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Surgical Endoscopy

, Volume 24, Issue 8, pp 2048–2052 | Cite as

Totally laparoscopic right colectomy with transvaginal specimen extraction: the authors’ initial institutional experience

  • Shaun McKenzieEmail author
  • Jeong-Heum Baek
  • Mark Wakabayashi
  • Julio Garcia-Aguilar
  • Alessio Pigazzi
Technique

Abstract

Background

The persistence of early and delayed wound complications related to both open and laparoscopic colectomy remains a significant health burden. Furthermore, as interest in natural orifice translumenal endosurgery (NOTES) continues to grow, bridging techniques may help to attenuate the learning curve associated with NOTES. The authors present their technique and short-term outcomes for totally laparoscopic right colectomy with transvaginal specimen extraction in a series of four patients.

Methods

Four consecutive patients from a prospectively maintained laparoscopic colectomy database were analyzed under an institutional review board-approved protocol. Clinicopathologic characteristics and short-term outcomes were reviewed.

Results

All the patients were women with no prior pelvic surgery. A four-trocar laparoscopic right colectomy with intracorporeal anastomosis was performed for cancer in two cases and for adenomatous polyp in two cases. Transvaginal extraction was possible in all cases. The average operating room time was 212.25 min. No patient experienced complications associated with the colpotomy; nor did any patient have pain or drainage from the extraction site postoperatively. The median hospital stay was 4.5 days. One patient experienced a bowel obstruction unrelated to the extraction site. The mean specimen length was 27 cm, and the mean number of lymph nodes retrieved was 15.75.

Conclusion

Totally laparoscopic right colectomy with transvaginal extraction appears to be safe and feasible. This technique may provide both an attractive way to reduce abdominal wall morbidity and a bridge to NOTES colon surgery.

Keywords

Laparoscopic colectomy Natural orifice translumenal endosurgery (NOTES) Totally laparoscopic right colectomy Transvaginal specimen extraction 

Notes

Disclosures

Shaun McKenzie, Jeong Heum-Baek, Mark Wakabayashi, Julio Garcia-Aguilar, and Alessio Pigazzi have no conflicts of interest or financial relationships to disclose.

References

  1. 1.
    Al-Akash M et al (2009) NOTES: The progression of a novel and emerging technique. Surg Oncol 18:95–103CrossRefPubMedGoogle Scholar
  2. 2.
    Al-Akash M et al (2009) Training on NOTES: from history we learn. Surg Oncol 18:111–119CrossRefPubMedGoogle Scholar
  3. 3.
    Palanivelu C et al (2008) An innovative technique for colorectal specimen retrieval: a new era of “natural orifice specimen extraction” (NOSE). Dis Colon Rectum 51:1120–1124CrossRefPubMedGoogle Scholar
  4. 4.
    Kuhry E, Schwenk W et al (2009) Long-term results of laparoscopic colorectal cancer resection. Cochrane Database Syst Rev 1:1–61Google Scholar
  5. 5.
    Tjandra J, Chan M (2006) Systematic review of the short-term outcomes of laparoscopic resection for colon and rectosigmoid cancer. Colorectal Dis 8:375–388CrossRefPubMedGoogle Scholar
  6. 6.
    Winslow ER, Fleshman JW et al (2002) Wound complications of laparoscopic versus open colectomy. Surg Endosc 16:1420–1425CrossRefPubMedGoogle Scholar
  7. 7.
    Ihediohau U, Mackay G et al (2008) Laparoscopic colorectal resection does not reduce incisional hernia rates when compared to open colorectal resection. Surg Endosc 22:689–692CrossRefGoogle Scholar
  8. 8.
    Singh R, Omiccioli A et al (2008) Does the extraction-site location in laparoscopic colorectal surgery have an impact on incisional hernia rates? Surg Endosc 22:2596–2600CrossRefPubMedGoogle Scholar
  9. 9.
    Ghezzi F, Raio L et al (2002) Vaginal extraction of pelvic masses following operative laparoscopy. Surg Endosc 16:1691–1696CrossRefPubMedGoogle Scholar
  10. 10.
    Yoong W, Pillai R (2009) Posterior colpotomy: a retrieval route for solid ovarian malignancies. BJOG: An International Journal of Obstetrics and Gynaecology 465–466Google Scholar
  11. 11.
    Malzoni M, Tinelli R et al (2009) Total laparoscopic radical hysterectomy versus abdominal radical hysterectomy with lymphadenectomy in patients with early cervical cancer. Ann Surg Oncol 16:1316–1323CrossRefPubMedGoogle Scholar
  12. 12.
    Wong C, Wong Y et al (2005) Laparoscopy compared with laparotomy for the surgical staging of endometrial carcinoma. J Obstet Gynecol Res 31:286–290CrossRefGoogle Scholar
  13. 13.
    Jung Y, Lee J et al (2009) Feasibility and efficacy of laparoscopic management of ovarian cancer. J Obstet Gyn Res 35:113–118CrossRefGoogle Scholar
  14. 14.
    Franklin ME, Kelley H et al (2008) Transvaginal extraction of the specimen after total laparoscopic right colectomy with intracorporeal anastomosis. Surg Laparosc Endosc Percut Tech 18:294–298CrossRefGoogle Scholar
  15. 15.
    Graves N, Halton K et al (2008) Who bears the cost of health care-acquired surgical-site infection. J Hosp Infect 69:274–282CrossRefPubMedGoogle Scholar
  16. 16.
    Bergamaschi R, Schochet E et al (2008) Standardized laparoscopic intracorporeal right colectomy for cancer: short-term outcome in 111 unselected patients. Dis Colon Rectum 51:1350–1355CrossRefPubMedGoogle Scholar
  17. 17.
    Raftopoulos I, Courcoulas A et al (2006) Should completely intracorporeal anastomosis be considered in obese patients who undergo laparoscopic colectomy for benign and malignant disease of the colon. Surgery 140:675–682CrossRefPubMedGoogle Scholar
  18. 18.
    Forgione A, Maggioni D et al (2008) Transvaginal endoscopic cholecystectomy in human beings: preliminary results. J Laparoendosc Adv Surg Tech 18:345–351CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Shaun McKenzie
    • 1
    Email author
  • Jeong-Heum Baek
    • 2
  • Mark Wakabayashi
    • 1
  • Julio Garcia-Aguilar
    • 1
  • Alessio Pigazzi
    • 1
  1. 1.Department of General and Oncologic SurgeryCity of Hope National Medical CenterDuarteUSA
  2. 2.Department of SurgeryGachon University of Medicine and ScienceIncheonKorea

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