Laparoscopic Liver Tumor Resection with Transvaginal Specimen Extraction

Abstract

Laparoscopic liver tumor resection with transvaginal natural orifice specimen extraction is mainly applicable to female patients with a specimen diameter of less than 5 cm. The procedure for liver tumor resection is the same as that for conventional laparoscopic hepatectomy. However, specimen extraction is accomplished transvaginally via an incision at the posterior vaginal fornix, which helps avoid the abdominal incision made during conventional laparoscopic hepatectomy, hence achieving the “most minimally invasive of minimally invasive” surgeries. This surgical procedure is considered a type of natural orifice specimen extraction surgery (NOSES) and requires that upper abdominal operations be converted to lower abdominal operations; the monitor and trocar placement should be adjusted where necessary. The main operative features of this procedure are that (1) upper abdominal liver tumor resection is performed under total laparoscopy, followed by wound assessment and placement of the specimen in a specimen retrieval bag; (2) transvaginal specimen extraction is performed without abdominal incision, thus avoiding pain at the incision site and accelerating patient recovery; and (3) this procedure is only applicable to female patients. Patients must be fully informed about this procedure, and their level of acceptance for this procedure must be assessed. A majority of surgeries using this procedure are similar to conventional laparoscopic hepatectomy, differing only in the method of specimen extraction. Therefore, as long as the surgeon is equipped with the surgical skills necessary for laparoscopic hepatectomy and adheres to the surgical indications for the technique, it is scientifically rational, safe, and feasible.