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Zhang ZC, Wang WS, Chen JH, Ma YH, Luo QF, Li YB, Yang Y, Ma D. Perioperative outcomes of transvaginal specimen extraction laparoscopic total gastrectomy and conventional laparoscopic-assisted total gastrectomy. World J Gastrointest Surg 2024; 16:1527-1536. [PMID: 38983348 PMCID: PMC11230027 DOI: 10.4240/wjgs.v16.i6.1527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 02/20/2024] [Accepted: 05/24/2024] [Indexed: 06/27/2024] Open
Abstract
BACKGROUND Natural orifice specimen extraction surgery (NOSES) has emerged as a promising alternative compared to conventional laparoscopic-assisted total gastrectomy (LATG) for treating gastric cancer (GC). However, evidence regarding the efficacy and safety of NOSES for GC surgery is limited. This study aimed to compare the safety and feasibility, in addition to postoperative complications of NOSES and LATG. AIM To discuss the postoperative effects of two different surgical methods in patients with GC. METHODS Dual circular staplers were used in Roux-en-Y digestive tract reconstruction for transvaginal specimen extraction LATG, and its outcomes were compared with LATG in a cohort of 51 GC patients with tumor size ≤ 5 cm. The study was conducted from May 2018 to September 2020, and patients were categorized into the NOSES group (n = 22) and LATG group (n = 29). Perioperative parameters were compared and analyzed, including patient and tumor characteristics, postoperative outcomes, and anastomosis-related complications, postoperative hospital stay, the length of abdominal incision, difference in tumor type, postoperative complications, and postoperative survival. RESULTS Postoperative exhaust time, operation duration, mean postoperative hospital stay, length of abdominal incision, number of specific staplers used, and Brief Illness Perception Questionnaire score were significant in both groups (P < 0.01). In the NOSES group, the postoperative time to first flatus, mean postoperative hospital stay, and length of abdominal incision were significantly shorter than those in the LATG group. Patients in the NOSES group had faster postoperative recovery, and achieved abdominal minimally invasive incision that met aesthetic requirements. There were no significant differences in gender, age, tumor type, postoperative complications, and postoperative survival between the two groups. CONCLUSION The application of dual circular staplers in Roux-en-Y digestive tract reconstruction combined with NOSES gastrectomy is safe and convenient. This approach offers better short-term outcomes compared to LATG, while long-term survival rates are comparable to those of conventional laparoscopic surgery.
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Affiliation(s)
- Zhi-Cao Zhang
- Department of General Surgery, Xinqiao Hospital of Army Medical University, Chongqing 400037, China
| | - Wen-Sheng Wang
- Department of General Surgery, Xinqiao Hospital of Army Medical University, Chongqing 400037, China
| | - Jiang-Hong Chen
- Department of General Surgery, Xinqiao Hospital of Army Medical University, Chongqing 400037, China
| | - Yuan-Hang Ma
- Department of General Surgery, Xinqiao Hospital of Army Medical University, Chongqing 400037, China
| | - Qi-Fa Luo
- Department of General Surgery, Xinqiao Hospital of Army Medical University, Chongqing 400037, China
| | - Yun-Bo Li
- Department of General Surgery, Xinqiao Hospital of Army Medical University, Chongqing 400037, China
| | - Yang Yang
- Department of General Surgery, Xinqiao Hospital of Army Medical University, Chongqing 400037, China
| | - Dan Ma
- Department of General Surgery, Xinqiao Hospital of Army Medical University, Chongqing 400037, China
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Li Z, Zhang X, Tian L, Liu Z, Liao X, Qiu J, Wang G, Yan L, Wang X, Wang X, Liu R. Case Report: Transvaginal specimen extraction following totally laparoscopic D2 distal gastrectomy for gastric cancer in a patient with situs inversus totalis: with video. Front Oncol 2023; 13:1189948. [PMID: 37287912 PMCID: PMC10242047 DOI: 10.3389/fonc.2023.1189948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 05/09/2023] [Indexed: 06/09/2023] Open
Abstract
Because of its significant advantage of fast postoperative recovery, natural orifice specimen extraction surgery (NOSES) has attracted increasing attention worldwide. However, the NOSES in gastric cancer (GC) treatment still needs more clinical practice, especially for the rare anatomical anomaly. Situs inversus totalis (SIT) is a rare autosomal recessive anatomical anomaly with an incidence ranging between 1/8,000 and 1/25,000 births. We present a video of transvaginal specimen extraction following totally laparoscopic D2 distal gastrectomy performed in a 59-year-old woman known to have SIT. Preoperative investigations revealed that the patient had early GC at the antrum. A gastroscopy report from the local hospital showed signet-ring cell carcinoma. The preoperative computed tomography scan revealed irregular thickening of the gastric wall at the junction of the greater curvature and antrum without metastasis to the lymph nodes. In total, laparoscopic D2 distal gastrectomy was performed with transvaginal specimen extraction. Billroth II with Braun anastomosis was performed for reconstruction. The length of the operation was 240 min without intraoperative complications and with minimal blood loss of 50 ml. The patient was uneventfully discharged on postoperative Day 7. The final pathology confirmed signet-ring cell carcinoma confined to the mucosal muscle without metastasis in 16 lymph nodes. Transvaginal specimen extraction following totally laparoscopic D2 distal gastrectomy can be safely performed in patients with SIT and has similar surgical outcomes to usual laparoscopic gastrectomy.
