Transvaginal specimen removal after laparoscopic distal pancreatic resection

Transvaginal Specimen Extraction After Laparoscopic Gastrectomy for Tumors

AIM

The aim was to evaluate the feasibility of transvaginal specimen extraction after laparoscopic gastrectomy for tumors.

METHOD

Inclusion criteria were females not planning to deliver a child and an accessible vaginal entry. Exclusion criteria were benign gastric pathologies and emergency cases.

RESULTS

There were 24 females with a mean age of 54.5±12.0. Subtotal, total, central, and vertical gastrectomies were implemented in 17, 4, 2, and 1 patients, respectively. There was no conversion to open or conventional laparoscopic surgery. Specimens were removed from the vagina in all cases successfully. Histopathologies were adenocarcinoma in 20, gastrointestinal stromal in 3, neuroendocrine tumors in 2 and high-grade dysplasia in the rest. Mean blood loss and duration of surgery were 122.5±163.4 (range: 10 to 800) ml. and 287.7±95.9 (range: 120 to 440) minutes, respectively. No patient required intraoperative blood transfusions. The median length of hospital stay was 7 days (range: 3 to 22). The mean tumor size was 7.8±6.5 (range: 0.5 to 24) cm. Fourteen of 24 cases were advanced gastric cancers. Mean dissected lymph node numbers in the patients with radical gastrectomy was 35.3±12.9 (range: 18 to 62). There were no early or late complications related to the specimen extraction and no wound-related problems were observed.

CONCLUSIONS

In the selected cases, transvaginal specimen extraction was feasible after laparoscopic gastric resections in patients with stomach tumors. As far as we know, this was the largest study on the transvaginal extraction of gastric tumors.

Natural orifice specimen extraction surgery in laparoscopic pancreaticoduodenectomy: A single-center case series

BACKGROUND

Laparoscopic pancreaticoduodenectomy is an appealing and minimally invasive method for pancreaticoduodenal tumors. However, an abdominal incision is still required to extract the specimen. We used the natural orifice specimen extraction technique in laparoscopic pancreaticoduodenectomy to accomplish specimen retraction in 8 female patients and summarized the clinical results.

MATERIALS AND METHODS

A total of 8 female patients with periampullary carcinoma or duodenal cancer who underwent laparoscopic pancreaticoduodenectomy were enrolled in our study between April 2018 and October 2019. A 4-cm transverse incision was made in the posterior vaginal wall, and the specimen was extracted via the vagina. Age, operative time, intraoperative hemorrhage, pathological data of the tumor, postoperative hospital stay, and postoperative complications were recorded and analyzed. All operations were performed laparoscopically, by the same team of surgeons.

RESULTS

The mean age of the patients was 67.5 ± 7.7 years. Mean BMI was 23.7 ± 1.7 kg/m2. The operative time ranged between 312 and 460 min. The intraoperative blood loss ranged from 100 to 600 ml. The average hospital stay of all patients was 9.9 ± 2.2 days; 5 out of 8 patients (62.5%) had postoperative complications, including postoperative pancreatic fistula, delayed gastric emptying, and postpancreatectomy hemorrhage. No patient developed short-term complications due to vaginal extraction of specimens. All patients underwent R0 resection.

CONCLUSION

Transvaginal specimen extraction is a practicable method for laparoscopic pancreaticoduodenectomy. By adhering to correct operation specifications and selecting patients with appropriate indications for natural orifice specimen extraction, this technique was safe and beneficial to selected female patients with pancreaticoduodenal tumors.

Long-term outcomes after Natural Orifice Specimen Extraction versus conventional laparoscopy-assisted surgery for rectal cancer: a matched case-control study

Purpose

The aim of this study was to compare the long-term outcomes of total laparoscopic surgery with Natural Orifice Specimen Extraction (NOSE) with those for conventional laparoscopy (CL)-assisted surgery for treating rectal cancers.

Methods

We reviewed the prospectively collected records of 844 patients (163 NOSE and 681 CL) who underwent curative surgery for mid- or upper rectal cancers from January 2006 to November 2012. We applied propensity score analyses and compared oncological outcomes for the NOSE and CL groups in a 1:1 matched cohort.

Results

After propensity score matching, each group included 138 patients; the NOSE and CL groups did not differ significantly in terms of baseline clinical characteristics. The median follow-up was 57.7 months (interquartile range, 42.4–82.5 months). The combined 5-year local recurrence rate for all tumor stages was 4.1% (95% confidence interval [CI], 0.9%–7.4%) in the NOSE group and 3.0% (95% CI, 0%–6.3%) in the CL group (P = 0.355). The combined 5-year disease-free survival rates for all stages were 89.3% (95% CI, 84.3%–94.3%) in the NOSE group and 87.3% (95% CI, 81.8%–92.9%) in the CL group (P = 0.639). The postoperative mean fecal incontinence scores at 6, 12, and 24 months were similar between the 2 groups.

Conclusion

In our experience, NOSE for mid- and upper rectal cancer had acceptable long-term oncologic outcomes comparable to those of conventional minimal invasive surgery and seems to be a safe alternative to reduce access trauma.

Systematic Review and Meta-analysis of Complications in Transvaginal Approach in Laparoscopic Surgery

Transvaginal access is the most popular natural orifice translumenal technique in the minimally invasive surgery. Reviews on non-gynecological transvaginal approach morbidities reveal that rates vary greatly. A systematic review of transvaginal approach in non-gynecological intraabdominal procedures was carried out to assess the risk of complications. A systematic search was conducted using MEDLINE, EMBASE, PubMed, and the Cochrane Library from the inception of these databases to March 2012. The following keywords were searched: "transvaginal", "NOTES", "single incision", and "single port". From the total of 231 potentially eligible abstracts, 87 papers were retrieved and evaluated as fulfilling the eligibility criteria. The final analysis included 32 articles. The overall complications rate was 4.4 %, and complications related to the transvaginal port reached 2.4 %. Conversion rate to open surgery was 3.4 %. The incidence of postoperative urinary tract infection was 0.8 %. The mean operative time was 119 min. The mean hospital stay was 3.1 days (range 6 h-12 days). The technique of transvaginal access can offer several advantages for a patient and is associated with an acceptable rate of complications.