated. Endometriosis infiltrate was stitched by thread that was used as a “holder”. An affected part of colon was resected by a linear endoscopic stitching device («MEDTRONIC COVIDIEN») in the transverse direction. Duration of this stage was 16 minutes.
You can read about this technique in detail on the personal cite of Professor Puchkov Konstantin Viktorovich. To go to the link.
