I. KHAT’ KOV Pancreatic duodeno cancer

Professor Kashkov, can you hear us?

Yes, we're hearing you. And do you hear us?

Yes, very well. On behalf of Professor Palazzini, we say good morning from Rome.

Yes, good morning from Moscow.

Okay. Can you tell us something about your procedure?

Yes, of course. So we have a woman, 45 years old. Do you hear me?

yes we can hear very well 45 years old she have she has duodenal cancer so we are going to perform

pancreatic duodenal resection and now we we can show just a moment we mobilized ligamentum

gastrocolica gastropeupleic vessels and now we are mobilizing duodenum here is duodenum

take it please here is the head of the pancreas and now we perform lymphadenectomy in aortic

aural segment here you can see inferior vena cava left renal vein aorta and now we are removing all

the try to remove all the lymph nodes from the aortic aural space okay thank you very much

so if you have question we will be happy to unsend to comment something and to

discuss something and to hear some suggestions for example okay okay

I think it would be better to do this at this stage.

A little bit on yourself.

Ok, it is possible to see how many ports and where are placed?

surgeon and okay okay so and you see there and you see yes yes yes absolutely it's very clear

so uh if you if it is interesting sorry can we switch laparoscopic images

okay thank you and now you can see that we

So we are trying to go along the superior mesenteric vein, here it is, here is the pancreas, and we are going here to make a tunnel under it, it's quite dangerous zone because of the vein branches to the mesenteric vein.

Okay, we can understand.

что-то у нас с локтями с вами давайте так что попробуем немножко стоять поехали поближе вот

видите да сейчас далековато получается как ни странно есть сейчас пока непонятно вообще 2

Please, prepare one more.

Raise your hand for the bubble.

It's me, by accident.

No, no need. I won't do it anymore.

Yes?

Take care of your right liver.

The bubble, it looks like hepatic.

Do you want it or not?

I want to see what's there.

Roman Yurievich took it,

I decided right away.

This is not right, we won't do it yet.

come on now a little more to the bubble now we will disconnect the bubble the liver will not interfere with the opinion now

all the same, no, it's okay now, we're like that on the side as usual, as usual, now a little closer to the camera opinion

Excuse me, not closer, but somehow.

Take this pen, Victor.

Go back a little, Victor.

Show me.

Just open your hand.

Let's cross the stomach.

No, no, no, I mean, in general, before lymphodonectomy.

Let's see the artery, no?

Let's see it somewhere.

Give me the lipator.

Or so.

Maybe it's not her.

Or the right one.

Or, no, it's probably the lymph node, Victor.

I think it's the lymph node, this one.

Or maybe the artery, yes, the artery.

And here, probably, the bubble one, no?

Here it is.

but this is the artery, we are already here, it's not very convenient to climb, yes, thank you, so

it's lymphatic for now, well, what is it, maybe we'll get here from the other side, it's not convenient,

nothing extra, it seems, well, that's enough, I just don't get it anymore, just a second, give me a rag, give me a rag,

Let's cross the flow now, let's see if we can do it now or not, pulsing it, wait, let's put a clip on it just in case.

Let's move here, it will give us the opportunity to move, Viktorovich.

little bit here, take it like this a little bit down like this, and carefully down here like this,

well, everything is fine, a little bit back now, once again, this is what we have, the artery is pulsing lower,

this is a flow, but hold on to prepare now, I'll see you for now, yes, yes, yes, now I want to

now on the right, so let's go through the same, you can cross correctly, I don't know correctly, let's

camera, come back like this, just pull it up, then a little bit back the camera a little bit back the

camera a little bit of a miracle bubble here to let go of the liver now the liver is not necessary to let go of the liver

down a little bit here where it is no no no here below even below they are the same it is superfluous

do not do it Viktor Viktorovich yes here it is now it should appear on the idea now look back a little

camera back yes let's look here now we will hide the liver here now why

you will then look a little closer to the camera, correct the horizon because I have already bent like this,

a little bit, please, yes, an unusual bend, a sharp check, or we pull something like that,

just go away because of this, so what is this here, we cross the gastrointestinal tract, there is very

well, we can cross it, it will go away, this is the lymph node system, and this is here on the clip,

Can you give me the clip? It's too thick.

