Christina Y Koh, MD, Mehraneh D Jafari, MD, Alessio Pigazzi, MD. University of California Irvine Medical Center
This video demonstrates various techniques for transvaginal extraction in laparoscopic colectomy. For the first case we show a laparoscopic right colectomy with a transvaginal extraction of the specimen through a posterior vaginotomy in a patient with a small uterus. For the second, more challenging case, we show a transvaginal extraction in a low anterior resection for obstructing rectosigmoid cancer in a patient with large symptomatic uterine fibroids. Given the large size of the uterine fibroids, distal dissection of the rectosigmoid was not possible, and the possibility of a hysterectomy was discussed with the patient prior to the operation. After intraoperative examination of the abdomen, the decision was made to perform a hysterectomy for symptomatic uterine fibroids and to allow for distal dissection into the pelvis, with transvaginal extraction of the specimen after the hysterectomy is completed.
To avoid an abdominal incision, a transvaginal extraction may be utilized. A suture is placed through the uterus to retract it anteriorly exposing the posterior vaginal wall. A vaginal manipulator is used to assist in creating a posterior wall vaginotomy. An endocatch bag is inserted into the abdomen. The specimen is inserted into the bag and delivered through the vagina. The posterior vaginotomy is then closed laparoscopically. The retraction suture is then cut and removed. In a case where a hysterectomy is indicated, the vaginotomy created during the hysterectomy may be used as the extraction site.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87331
Program Number: V053
Presentation Session: Colorectal Videos Session
Presentation Type: Video