A case of splenic metastasis of ovarian cancer treated with complete laparoscopic splenectomy and transvaginal specimen extraction

Abstract

A 61-year-old woman was diagnosed with right inguinal lymph node and splenic metastasis of ovarian serous cystadenocarcinoma. We performed right inguinal lymph node dissection and total laparoscopic splenectomy in the supine position followed by transvaginal specimen extraction (TVSE). First, using three ports, we extracted the right inguinal lymph node. We repaired the posterior wall of the inguinal canal using a mesh plug. We added two ports and displaced the spleen from the retroperitoneum and lifted it using a snake retractor, disconnecting the hilum using an automatic suturing device. Next, the posterior wall of the vagina was intraperitoneally incised. And an Alexis® laparoscopic system was inserted into the vagina. The cap maintained aeroperitoneum, a collection bag was inserted in the abdominal cavity via the vagina, and the spleen was collected. When the spleen was removed from the body, partial fragmentation of the organ was required in the bag. Organ fragmentation was performed only within the bag, and we made sure not to tear the bag. The vaginal wound was laparoscopically sutured. The patient had no operative complications and was able to actively ambulate at the first day after surgery due to a slight postoperative pain. Total laparoscopic splenectomy with TVSE in the supine position may be a safe and feasible method for selected female patients. This technique enables minimally invasive surgery for female patients with splenic disease.

Transvaginal Specimen Extraction After Laparoscopic Gastrectomy for Tumors

“…Except for the gynecological organs, it was first described for the gall bladder in 1993 by Delvaux et al11 for large stones. In time, transvaginal extraction of several specimens belonging to different organs such as the colon, spleen, kidney, adrenal, liver, appendix, and pancreas have been published 12–17. Transvaginal extraction of a gastric specimen was first reported in a swine model by Nakajima in 2008 and 1 year later the same author published 2 cases of transvaginally extracted partial gastrectomies for small submucosal tumors 7.…”

“…In time, transvaginal extraction of several specimens belonging to different organs such as the colon, spleen, kidney, adrenal, liver, appendix, and pancreas have been published. [12][13][14][15][16][17] Transvaginal extraction of a gastric specimen was first reported in a swine model by Nakajima in 2008 and 1 year later the same author published 2 cases of transvaginally extracted partial gastrectomies for small submucosal tumors. 7 Subsequently, Jeong et al in 2011 18 implemented transvaginal gastrectomy extractions in 4 patients with early gastric cancers.…”