Abstract
We report a technique of transvaginal extraction of pelvic masses or larger specimens removed during robot-assisted laparoscopic surgery in order to avoid larger port incisions and postoperatively reduce pain. Fifty women underwent a transvaginal incision to remove large pelvic masses after robot-assisted laparoscopic hysterectomies. Posterior colpotomies were performed with bagged specimens delivered into the vagina, extracted, and then closed robotically with a running suture. Vaginal extraction of pelvic masses was successful in all attempted cases and in no case was there any spillage, with an average operative time of 94.22 ± 4.48 and no intraoperative complications. This technique can be considered efficacious and safe with minimal morbidity. We suggest a surgical set-up including vaginal–cervical Ahluwalia retractor elevator to be prepared should the specimen be too large to remove via the port site, thus giving the surgeon the opportunity to perform this procedure with ease if necessary.
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References
Reynolds R, Advincula A (2006) Robot-assisted laparoscopic hysterectomy: technique and initial experience. Am J Surg 191:555–560
Boggess JF (2007) Robotic surgery in gynecologic oncology: evolution of a new surgical paradigm. J Robot Surg 1:31–37
Beste T, Nelson K, Daucher J (2005) Total laparoscopic hysterectomy utilizing a robotic surgical system. JSLS 9:13–15
Advincula AR (2005) The use of robot-assisted laparoscopic hysterectomy in the patient with a scarred or obliterated anterior cul-de-sac. JSLS 9:287–291
Kho R, Hilger W, Hentz J, Magtibay P, Magrina JF (2007) Robotic hysterectomy: technique and initial outcomes. Am J Obstet Gynecol 197:113.e1–113.e4
DeNardis S, Holloway R, Bigsby G, Pikaart D, Ahmad S, Finkler N (2008) Robotically assisted laparoscopic hysterectomy versus total abdominal hysterectomy and lymphadenectomy for endometrial cancer. Gynecol Oncol 111:412–417
Fader AN, Escobar PF (2009) Laparoendoscopic single-site surgery (LESS) in gynecologic oncology: technique and initial report. Gynecol Oncol 114(2):157–161
Lambaudie E, Houvenaeghel G, Walz J, Bannier M, Buttarelli M, Gurriet B, De Laparrent T, Blache JL (2008) Robot-assisted laparoscopy in gynecologic oncology. Surg Endosc 22(12):2743–2747
Maiman M, Seltzer V, Boyce J (1991) Laparoscopic excision of ovarian neoplasms subsequently found to be malignant. Obstet Gynecol 77:564–565
Ghezzi F, Cromi A, Bergamini V, Uccella S, Siesto G, Franchi M, Bolis P (2008) Should adnexal mass size influence surgical approach? A series of 186 laparoscopically managed large adnexal masses. BJOG 115:1020–1027
Kelly HA (1896) Treatment of ectopic pregnancy by vaginal puncture. Bull Johns Hopkins Hosp 7:208
Ghezzi F, Cromi A, Uccella S, Siesto G, Bergamini V, Polis P (2008) Transumbilical surgical specimen retrieval: a viable refinement of laparoscopic surgery for pelvic masses. BJOG 115:1316–1320
Pardi G, Carminati R, Ferrari M, Ferrazzi E, Bulfoni G, Marcozzi S (1995) Laparoscopically assisted vaginal removal of ovarian dermoid cysts. Obstet Gynecol 85:129–132
Teng FY, Muzsnai D, Perez R, Mazdisnian F, Ross A, Sayre J (1996) A comparative study of laparoscopy and colpotomy for the removal of ovarian dermoid cysts. Obstet Gynecol 87:1009–1013
Yoong W, Pillai R (2009) Posterior colpotomy: a retrieval route for solid ovarian tumours. BJOG 116(3):465–466
Fiorentino RP et al (2006) Pilot study assessing robotic laparascopic hysterectomy and patient outcomes. J Minim Invasive Gynecol 13:60–63
Payne T, Dauterive FA (2008) Comparison of total laparoscopic hysterectomy to robotically assisted hysterectomy: surgical outcomes in a community practice. J Minim Invasive Gynecol 15:286–291
Breda G, Silvestre P, Giunta A, Xausa D, Tamai A, Gherardi L (1993) Laparoscopic nephrectomy with vaginal delivery of the intact kidney. Eur Urol 24:116–117
Dauleh MI, Townell NH (1993) Laparoscopic nephroureterectomy for malignancy: vaginal route for retrieval of intact specimens. Br J Urol 72:667–668
Davis GD, Hruby PH (1989) Transabdominal laser colpotomy. J Reprod Med 34:438–440
Delvaux G, Devroey P, De Waele B, Willems G (1993) Transvaginal removal of gallbladders with large stones after laparoscopic cholecystectomy. Surg Laparosc Endosc 3:307–309
Dubuisson JB, Chapron C (1996) Uterine fibroids: place and modalities of laparoscopic treatment. Eur J Obstet Gynecol Reprod Biol 65:91–94
Robinson BL, Liao JB, Adams SF, Randall TC (2009) Vaginal cuff dehiscence after robotic total laparoscopic hysterectomy. Obstet Gynecol 114(2 Pt 1):369–371
Feuer GA, Burrell MO, Salmieri SS, Hernandez PE (2011) Perioperative and pathologic outcomes following robotic-assisted laparoscopic versus abdominal management of ovarian cancer. In: Society of Gynecological Oncologists Annual Meeting on Women’s Cancer, March 6–9, Orlando, Florida. Abstract 302
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Feuer, G., Yap, S. & Hernandez, P. Posterior colpotomy: a successful retrieval route for pelvic masses following robot-assisted laparoscopic surgery. J Robotic Surg 6, 277–282 (2012). https://doi.org/10.1007/s11701-011-0306-3
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DOI: https://doi.org/10.1007/s11701-011-0306-3