Abstract
Background
Natural orifice specimen extraction (NOSE) has been developed as a means of decreasing the incidence of surgical wound complications. We refined the procedure for totally laparoscopic colectomy with transvaginal specimen extraction using the reduced port surgery technique with the ultimate goal of attenuating damage to the abdominal wall. We herein report this innovative technique and its short- and long-term outcomes.
Methods
We prospectively collected data on seven patients who underwent totally laparoscopic colectomy using transvaginal specimen extraction with a 10-mm-long abdominal incision for right-sided colon cancer from January 2014 to December 2021. Two 5-mm ports were used in the procedure without laparotomy. Transverse transabdominal posterior colpotomy was then performed. We introduced a GelPOINT Mini advanced access platform (Applied Medical, Rancho Santa Margarita, CA, USA) into the transvaginal route for the insertion of a laparoscope, forceps, and stapling device. Lymph node dissection and transection of the ileum and distal colon were performed with transvaginal assistance. A specimen was then extracted transvaginally. Intracorporeal functional end-to-end anastomosis was conducted using a linear stapler through the vagina. After the removal of GelPOINT Mini, the vaginal incision was closed transvaginally.
Results
Seven patients successfully underwent this procedure. Median operative time was 219 min (range 174–255 min), median blood loss was 23 ml (range 10–37 ml), median number of harvested lymph nodes was 21 (range 17–35 lymph nodes) and median margins were 17.0 cm (range 9.0–25.0 cm) for the proximal margin and 9.5 cm (range 5.0–13.0 cm) for the distal margin. There were no complications more severe than Clavien–Dindo Grade II and there was no mortality. The median frequency of use intravenous analgesics from postoperative day 1 to discharge was once. Two patients did not require analgesics. A node-positive patient developed recurrence at the lung and paraaortic lymph nodes.
Conclusions
This procedure appears to be feasible, safe, and oncologically acceptable for selected cases.
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Data availability
The datasets generated during the current study are available from the corresponding author on reasonable request.
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Acknowledgements
The authors thank H. Ohkura for his helpful discussions.
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All authors contributed to the study conception and design. Data collection and analysis were performed by Atsushi Nishimura. All authors read and approved the final manuscript.
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Atsushi Nishimura, Mikako Kawahara, Yasuyuki Kawachi, Jun Hasegawa, Shigeto Makino, Chie Kitami, Tetsuya Nakano, Takahiro Ootani, Mariko Nemoto Shuta Hattori, and Keiya Nikkuni have no conflicts of interest or financial ties to disclose.
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This study was performed in line with the principle of the Declaration of Helsinki. Approval was granted by the Ethics Committee of Nagaoka Chuo General Hospital.
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Nishimura, A., Kawahara, M., Kawachi, Y. et al. Totally laparoscopic resection of right-sided colon cancer using transvaginal specimen extraction with a 10-mm-long abdominal incision. Tech Coloproctol 26, 755–760 (2022). https://doi.org/10.1007/s10151-022-02636-7
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DOI: https://doi.org/10.1007/s10151-022-02636-7