Specimen retrieval approaches in patients undergoing laparoscopic colorectal resections: a literature-based review of published studies

Abstract

Objective: To review the published studies reporting various specimen retrieval incisions being used by colorectal surgeons in patients undergoing laparoscopic colorectal resections (LCR).Methods: Standard medical electronic databases were searched to find relevant articles and a summary conclusion was generated.Results: There were 43 studies reporting various approaches used for the purpose of specimen retrieval in 2388 patients undergoing LCR. The most common approaches were periumbilical midline incision (1260 reported case in the literature), transverse incision (583 reported cases in the literature) in the right- or left iliac fossa, depending on the side of colonic resection, and Pfannensteil incision (293 reported cases in the literature). Periumbilical midline incision was associated with the higher risk of developing incisional hernia (odds ratio 53.72; 95% confidence interval 7.48–386.04; Z = 3.96; P = 0.0001). In terms of surgical site infection (SSI), there was no difference between the three common approaches to specimen retrieval. Transanal and transvaginal approaches were associated with higher risk of SSI.Conclusions: Midline, transverse and Pfannensteil incisions were the most commonly used approaches for specimen retrieval following LCR. Midline incision was associated with higher risk of incisional hernia. Risk of SSI was similar in all three common approaches. The transanal and transvaginal approaches pose a higher risk of SSI. These conclusions are based on the combined outcome of published case series, case reports and comparative studies. Randomized, controlled trials with longer follow-up are required before recommending the routine use of any approach for specimen retrieval in patients undergoing LCR.

Risk of postoperative deep venous thrombosis in patients with colorectal cancer treated with open or laparoscopic colorectal surgery: A meta-analysis

“…[14] And with the development of surgery technique and instrument, the laparoscopic-assisted colorectal surgery was performed more and more extensive in the treatment of colorectal cancer with the advantages of overall survival, disease free survival faster recovery and shorter hospital stays. [15] However, the laparoscopic-assisted colorectal surgery also has its disadvantages such as relative long operation time and long training period for surgeon. [16] …”

Does the Choice of Extraction Site During Minimally Invasive Colorectal Surgery Change the Incidence of Incisional Hernia? Protocol for a Systematic Review and Network Meta-Analysis

“…MEDLINE and Embase will be searched from inception to the 1 st of August 2021 for observational and interventional studies written in English including patients who benefited from minimally invasive colorectal surgery and comparing at least two specimen extraction sites in terms of incidence of IH. Review of titles and abstracts from studies in the field identified by experts or included into existing reviews [ 12 14 ] allowed to develop a literature search strategy, which is reported in Table S2. Additional records will be identified by manual search of the reference lists of the included publications and existing reviews.…”

Extraction Site in Minimally Invasive Colorectal Surgery

“…20 Early reports included small case numbers. 2,[20][21][22] In 2009, Eshuis et al published a series of 10 cases using transcolonic, colonoscopic extraction of the specimen after ileocolic resection; they were successful in 8 out of 10 cases and noted difficulty when there was a larger inflammatory mass within the specimen. 23 Gardenbroek et al published a series of seven patients using a transrectal extraction after emergency total Minimally Invasive Colorectal Surgery Paruch 49 abdominal colectomy for inflammatory bowel disease.…”

“…Selection of the location for extraction site incisions is driven by a multitude of patient, disease, and surgeon-related factors. The most commonly published specimen extraction site remains the midline incision, 2 although many datasets do not include this as a variable, making retrospective comparative studies difficult. More recently, many groups have also begun reporting results using natural orifice specimen extraction (NOSE) through transanal, transvaginal, and transcolonic routes.…”