Specimen Retrieval in Laparoscopic Colon Surgery

Abstract

In the past decade, for benign as well as malignant colon diseases, minimally invasive surgery has gained more and more importance in colon surgery. Specimen retrieval after colonic resections is difficult due to the large size of the specimen usually resected. To date there is no standardized retrieval technique for the different procedures. Four incision sites are common for transabdominal specimen retrieval: left or right lower quadrant transrectal portside incision; periumbilical midline incision, and transverse suprapubic incision. Perineal incisions are used for retrieval following low anterior resection or abdomino-perineal extirpation. Three major complications are described in the literature: wound infection (0–9%); hernias (0–2%), and incision site recurrence (0–1.3%). There are no significant differences between the different incision sites with regard to the occurrence of complications. In laparoscopic surgery for malignant diseases retrieval is usually performed using a plastic bag, whereas retrieval can be performed hand-assisted without a bag during surgery for benign diseases. Wound edge protectors are recommended by several authors, yet there is no standard system which is accepted broadly. In conclusion, specimen retrieval in laparoscopic colon surgery is not standardized. The morbidity rate for specific retrieval complications ranges between 0 and 9%, yet there are no randomized controlled studies or evidence-based data regarding different retrieval approaches and systems.

Long-term outcomes after laparoscopic colectomy

“…Prevention of port-site recurrence requires a careful technique avoiding any injury to the colon and minimizing manipulation of the tumor [15] . Pulling large specimens through a small incision should be avoided and the routine protection of the wound with a plastic device can prevent tumor inoculation [16,17] . In the current trial only one patient of the laparoscopic group developed port-site recurrence and one patient in the open group wound-site recurrence.…”

Totally intracorporeal laparoscopic colorectal anastomosis using circular stapler

“…Moreover, wound protectors only protect the abdominal wall from tumor cells seeding, but doe not offer any protection against cells seeding in the abdominal cavity when the colon is extracted through a small incision for proximal bowel preparation. The use of a laparoscopic retrieval bag for the extraction of the resected specimen has been shown to decrease the incidence of wound infection at the extraction incision and lower the risk of seeding of tumor cells into the abdominal cavity and wound metastasis during specimen manipulation [31][32][33]. For TLCCA a specimen retrieval bag is used for these reasons and allows easy handling of the resected bowel segment for extraction through the right iliac port incision.…”

Laparoscopic sigmoidectomy in Germany—a standardised procedure?

“…During the last decade, several publications were reported covering technical details of the operative technique for laparoscopic sigmoid resection [7][8][9][10][11][12][13][14][15]. A standardised operative technique could provide surgeons with objective measures of operative progress to limit unduly long operations, avoid unnecessary conversions, reduce the learning curve and optimize the results [23].…”

“…In contrast to these expectations, technical details of laparoscopic sigmoidectomy varied considerably. Although evidence-based guidelines on colon and rectal cancer surgery exist [11,12], and surgical procedures have been described in detail [7][8][9][10][13][14][15], there obviously is no standardised pathway concerning the technical issues of laparoscopic sigmoid resection in Germany. This is important because it has been shown that details of laparoscopic surgery, like trocar position [24] or size of incisions [25,26], have a clinically relevant impact on postoperative recovery after minimal invasive surgery.…”

“…Today, laparoscopic sigmoidectomy may be considered the most common laparoscopic colonic resection in Europe and all over the world. Although the technical issues and details were numerously described and some guidelines pronounced, no standardisation exists yet [7][8][9][10][11][12][13][14][15].…”