Transabdominal versus transvaginal specimen extraction in mini‐laparoscopic surgery

Abstract

Aim: The objective of this study was to present our experiences of tissue extraction via the transvaginal (TV) route after a mini-laparoscopic gynecological surgery and compare them with our transabdominal (TA) specimen extraction experiences. Methods: This prospective randomized controlled study was conducted in a tertiary care center between July 2014 and February 2016. Fifty-eight women who were undergoing mini-laparoscopy for adnexal mass removal were randomized into two groups according to the surgical specimen removal by the TV route (n = 28) or the TA route (n = 30). The main outcome measures were the postoperative incisional pain, cosmetic outcomes and overall satisfaction rate. The secondary outcome measures were additional blood loss, additional operation duration and the need for morcellation. Results: The TV group had significantly lower visual analog scale scores than the TA group at 6 and 24 h postoperatively. The morcellation needs were lower in the TV group than in the TA group. Three months after the surgery, the participants scored a higher rate of overall satisfaction in the cosmetic outcomes in the TV group than in the TA group. Conclusion: Tissue extraction through a posterior colpotomy after mini-laparoscopic surgery may be a feasible technique for improving cosmetic results, decreasing postoperative pain and decreasing the need for morcellation when compared to TA specimen retrieval.

Cosmesis and feasibility of transvaginal natural orifice Specimen extraction (NOSE) for large organ specimen: a prospective pilot study

“…When performing multiport laparoscopic surgery for large organs such as the stomach, colon, kidney, liver, and spleen, the extraction of surgical specimens requires an additional or enlarged abdominal wall incision to remove the resected organ or tissue. Enlargement of the incision may cause abdominal pain, infection, and incisional hernia during the postoperative period [ 2 ]. Natural orifice specimen extraction (NOSE) has been suggested to reduce incision-related morbidity and maximize the advantages of laparoscopic surgery [ 1 ].…”

“…Among various developed NOSE techniques, gynecologists have most widely selected the transvaginal access route through a posterior colpotomy incision [ 2 , 3 ]. The posterior vaginal fornix is a large recess behind the cervix, a relatively accessible part of the vagina, and has good healing ability due to adequate vascular supply [ 4 ].…”

Safety and Efficacy of Transvaginal Natural Orifice Specimen Extraction for Large Organ Specimen: a Prospective Pilot Study

“…Enlargement of the abdominal wall incision can lead to postoperative complications, including postoperative pain, surgical site infections, incisional hernias, and cosmetic problems (2,3). NOSE can address these problems when surgeons incorporate it into existing minimally invasive surgical procedures.…”

“…When performing multiport laparoscopic surgery for large organs such as the stomach, colon, kidney, liver, and spleen, the extraction of surgical specimens requires an additional or enlarged abdominal wall incision to remove the resected organ or tissue. Enlargement of the incision may cause abdominal pain, infection, and incisional hernia during the postoperative period (2). Natural ori ce specimen extraction (NOSE) has been suggested to reduce incision-related morbidity and maximize the advantages of laparoscopic surgery (1).…”

Comparison of conventional versus single port laparoscopy for surgical treatment of gynecological diseases: a pilot study.

“…This may be because the self-made device lacks a fixed point or fulcrum. Numerous studies have suggested that using posterior colpotomy to extract surgical specimens during laparoscopy or to perform an endoscopic operation has no negative effects on female sexual function [31][32][33]. In addition, Uccella et al showed that using the vagina for mass extraction allows the introduction of larger endobags without increasing the width of the incision on the abdomen during laparoscopic surgery [34].…”