Vaginal extraction of pelvic masses following operative laparoscopy

Ghezzi, Fabio; Raio, Luigi; Mueller, Christoph; Gyr, Thomas; Buttarelli, M; Franchi, Massimo Piergiuseppe

doi:10.1007/s00464-002-9043-z

Cited by 98 publications

(69 citation statements)

References 18 publications

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“…It is extremely important to ensure oncological suitability. No relapse specifically caused by TVSE has been reported for colon cancer [9,12]; however, some reports have pointed out that to prevent peritoneal dissemination or delivery site metastasis, specimens should be put in a bag before extraction [6]. However, others claim that as long as oncological principles and procedures are followed, there should be no increase in the dissemination as a result of TVSE, and the validity of TVSE in early-stage uterine cervical cancer has been demonstrated in the field of gynecology [10].…”

Section: Discussionmentioning

confidence: 97%

“…Complications of TVSE are reportedly infrequent [9,10], but the risk of infection due to the transvaginal maneuvers is of concern. In our department, we irrigate the vagina and abdominal cavity with saline before and after extraction, and an Alexis® wound retractor and tissue collection bags are used for specimen extraction so as to protect the vagina and help prevent infections.…”

Section: Discussionmentioning

confidence: 99%

“…"Natural orifice specimen extraction" (NOSE) techniques that are similar to NOTES have been attempted in recent years. Transvaginal specimen extraction (TVSE), one of these techniques, has been attempted mainly in Europe and the USA, and it is claimed to have the advantages of reducing surgical wound pain, reducing wound complications, shortening the period of hospitalization, and ensuring excellent esthetic outcomes [5][6][7][8][9][10].…”

Section: Introductionmentioning

confidence: 99%

“…Widespread experience with laparoscopic pancreatectomies has allowed safe splenectomies in the supine position, by a safe and even less invasive surgical method using TVSE without the changing of body positions as required in conventional laparoscopic splenectomy [5][6][7][8][9][10]. The present surgical procedure was performed after obtaining approval from the Japanese Meabashi Red Cross hospital ethical committee.…”

Section: Introductionmentioning

confidence: 99%

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A Case of Splenic Metastasis of Ovarian Cancer Treated with Complete Laparoscopic Splenectomy and Transvaginal Specimen Extraction

et al. 2016

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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.

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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A Case of Splenic Metastasis of Ovarian Cancer Treated with Complete Laparoscopic Splenectomy and Transvaginal Specimen Extraction

et al. 2016

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“…To reduce abdominal scarification in women, specimen retrieval through a vaginal incision has been proposed in a reproducible technique, with excellent patient acceptance and satisfaction and low morbidity. However this technique should not be performed in young nulliparious women, patients with atrophic vaginitis, an extremely large specimen, vaginal infection or a vaginal prolapse, or in those in whom the cosmetic result is not a matter of concern (15,16).…”

Section: Specimen Retrievalmentioning

confidence: 99%

The final stage of the laparoscopic procedure: exploring final steps

et al. 2012

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INTRODuCTIONUrologic surgery continues to evolve focusing efforts on adequate treatment of pathologic urologic conditions in a safe and minimally invasive manner (1).Laparoscopic surgery has well defined benefits for the patient and has, over time, become accepted as a standard of care access strategy for the management of benign and malignant Urologic diseases. Despite significant advances in laparoscopic technique and technologies, laparoscopic Urologic surgery remains technically demanding. Unlike open surgery, at the end of laparoscopic extirpative procedures, the Urologist is often faced with the additional challenges of specimen retrieval and extraction.Laparoscopic specimen entrapment and extraction occur at what is falsely considered the "end of the procedure". During open surgery, after the specimen has been mobilized, the specimen is Despite significant advances in laparoscopic technique and technologies, laparoscopic Urologic surgery remains technically demanding regarding various surgical steps including the challenge of specimen retrieval and extraction, whether to install a drainage system and the best option for wound closure. Laparoscopic specimen entrapment and extraction occurs at what is falsely considered the "end of the procedure". During open surgery, after the specimen has been mobilized, the specimen is simply lifted out of the larger incision which has been made to achieve the surgical objectives. In contrast, significant laparoscopic skill is required to entrap and safely extract laparoscopic specimens. Indeed, the Urologist and surgical team which are transitioning from open surgery may disregard this important part of the procedure which may lead to significant morbidity. As such, it is imperative that during laparoscopic procedures, the "end of the procedure" be strictly defined as the termination of skin closure and dressing placement. Taking a few minutes to focus on safe specimen entrapment and extraction will substantially reduce major morbidity. The following review focus on the technology and technique of specimen entrapment and extraction, on the matter of whether to install a drainage system of the abdominal cavity and the options for adequate closure of trocar site wounds. This article's primary objectives are to focus on how to minimize morbidity while maintain the advantages of a minimally invasive surgical approach.

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