Endometriosis infiltration

Laparoscopic reimplantation of the ureter in surgical treatment of endometriosis infiltration

Laparoscopic reimplantation of the ureter in surgical treatment of endometriosis infiltration.
Professor M.Malzoni (2018) is performing an operation

The patient, aged 30, has infiltrating endometriosis, invading to the anal wall and the right ureter. In this video the technique of the exposure of endometrioid infiltrate by means of the bipolar forceps and endoscopic scissors with the preliminary exposure of the right ureter up to the stenosis level is presented. Then the transection of the colon by the linear endoscopic stitching apparatus is immediately performed when infiltration is noticed. Then, using a 5-mm Thunderbeat Olympus instrument, dissection of the urinary bladder is performed. When the urinary bladder is inflated, the right wall of it is fixed to the lumbar muscle. The ureter and the urinary bladder are opened, and the ureter stent is inserted into the lumen. Then anastomosis is performed between the urinary bladder and the ureter by the interrupted suture, using “Polysorb” thread.

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 “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.

Laparoscopic disc-shaped resection of the rectal wall by means of the circular stitching apparatus

Laparoscopic disc-shaped resection of the rectal wall by means of the circular stitching apparatus.
Professor Puchkov K.V. is performing an operation (2017).

The patient had infiltrating endometriosis, invading to the anterior wall of the rectum without deformation of the lumen. In this situation “shaving” is not efficient. In this video the technique of exposure of endometriosis infiltrate from the surrounding tissue is presented, using a 5 mm monopolar electrode and LigaSure («MEDTRONIC COVIDIEN») instrument. At the first stage the endometriosis infiltrate was dissected as much as possible up to the submucous layer (in order to decrease the volume of the affected tissue), and the affected area is immersed with the help of the thread between the edges of a 31 mm circular stitching («MEDTRONIC COVIDIEN») device, that was inserted in the lumen of rectum. The affected area of rectum was resected with a stitching device in the transverse direction – it is one/third of its circumference. The duration of this stage aws 36 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 hypogastic plexus in case of nerve-preserving resection of rectum

Laparoscopic dissection of the hypogastic plexus in case of nerve-preserving resection of rectum
Professor Puchkov K.V. is performing an operation (2017).

A 32 year-old patient was operated for infiltrative endometriosis, invading to the wall of rectum, with stenosis of lumen more than 50%.The film presents safe technique of exposure of the right and left inferior hypogastric nerves by a 5 mm monopolar electrode during resection of colon.

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