Laparoscopic Transvaginal Right Colectomy with a Novel Vaginal Access Port

Andrew D Prather, MD, Manoel G Neto, MD, Almino Ramos, MD, Ricardo Zorron, MD, James J Mateka, Jorge E Marcet, MD. University of South Florida College of Medicine

This video demonstrates a laparoscopic transvaginal right colectomy via novel transvaginal access port in a cadaveric model. There is increasing interest in transvaginal access into the peritoneal cavity as a means of performing intraabdominal operations. The transvaginal approach also provides a portal for extraction of intraabdominal tissues. This reduces or eliminates the need for an abdominal incision not only resulting in improved cosmesis but also potentially reducing postoperative pain and wound complications.

This transvaginal access port is a prototype currently being developed that allows insufflation of the peritoneal cavity and insertion of multiple instruments.

In this video, the pelvis is to the left and the upper abdomen is to the right. The video is being shot through a 5mm camera placed through an umbilical inscision. Adhesions in the right lower quadrant are first taken down using instruments passed through the transvaginal port. These adhesions were extensive and required placement of an additional periumbilical 5mm port was placed to assist in adhesiolysis. The transvaginal instruments were then used for retraction and dissection continued with the periumbilical instruments.

The ileocolic mesentery was then divided using a combination of the instruments from both ports. After completion of the mesenteric dissection, a linear stapling device is passed through the transvaginal access port and the proximal transverse colon and ileum are divided. The stapled ends of the ileum and colon are sutured together to facilitate creation of the intracorporeal anastomosis. A colotomy and an enterotomy are made at the stapled end of the bowel and a side to side functional end to end enterocolic anastomosis is made with the linear stapler.

The specimen is then extracted through the colpotomy made for placement of the transvaginal access port. After removal of the specimen, the port is reinserted to allow for inspection and irrigation of the peritoneal cavity.

We have demonstrated the use of a novel transvaginal access port in a cadaveric model to perform a right colectomy with an intracorporeal anastomosis and transvaginal specimen extraction.