Scarless hepatectomy: natural orifice specimen extraction after left lateral sectionectomy

Abstract

BackgroundThe use of laparoscopy in liver surgery is well established and considered as the gold standard for small resections. The laparoscopic resections have lower morbidity and better cosmetic results, but still require an incision to remove the surgical specimen. The possibility of remove the specimen through natural orifices and avoid an abdominal incision may further improve the benefits offered by minimally invasive procedures.AimTo describe the technique of transvaginal extraction of the specimen after laparoscopic liver left lateral sectionectomy.MethodThe laparoscopic liver resection is performed in a standard fashion. After completing the resection, the specimen is placed into a retrieval plastic bag. To perform de extraction, a vaginal colpotomy is performed, guided by a 12 mm trocar introduced through the vagina. Then the extraction bag is removed pulling the bag through the extended incision in the posterior wall of the vagina. After the extraction, the colpotomy incision is closed laparoscopically.ResultsThis technique was performed in a 74-year-old woman with a 3 cm lesion between liver segments 2 and 3. She had a fast and uneventful recovery.ConclusionThis technique appears to be feasible, safe and avoid the complications of an abdominal incision.

Robotic Full Lobe Hepatectomy With Natural Orifice Extraction

“…Although transvaginal specimen extraction in itself is not a new concept, using this technique for removal of specimen following major hepatectomy has not been previously described. 15 – 18 …”

Transanal Natural Orifice Specimen Extraction Following Combined Laparoscopic Anterior Resection and Liver Resection

“…[1][2][3] Transvaginal NOSE has been described following hepatectomies. 4,5 To our knowledge, transanal specimen extraction following laparoscopic liver-only resection has not yet been reported. However, combined multiorgan resections with NOSE have been documented, albeit rarely.…”

Transvaginal Natural Orifice Specimen Extraction Following Laparoscopic Combined D3 Right Hemicolectomy and Liver Resection

“…In contrast to colectomy, transvaginal NOSE after laparoscopic liver-only resection is limited to a few case reports. 6,7 The feasibility of liver resection with transvaginal NOSE was demonstrated using a hybrid method of laparoscopy and transvaginal endoscopic surgery in a series of porcine models. 8 Combined laparoscopic resections with NOSE have been described, albeit also in the form of 2 isolated case reports.…”