Give me the clip.

Let's put it here.

Yes, so that there is no lymph flow.

Put it in.

Yes, yes, yes. Wait, I didn't see it.

Wait, this one.

Now, now, now.

Now.

Now, now, now.

Just a second.

Wait.

Yes.

Wait.

It's better to move the liver away a little.

Move the liver away.

A little back.

No, that's too much.

Just a second.

the best of the world with this, this is what we will cut off this, let's cut it off now like this, yes,

it's lymph nodes, it's also possible to take it, right, it's lymph nodes now, Victor, shift

12 percent, yes, yes, yes, yes, yes, yes, that's all, we look, we look, let's cut it off with a

large, but it's good, it was like that, but the table is always twitching, so let's look at the

I don't understand how she is there, probably it is she and the colors give the colors give before somehow this is a little static

stand a little bit so that where is the right one this is a little bit back move away close stand with the camera

back a little bit like this everything is fine like this let go let go all hold hold

take it please again here lymph node see it there now we have a little bit back

назад немножко вот я сейчас и иду к протоку что пересечь чуть назад чуть

назад камеру назад немножко по оси не надо

давай что-то это я тоже устал давайте эту серфин так это все чуть-чуть

салфетку покажите салфетку покажите отпустить артерию сейчас не надо

вставляйте этот вставьте колфингер с вашей стороны ночью бит пересечем без

this opinion without surfing we will cross I want you to just lift it up, open it,

let's highlight it a little bit here and cross it, I think let's put this thing all the same,

move a little, go away, go away, you will see it hard, yes, where is it, here it is, let's go normally,

now it will be a little closer, hold the scissors, the usual scissors, the flow, in general, the liver flow, the

ordinary scissors and Viktor Viktorovich probably tough now yes here I am thinking about the report

for all this now I'm just here you will not hold it a little back the camera take it as a

short-range take it will not hold it will be good it remains a little closer a little

стало понятно фанатизм чуть ближе камеру ведь я сейчас сделаем этот узел сейчас выделено вот он

просачивается просачивается так так назад муж камеру сделать чуть-чуть и горизонт роман

yes, yes, yes, I'm a little back, the camera is back, we need to leave everything well, these are now the layers, let's

go together with him like this, you see the artery to the liver and closer to me, right here, before

now we will finish it here, we will now throw it over there, now you can see it can be

will go there now let's get this knot yes yes yes yes this speech can now you are still doing

this here I am now just not here we are all let's now liquidate the liquidation of what is superfluous like this

pull out now that we are in the direction I see I see in the direction of the liver there we will do something

this is so a little bit to betray us closer to the camera to move one strong we will not be here already

doing everything like this a little bit to the artery to the bottom, open the right branch and the lower branch and now

like this and like this, open it, open it straight, just open it again and like this, and the artery is right

left, this is the whole vein, I think the vein is like a leg, the leg is too low for the leg and not this

veins, it seems to me that the veins are just like that, the poem is torn off quietly quietly back 6666

once I took it, take the camera back a little, well, try or flat, you don't need it, I just showed it

there like me quietly quietly, well, come back what's there, they beat it up somewhere now, but here you can burn it, it

seems to me to go back very close to add cutting, you need to add something somehow, but

tic tic tic why don't you leave so everything goes away here closer to the camera closer to the camera

veins veins veins press it a little bit like this to the bottom and that's it, well, maybe the liver, I don't know what

the difference is, we don't touch it now, we're finishing here, yes, there's an artery like this, press it like this,

and here it's the same, yes, it flew out again, the artery flew out, usually you can cook everything right here,

total liver artery back a little back a little back show what we have there again

closer to the camera I think everything is finished before we cross the stomach so wait before

we cross the stomach, we need to open the small saline where we will cross it, I think the stomach

but here we can cross what is special here we will come like this to raise it was good why

state is still the apparatus of the soul then we will finish it there when we cut it off we will look separately

show here a big curve now carefully only yes not in a hurry let

Hello, Professor Kashkov, can you hear us?

