Abstract
Purpose
The relevance of transvaginal specimen extraction (TVSE) combined with reduced port surgery (RPS) remains unknown. This study investigated the feasibility of TVSE with RPS according to short-term outcomes and cosmesis.
Methods
This prospective multicenter study enrolled ten patients at three institutions. For the semi-quantification of each parameter, we administered questionnaires to assess pain (visual analogue scale), subjective/objective wound healing esthetics [photo series questionnaires (PSQ)], and quality of life (QOL).
Results
No operative complications occurred, except one case of urinary tract infection, which was promptly cured with antibiotics. On day 0, pain was rated at 2.3 ± 0.67 at rest and 4.9 ± 0.82 during sneezing; these ratings gradually declined over time. The PSQ showed that the patient ratings of wound esthetics after TVSE were not inferior to ratings from patients after conventional laparoscopy or single incision laparoscopic surgery, and they were significantly higher than the patient ratings of wounds after laparotomy (P < 0.05). The QOL scores showed that, in comparison to before surgery, after surgery, patients reported significant deterioration of their physical function (96.67 ± 1.49 vs. 87.33 ± 2.71), emotional function (93.33 ± 2.72 vs. 86.67 ± 2.22), fatigue (7.78 ± 3.72 vs. 26.67 ± 8.31), and pain (6.67 ± 3.69 vs. 18.33 ± 4.61).
Conclusion
TVSE with RPS for colorectal cancer was feasible and was associated with a low degree of postoperative pain.
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References
Lacy AM, García-Valdecasas JC, Delgado S, Castells A, Taura P, Pique JM, et al. Laparoscopy-assisted colectomy versus open colectomy for treatment of non-metastatic colon cancer: a randomised trial. Lancet. 2002;359:2224–9.
Veldkamp R, Kuhry E, Hop WC, Jeekel J, Kazemier G, Bonjer HJ, et al. Laparoscopic surgery versus open surgery for colon cancer: short-term outcomes of a randomised trial. Lancet Oncol. 2005;6:477–84.
Guillou PJ, Quirke P, Thorpe H, Walker J, Jayne DG, Smith AM, et al. Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial. Lancet. 2005;365:1718–26.
Hewett PJ, Allardyce RA, Bagshaw PF, Framptom CM, Frizelle FA, Rieger NA, et al. Short-term outcomes of the Australasian randomized clinical study comparing laparoscopic and conventional open surgical treatments for colon cancer: the ALCCaS trial. Ann Surg. 2008;248:728–38.
Neudecker J, Klein F, Bittner R, Carus T, Stroux A, Schwenk W, et al. Short-term outcomes from a prospective randomized trial comparing laparoscopic and open surgery for colorectal cancer. Br J Surg. 2009;96:1458–67.
Hemandas AK, Abdelrahman T, Flashman KG, Slull AJ, Senapati A, O’Leary DP, et al. Laparoscopic colorectal surgery produces better outcomes for high risk cancer patients compared to open surgery. Ann Surg. 2010;252:84–9.
Yamamoto S, Inomata M, Katayama H, Mizusawa J, Etoh T, Konishi F, et al. Short-term surgical outcomes from a randomized controlled trial to evaluate laparoscopic and open D3 dissection for stage II/III colon cancer: Japan Clinical Oncology Group Study JCOG 0404. Ann Surg. 2014;260:23–30.
Clinical Outcomes of Surgical Therapy Study Group. A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med. 2004;350:2050–9.
Lacy AM, Delgado S, Castells A, Prins HA, Arroyo V, Ibarzabal A, et al. The long-term results of a randomized clinical trial of laparoscopy-assisted versus open surgery for colon cancer. Ann Surg. 2008;248:1–7.
Fleshman J, Sargent DJ, Green E, Anvari M, Stryker SJ, Beart RW Jr, et al. Laparoscopic colectomy for cancer is not inferior to open surgery based on 5-year data from the COST Study Group trial. Ann Surg. 2007;246:655–62.
The Colon Cancer Laparoscopic or Open Resection Study Group. Survival after laparoscopic surgery versus open surgery for colon cancer: long-term outcome of a randomised clinical trial. Lancet Oncol. 2009;10:44–52.
Jayne DG, Thorpe HC, Copeland J, Quirke P, Brown JM, Guillou PJ. Five-year follow-up of the Medical Research Council CLASICC trial of laparoscopically assisted versus open surgery for colorectal cancer. Br J Surg. 2010;97:1638–45.
Kitano S, Inomata M, Mizusawa J, Katayama H, Watanabe M, Yamamoto S, et al. Survival outcomes following laparoscopic versus open D3 dissection for stage II or III colon cancer (JCOG0404): a phase 3, randomised controlled trial. Lancet Gastroenterol Hepatol. 2017;2:261–8.
Curcillo PG, Podolsky ER, King SA. The road to reduced port surgery: from single big incisions to single small incisions, and beyond. World J Surg. 2011;35:1526–31.
Gagner M, Garcia-Ruiz A. Technical aspects of minimally invasive abdominal surgery performed with needlescopic instruments. Surg Laparosc Endosc. 1998;8:171–9.
