Two cases of laparoscopic total colectomy with natural orifice specimen extraction and review of the literature.

Abstract

We present two cases of natural orifice specimen extraction (NOSE) after laparoscopic total colectomy and ileorectal anastomosis (TC-IRA), and we also review all of the previously reported cases. Our aim was to focus on patient selection for NOSE after TC-IRA. The PubMed and Google Scholar databases were scanned. Demographic features, surgical indications, and techniques were analyzed. Basic calculations were used for statistical analysis. A total of 13 cases were detected in addition to our 2 cases. All of the specimens were removed through the natural orifices successfully. No case required a diverting ileostomy. No patients were converted to open surgery or to conventional laparoscopy. Complications were reported in three patients. Transanal extractions were performed in 12 cases (10 colonic inertia, 2 polyposis), and transvaginal extractions were performed in 3 cases (2 malignancy, 1 colonic inertia). Both transanal and transvaginal specimen extractions after laparoscopic TC-IRA can be preferred. However, transanal extraction seems to be feasible in cases of TC for benign disease with a limited mesenteric-omental resection. If the indication is a malignancy requiring a mesenteric-omental resection, a transvaginal route should be preferred for a voluminous specimen.

Extracción de muestras de orificio natural versus extracción transabdominal después de una hemicolectomía derecha totalmente laparoscópica

“…In our study, wound infections were not detected in the NOSE group, whereas in the transabdominal group, three patients (8.5%) developed infections at the specimen extraction area despite the routine, rigorous care with wound protector. When the literature was reviewed, this complication is as high as 20% in patients who undergo laparoscopic right hemicolectomy and transabdominal extraction 11 . In a previous study comparing the two techniques, no wound infections were seen in the NOSE group but two patients (5.8%) in the transabdominal group 6 .…”

“…In our study, one patient in the transabdominal extraction group had a midline incisional hernia. In the literature, it is reported that the incidence of midline incisional hernia is as high as 8.7% in patients undergoing laparoscopic right hemicolectomy following transabdominal extraction 11 . In our study, no hernia was found in the suprapubic incision or in the NOSE group.…”

Extracción de muestra transanal después de colectomía laparoscópica combinada y resección hepática

“…Natural orifice surgery is a technique developed to reduce the length of abdominal wall incision and to minimize the related complications. Transanal route as a field of extraction is used for benign tumors and occasionally for small volume malign tumors, but transvaginal tract is frequently used for larger lesions 1 . Isolated laparoscopic liver resection combined with transvaginal extraction has been reported before 2 ; however, transanal removal of a liver specimen has not been reported in the literature yet.…”