Yes, we are hearing, and do you hear us?

Yes, yes, we can hear you very well, but just for some seconds we lost you.

Is it okay now?

Now it's okay, it's okay.

so we have a problem with the suturing device so I can well we are changing the

device I can make some comments if it is necessary so I think that you have seen

that so we before practically performed all lymphadenectomy and now we are going

to transect the stomach but some problems with the suturing device

Otherwise, everything will be repaired in a few minutes and we'll continue.

Okay.

You can see that the pancreas is not very good for suturing.

It is very soft.

Okay.

And we think that there are some problems with suturing of the pancreatic anastomosis.

Oh, we'll see.

No, don't show it.

Don't show it.

You don't need to let it go.

Pull the trachea a little.

Stop.

Okay.

Where is Stalin?

Professor Kashkov?

I see him.

He should be in the basement, otherwise he won't close.

Something is not closing.

Hold it.

Okay.

So, what? The stomach?

In the lower floor?

There is no blood here.

Dry it.

Take it away.

Are you in touch?

Give me a napkin and dry it.

soft it just not слышно сразу достанем или оставьте пусть лежит да пусть лежит да

до сауна увы огонь тут transect а как узнать а ну то сейчас не выведен ничего ну все тогда

them no yes yes here there are very many there are they consist that they have it is very soft tissue

and she think that it i don't know what is it but she was examined by oncologist and they say that

everything is okay with them so i think that it's the same with the intestine and we're thinking

now uh that's me and what do you think about this pick up some somebody from the audience can make

an advice any advices victor shazmiti or ronald возьмите дайте мне мягкий зажим мягкий зажим

So, do you hear me?

Yes, we can hear you.

So, did you see that we measured the distance from the measurement,

so you see that yes we can see there is there is there is no two months

so this is the heliocycle valve it's okay so

I think this is the last one. We'll cross it somewhere here now.

Take it from there. And please make a horizon.

Give me a monopolar. Or ultrasonic first.

Send him an SMS. I sent it to you yesterday.

Then I can't tell you anything.

I can't tell you anything.

Ask the technical people.

So, lift it up here closer.

Take it closer here.

Is the gas going?

каких у нас там на youtube ну и чё раскрываете брыжейка так но вдоль кишки мы будем долго идти

, by the way, too, the market is not exactly from me and there is a head, take the skin, the skin is mine,

mine, look, I have it from this side, I didn't want it a little bit, a little bit, on the contrary,

head there to the left shoulder, yes, so that it is from me, it can be better to take it from Roman Evgenievich,

let go of this one, give me the skin, this part, take it there, so now we are here, we will

so grab it quietly here, close it, take it instead of me, I will be there closer to tighten the

general tension of interesting cases, but it has been examined for a long time, I took it, show the center, show it

here, it looks like this, it's like this, so the arcade is there, then maybe it's generally like this, we'll pull it out

later through the truth, not such a cut to pull it out, it will be like a big laparotomy in general on her

in the belly of the left side and please raise it, but no, it's not necessary, it's not necessary, it's not necessary, it's all

heated up, listen to how we will translate it to the top, we will deliver it separately, prepare a couple more there 45

is not normal, so that the romance is not convenient, take it further away, it's right there, and so far nothing is good,

затянули как-то кишка ждет кишка уже отряд на и лет какой-то ну-ка возьмите вот подождите назад

немножко отъехайте но вот троится уже да так подождите тогда давайте и отпустите чего так

на себя что ли вы вернете вы верните на себя да да да вот на себя я роман агенчук говорю да стоп

стоп стоп стоп сейчас я теперь перехвачу и 3 вот эту часть назад камеру немножко покажите вот так

looked at her oncologist there all the time watched the work of the search for the motherland there from 3 down

and there is a thousand to where in general a little saline that I will not be able to close the camera now we have

already found it, let's live here, and this one has already gone away from us, and I don't know what can be cut off

I don't understand what's special here.