Kalloo AN, Singh VK, Jagannath SB, Niiyama H, Hill SL, Vaughn CA, et al. Flexible transgastric peritoneoscopy: a novel approach to diagnostic and therapeutic interventions in the peritoneal cavity. Gastrointest Endosc. 2004;60:114–7.
Diana M, Perretta S, Wall J, Wall J, Costantino FA, Leroy J, et al. Transvaginal specimen extraction in colorectal surgery: current state of the art. Colorectal Dis. 2011;13:104–11.
Nishimura A, Kawahara M, Honda K, Ootani T, Kakuta T, Kitami C, et al. Totally laparoscopic anterior resection with transvaginal assistance and transvaginal specimen extraction: a technique for natural orifice surgery combined with reduced-port surgery. Surg Endosc. 2013;27:4734–40.
Sobin LH, Gospodarowicz MK, Wittekind C. TNM classification of malignant tumors. 7th ed. Hoboken: Wiley; 2011.
Mori T, Kimura T, Kitajima M. Skilled accreditation system for laparoscopic gastroenterological surgeons in Japan. Minim Invasive Ther Allied Technol. 2010;19:18–23.
Collins SL, Moore RA, McQuay HJ. The visual analogue pain intensity scale: what is moderate pain in millimetres? Pain. 1997;72:95–7.
Bergman B, Aaronson NK, Ahmedzai S, Kaasa S, Sullivan M. The EORTC QLO-LC 13: a modular supplement to the EORTC core quality of life questionnaire (QLQ-C30) for use in lung cancer clinical trials. Eur J Cancer. 1994;30:635–42.
Dunker MS, Stiggelbout AM, van Hogezand RA, Ringers J, Griffioen G, et al. Cosmesis and body image after laparoscopic-assisted and open ileocolic resection for Crohn’s disease. Surg Endosc. 1998;12:1334–400.
Rattner D, Kalloo A. ASGE/SAGES working group on natural orifice transluminal endoscopic surgery. Surg Endsc. 2006;20:329–33.
McGee MF, Rosen MJ, Marks J, Onders RP, Chak A, Faulx A, et al. A primer on natural orifice translumenal endoscopic surgery: building a new paradigm. Surg Innov. 2006;13:86–93.
Giday SA, Kantsevoy SV, Kalloo AN. Principle and history of natural orifice translumenal endoscopic surgery (NOTES). Minim Invasive Ther Allied Technol. 2006;15:373–7.
Baron TH. Natural orifice transluminal endoscopic surgery. Br J Surg. 2007;94:1–2.
Lamadé W, Hochberger J. Transgastric surgery: avoiding pitfalls in the development of a new technique. Gastrointest Endosc. 2006; 63:698–700
Park JS, Choi GS, Lim KH, Jang YS, Kim HJ, Park SY, et al. Clinical outcome of laparoscopic right hemicolectomy with transvaginal resection, anastomosis, and retrieval of specimen. Dis Colon Rectum. 2010;53:1473–9.
Awad Z. Laparoscopic total colectomy with transvaginal extraction of the colon and ileorectal anastomosis. Ann Surg Oncol. 2014;21:3029.
Wolthuis AM, Fieuws S, Van Den Bosch A, de Buck van Overstraeten A, D’Hoore A. Randomized clinical trial of laparoscopic colectomy with or without natural-orifice specimen extraction. Br J Surg. 2015;102:630–37.
Ministry of Internal Affairs and Communications. Statistics Japan; 2018. https://www.stat.go.jp/english/index.html.
Trichak S. Three-port vs standard four-port laparoscopic cholecystectomy. Surg Endosc. 2003;17:1434–6.
Poon CM, Chan KW, Lee DW, Chan KC, Cheung HY, Lee KW. Two-port versus four-port laparoscopic cholecystectomy. Surg Endosc. 2003;17:1624–7.
Hiraki M, Takemasa I, Uemura M, Haraguchi N, Nishimura J, Hata T, et al. Evaluation of invasiveness in single-site laparoscopic colectomy, using the PainVision™ system for quantitative analysis of pain sensation. Surg Endosc. 2014;28:3216–23.
Kang SB, Park JW, Jeong SY, Nam BH, Choi HS, Kim DW, et al. Open versus laparoscopic surgery for mid or low rectal cancer after neoadjuvant chemoradiotherapy (COREAN trial): short-term outcomes of an open-label randomized controlled trial. Lancet Oncol. 2010;11:637–45.
Jayne DG, Guillow PJ, Thorpe H, Quirke P, Copeland J, Smith AMH, et al. Randomised trial of laparoscopic-assisted resection of colorectal carcinoma: 3-year results of the UK MRC CLASICC Trial Group. J Clin Oncol. 2007;25:3061–8.
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Takahashi, H., Hamabe, A., Hata, T. et al. Prospective multicenter study of reduced port surgery combined with transvaginal specimen extraction for colorectal cancer resection. Surg Today 50, 734–742 (2020). https://doi.org/10.1007/s00595-019-01946-y
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DOI: https://doi.org/10.1007/s00595-019-01946-y