TV vs transumbilical extraction in CR resection after minilap approach or SILS approach

Alerjandra Garcia Novoa¹, Nicolasa Fernandez Soria¹, Sergio Builes Ramirez¹, Namibia Sanluis Verdes¹, Jose M Munoz², Gonzalo Martin, MD³, Antonio Melero⁴, Jose F Noguera, MD, PhD¹. ¹Hospital A Coruna, ²Hospital Son Llatzer, ³Hospital Universitario Son Espases, ⁴Consorcio Hsopital General Universitario

AIM. To compare the colorectal extraction trought the vagina vs the umbilical incision for SILS technique after colorectal laparoscopic resection.

METHODS. Prospective clinical series comparing two surgical approaches for colorectal minimally invasive resection. 24 female patients operated by the same surgeon in the same institution, 12 with minilaparoscopic approach and transvaginal extraction and 12 with SILS transumbilical approach with transumbilical extraction.

For the minilaparospic approach and transvaginal extraction a 3-throcar technique was employed (1×12, 1×11, 1×5 mm transparietal throcars) with transvaginal assistance and extraction trought a posterior vaginal fornix access.

For the SILSTM an umbilical approach was employed to introduce the decive and after the single port resection with an internal or external anastomosis the colorectal specimen was extracted trought the umbilicus.

In both cases the specimen was introduced in a plastic bag before the extraction or the surgical field protected with a plastic bag.

Patients were prospectively followed-up in order to obtain results about the surgical and oncological outcomes.

RESULTS. In female patients with minilaparoscopy and transvaginal approach no postoperative complications were found. In all cases a finger dilation of the vaginal incisión was needed. We didn’t find any problems related to the extraction or the vaginal closure. No surgical infections, postoperative hernias or oncological problems were found.

In female patients with Single-Incision-Laparoscopic Surgery trought transumbilical approach we need to enlarge the umbilical incision in order to perform a safe extraction of the specimen. We found postoperative problems in three cases (Overall complications, 25%). Two patients with surgical site infection at the umbilicus and in one case with a late postoperative ventral hernia (Surgical Infection Site, 16.66%, Postoperative Ventral Hernia, 8.33%). In one case we found a parietal recurrence of the colonic adenocarcinoma at the umbilical incision as an only abdominal wall implant (Port-site metastasis, 8.33%) .

DISCUSSION. In female colorectal laparoscopic resection the transvaginal extraction is better than the transumbilical extraction in order to avoid some complications regarding to the extgraction route. We can find some problems related to the specimen extraction as the surgical infection site, the postoperative ventral hernia even the port-site metastasis. To avoid these problems in transumbilical approach, the specimen must be introduced in a plastic bag and the surgical field covered with a plastic protection.