I think there's no point in dragging it.

Let's sew the apparatus, we'll cross it right here.

But why? We'll cross it anyway.

We won't pull it up anyway.

No, here it is.

Pull up the tracker, please, the twelfth one.

More, more, more, more, more.

That's it.

No, Denis Leonidovich, I missed you.

Your music, your music.

A little bit back.

It won't fit.

Two containers won't fit at all.

and did not cut off now why intercept the same now let's finish this part while it is visible

the intestines are nowhere not in the far part somehow I'm not so sure that the thin one is pulled up, maybe

back a little while it is enough to pull it out from there it flowed the clipper give no stop stop

vein take it under the ligature under my under the ligature take me just lift it up you don't even

need to take it 5 the clipper will turn out here it is here is the hole so it may be better to extinguish let's

even hold the thread is small centimeters 10-12 so hold on pull a little into yourself so

normal normal pull everything cut off right at the base plus a centimeter and then hold this clamp

camera, give hold the camera, please take the disector, let's wipe the camera, but

laparoscopic well, there are a few people a little back, so how would we now do so that

it does not happen again, take it, take it, take it, lift it up, Victor, then now

here, here, now, now, now, Victor, show it, yes, that's all, all, all, all, and now show it here,

lower it down, lower it down, the gut, in general, the trade, lift it up like this, yes, and we were happy a little

чуть-чуть назад приготовьтесь этот протереть а легошур чем-нибудь там жиденьким да сейчас

протрем там какой-то выглядит плохо давайте пальцы палец и протирайте легошур а мне это

это что-ли ну кота вот здесь поднимите не надо здесь вот ругается еще назад немножко отъехать

very close to the camera, I'm afraid that we will put the gut in the container class, it will be very

did not lower who will help the very gut that we do not need here, look, let's

dry it there, so get this napkin, we'll pull it out here, wait for the account, we'll pull it out,

No, it's double-edged, through the insert, right? It's hard.

No, but now I want... Wait, wait, don't hide it.

But I took it.

One.

Well, that's it for now.

Lie down.

That's it, let's go.

Give me a new napkin.

A little back to the high one.

Now let go, let go.

And the goal of the look in the series is my sleepy artery.

Lie down.

Some blood is flowing.

Wait.

Tell me, will you connect the monopolar to my left clamp?

Is it there, right?

everything-everything-everything nothing and you are doing everything now here the artery is full he pulses

quiet-quiet-quiet-quiet do not hurry something 5 wait collector collector dry and make a

horizon please put the drain under me now take it with another one I'll grab it wait

you say let go and dry them a little all the quiet quiet quiet do not move strongly the clipper

two eclipses I will pass myself hold on decided to collect

vertebrae we will not cross the horizon, there is no horizon, there is still a little more, please, a little bit

more, please, it is better for us to cross the line, let's cross the line, let's go to the

железу совсем покажите сверху фингер дайте пройдем все таки так для приличия что как

говорить тихо-тихо-тихо роман но не надрывать она выше подождите может они над фингер не как

железа конечно тихо-тихо-тихо-тихо подождите подождите чуть ближе камеру тут можно же

пересечь виды как одна все с ними дядька черномор пролезть аккуратненько тут не не

Zagitev, Zagitev, come closer to the camera.

Should I cut something here?

The camera is closer.

The artery is gone, it's on the liver side.

Easy, easy.

Wait, stop like this.

I don't know, I think it's lymphatic.

It's not the liver artery.

So, we cross, right?

Right here, I think.

The blood is terrible.

Let's leave it for now. I won't do it now.

It's not going anywhere.

Excuse me.

Excuse me.

Leave this.

Come here.

Wipe the ultrasound, please.

Now, show me.

He's making sex here.

