Joshua A Waters, MD, Michael J Guzman, MD, Andrea L Jester, MD, Don J Selzer, MD, Bruce W Robb, MD, Virgilio V George, MD. Indiana University Department of Surgery
INTRODUCTION: Laparoscopic colectomy has been widely adopted as an acceptable approach for both benign and malignant lesions of the sigmoid colon. A major limitation to reducing the surgical footprint is the need for a larger incision on the abdomen for specimen extraction. This video demonstrates use of the vagina as a natural orifice for specimen extraction following laparoscopic sigmoid colectomy.
METHODS AND PROCEDURES: With the patient in modified low-lithotomy position; two 5mm and one 12mm ports are placed through the umbilicus and right lower quadrant respectively. Standard laparoscopic instrumentation and optics were then used to mobilize the sigmoid colon, take down the splenic flexure and perform high ligation of the vascular supply. A 15mm port is used to create a colpotomy. This is used for introduction of the end-to-end stapler anvil, as well as externalization of the surgical specimen.
RESULTS: This operation was performed without significant morbidity, while maintaining sound oncologic principles of vascular high ligation. The duration of operation was 145 minutes. Duration of hospital stay was 4 days. IV narcotic use was limited to post-operative day one. With 3 months follow-up, the patient is without any complaint attributable to use of the colpotomy for extraction.
CONCLUSIONS: Transvaginal specimen extraction represents a safe and reasonable method to reduce the size of the abdominal incision for female patients, particularly with surgically absent uterus, who are undergoing laparoscopic sigmoid colectomy.
Program Number: V092