Natural Orifice Specimen Extraction in laparoscopic colorectal surgery: Transvaginal Specimen Extraction

Miguel A Hernandez, MD, Morris E Franklin, MD, FACS, Zanndor Del Real Romo, MD, Guillermo Peralta, MD, Denisse L Sepulveda, MD, David Martinez, MD. Texas Endosurgery Institute.

Background: Since the first laparoscopic approach for colonic disease, minimal access techniques have revolutionized colonic surgery. Natural orifice specimen extraction (NOSE) offers the advantages of laparoscopic surgery and allows performing the anastomosis and extraction of the surgical specimen without enlarging any trocar incision. This study was designed to evaluate the outcomes of patients who underwent to a totally laparoscopic right hemicolectomy resection with transvaginal extraction. The predicted benefits of transvaginal extraction in colorectal surgery are to reduce incision-related morbidity such as pain, a reduced rate of surgical site infection and incisional hernias by avoiding minilaparotomy for specimen extraction.

Methods: We analyzed a prospectively designed database of consecutive patients who underwent totally laparoscopic right colon surgery with transvaginal extraction for different pathologies between April 2007 and September 2013 at Texas Endosurgery Institute. The selection criteria for the NOSE approach were based on a disease entities, site and size of the tumors.

Results: A total of 31 patients underwent to right hemicolectomy with NOSE approach and vaginal extraction. The operative time for the procedure was 159 ± 27.1 min and the estimated blood loss was 83.5 ± 14.4 ml. Intraoperatively, trasvaginal extraction was associated with 2 complications 6.4%); with no post operative complications. The length hospital stay was 5.2±2.2 days.

Conclusion: The NOSE approach is possible with favorable short-term surgical outcomes. This novel technical approach is feasible and safe, eliminates the need for extraction through minilaparotomy with a potentially shorter recovery time, earlier ambulation, bowel function, fewer complications, decreased drugs use, and improved cosmesis; it might be considered for patients requiring abdominal right hemicolectomy.

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