I see. Let's go there and cut off something.

Stop, stop, stop.

I see.

Why?

I'm looking for an opportunity to joke.

I found it.

Closer.

I like it.

This wedding is English.

You don't want to watch, but you still watch.

you are watching somewhere, well, I just stumbled upon the prince, well done, you know what he asked, this is the

very small family celebration that we planned, he asked when they came to the wedding

back there, let's go with the artery, let's all go from the bottom, he asked this is the very small one, too,

when they came there, we are smiths, this is the abbey, there are a lot of people watching all over the world, the

very small family celebration that we planned like this, this is the artery, yes, that's it, I

understood hold what to do where the artery is now Roman something I cling to everything is fine already

a little bit a little bit to do this horizon Roman horizon a little more yes like this

here everything is good, it's good, so what are you going to dry there, something is leaking here, what kind of

iron is that with one block, whether it is not one closer to the camera horizon, do it here, I don't quite

understand this, what is the artery, where is it, here it is, well, like this, listen, we don't leave the hook,

here, let's start, no, listen, listen to the horizon, I don't understand how to turn a little more, no, no, no,

in the other direction, like this, turn it a little more, but this is not our way now, a second, a second, a

Roman Evgenievich, please, the horizon, turn there even more, turn there, I don't know, maybe it's ...

Let's pull it out and cut it off somehow, that's it.

That's how I think, right? Maybe with the calypso?

Yes, yes, a little closer to the camera now.

Good. Stop, stop. Roman Evgenievich, give me the calypso.

so not clearly the artery wall is now good I see it pulsates straight very well we are going to

the church now where we need to go back to those who just if at least fifty percent of the

feeling of how we work the same as you are, then I am satisfied with what it is, let's do it

below, let's all this container container we will take or now we will not

at all we will not give please give please dissectors to the victor look there it is quite possible that

they can hear us and on the Internet, therefore, on the Internet, I think you should hear the meaning of the Internet

then what kind of so let's go to the liver show on the other side of the principle of great meaning, of course,

hide it in a container wait wait before it is necessary to let the victor take the victor show

show let him take all this hold your side show your side take no

here is yours take this one take all the tail I will straighten only a little

the camera and a little higher than the camera, their intestines will fit for a month, we will pull it out through this

better don't do it all yes no why do we need the second when now they will be everything will not interfere

all let go I think the only thing you can pull out then go back but I don't want to waste time

on it just so let's get the napkin everyone will get it back now a little bit of the camera a little

back on come back once we will pick up the iron and under the stomach we have to show the left stomach

Have you ever been to Italy from Austria? I've been to Italy in a car, and it immediately catches my eye.

Absolutely.

I don't know if you can hear us in the audience, but Italy is my favorite country.

Really, it's super, super simple.

Wait, wait, we're going to take up a lot of space, really.

сюда вот так вот который с этим да техника вот кого-то можем конечно не знаю запихаем

в контейнер что будет у нас дайте контейнер да дайте контейнер еще так виктор берите за

вашу сторону к старую железу там покажите мне кишку не взяли уже все не хочу сказать

please show us now here we are talking there can be heard no us there can be heard no no no they are here we are just

we are talking something here we are talking here now here we can hear these words you hold the

other side show show while it is not necessary to keep the gut, take this one, well, why, well, it is liquid,

it is clear that it should not be here, well, it pierced it, take it now, I just don't know who to turn to,

Professor Kashkov. Yes. Okay, we have to move to another surgical procedure. So, thanks a lot from Rome and hope to see you next year.

yes thank you for your attention okay but it's time you see that it's the most

the most difficult stages of operation there have been performed so now we are going to

perform all the anastomosis on one loop on the ilium now we are going to pass it through the

yes yes through the under the under the colon and now and then we'll perform pancreatic

union anastomosis then hepatic union anastomosis and then gastrojuna okay on one loop okay thank

Thank you very much.

Hope to see you next year.

Yes, I hope also.

Ciao, bye-bye.