Novosti
Khirurgii

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Year 2016 Vol. 24 No 5

EXCHANGE OF EXPERIENCE

K.V. PUCHKOV1,2, D.A. KHUBEZOV2,3, D.K. PUCHKOV2,3, R.V. LUKANIN3

LAPAROSCOPIC RIGHT HEMICOLECTOMY WITH SPECIMEN EXTRACTION ACCORDING TO NOSE METHOD

ANCO "Center of Clinical and Experimental Surgery"1, Moscow,
SBEE HPE "Ryazan State Medical University Named after Academician I.P. Pavlov"2,
SBE RR "Ryazan Regional Clinical Hospital",
Ryazan.
The Russian Federation

Objectives. To evaluate the immediate and long-term results of surgical treatment of patients with simultaneous diseases of the abdominal and pelvic organs after laparoscopic right hemicolectomy with the specimen extraction transvaginelly according to the natural orifice organs specimen extraction (NOSE) method.
Methods. The article details the first clinical case: the patient with the tumour of the colon and uterus myoma nodes, and therefore, she was subjected to a simultaneous laparoscopic operation – hysterectomy, right hemicolectomy with extraction of resected specimen transvaginally with intracorporal anastomosis fistulization. At the first stage hysterectomy was performed, right hemicolectomy was carried out using the original combined latero-medial technique. Within 3 years 5 similar surgical procedures had been done and the results are presented in this article.
Results. Mean operative time was 133+12,9 min. Intraoperative blood loss did not exceed 90-100 ml. The length of the vascular pedicle (indersected iliac colic artery) was 9±1 cm. The fascia of colon was saved in all 5 cases. No intraoperative complication was observed. Postoperative complications were registered in 2 cases: the development of functional complication – dyspareunia was noted in 1 case. The development of this complication was associated with the violation of treatment guidelines – abstinence from sexual intercourse after an operation is advisable for 2 months. This complication was cured with vaginal suppositories within 2 weeks after the first symptoms appearance. One case of acute urinary retention was observed on the second day after surgery (after the urinary catheter removal). There was a need to set a urinary catheter within 12 hours. The level of postoperative pain ranged from 0 to 1.
Conclusion. Transvaginal access is considered to be an ideal way to extract the resected specimen due to anatomical and physiological features of the given area during the colon operations.

Keywords: laparoscopy, laparoscopic hemicolectomy, NOSE, intracorporeal interintestinal anastomosis formation, transvaginal access, postoperative pain, complication
p. 519-524 of the original issue
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Address for correspondence:
390026, Russian Federation, Ryazan, Vyisokovoltnaya st.,
9, Ryazan State Medical University named by Academician I.P. Pavlov,
department of surgery with the course of endosurgery FAPE.
Tel: +7 (952) 122-81-85
E-mail: puchkovdk@mail.ru
Puchkov Dmitry Konstantinovich
Information about the authors:
Puchkov K.V. MD, Professor, Director, ANCO "Center of Clinical and Experimental Surgery", Moscow, Professor of department of surgery with the course of endosurgery FAPE, SBEE HPE "Ryazan State Medical University named after Academician I.P.Pavlov", Professor of department of obstetrics and gynaecology, SBEE APE "Russian Medical Academy of Post-graduate Education".
Khubezov D.A. MD, Professor, Head of department of surgery with the course of endosurgery FAPE, SBEE HPE "Ryazan State Medical University named after Academician I.P.Pavlov", Head of department of coloproctology, SBE RR "Ryazan Regional Clinical Hospital".
Puchkov D.K. Assistant of department of surgery with the course of endosurgery FAPE, SBEE HPE "Ryazan State Medical University named after Academician I.P.Pavlov", Coloproctologist of department of coloproctology, SBE RR "Ryazan Regional Clinical Hospital".
Lukanin R.V. Coloproctologist of department of coloproctology, SBE RR "Ryazan Regional Clinical Hospital".
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