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Affiliation(s)
- Zeyu Li
- Department of General Surgery, Shaanxi Provincial People’s Hospital, Xi’an, Shaanxi, China
| | - Xiaolong Zhang
- Department of General Surgery, Shaanxi Provincial People’s Hospital, Xi’an, Shaanxi, China
| | - Lifei Tian
- Department of General Surgery, Shaanxi Provincial People’s Hospital, Xi’an, Shaanxi, China
| | - Zheng Liu
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xinhua Liao
- Department of General Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Jian Qiu
- Department of General Surgery, Shaanxi Provincial People’s Hospital, Xi’an, Shaanxi, China
| | - Guorong Wang
- Department of General Surgery, Shaanxi Provincial People’s Hospital, Xi’an, Shaanxi, China
| | - Likun Yan
- Department of General Surgery, Shaanxi Provincial People’s Hospital, Xi’an, Shaanxi, China
| | - Xiaoqiang Wang
- Department of General Surgery, Shaanxi Provincial People’s Hospital, Xi’an, Shaanxi, China
| | - Xishan Wang
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ruiting Liu
- Department of General Surgery, Shaanxi Provincial People’s Hospital, Xi’an, Shaanxi, China
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Guan X, Liu Z, Parvaiz A, Longo A, Saklani A, Shafik AA, Cai JC, Ternent CA, Chen L, Kayaalp C, Sumer F, Nogueira F, Gao F, Han FH, He QS, Chun HK, Huang CM, Huang HY, Huang R, Jiang ZW, Khan JS, da Costa Pereira JM, Nunoo-Mensah JW, Son JT, Kang L, Uehara K, Lan P, Li LP, Liang H, Liu BR, Liu J, Ma D, Shen MY, Islam MR, Samalavicius NE, Pan K, Tsarkov PV, Qin XY, Escalante R, Efetov S, Jeong SK, Lee SH, Sun DH, Sun L, Garmanova T, Tian YT, Wang GY, Wang GJ, Wang GR, Wang XQ, Chen WTL, Lee WY, Yan S, Yang ZL, Yu G, Yu PW, Zhao D, Zhong YS, Wang JP, Wang X. International Consensus on Natural Orifice Specimen Extraction Surgery (NOSES) for Gastric Cancer (2019). NATURAL ORIFICE SPECIMEN EXTRACTION SURGERY 2023:963-970. [DOI: 10.1007/978-981-99-2750-0_76] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2025]
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Zhang ZC, Luo QF, Wang WS, Chen JH, Wang CY, Ma D. Development and future perspectives of natural orifice specimen extraction surgery for gastric cancer. World J Gastrointest Surg 2022; 14:1198-1203. [PMID: 36504515 PMCID: PMC9727573 DOI: 10.4240/wjgs.v14.i11.1198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 08/30/2022] [Accepted: 10/18/2022] [Indexed: 02/07/2023] Open
Abstract
In recent years, natural orifice specimen extraction surgery (NOSES), a novel minimally invasive surgical technique, has become a focus in the surgical field, and has been initially applied in gastric surgery in many national medical centers worldwide. In addition, this new surgical technique was launched in major hospitals in China. With an increasing number of patients who have accepted this new surgical technique, NOSES has provided new prospects for the treatment of gastric cancer (GC), which may achieve a better outcome for both patients and surgeons. More and more experts and scholars from different countries and regions are currently paying close attention to NOSES for the treatment of GC. However, there are only a few reports of its use in GC. This review focuses on the research progress in NOSES for radical gastrectomy in recent years. We also discuss the challenges and prospects of NOSES in clinical practice.
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Affiliation(s)
- Zhi-Cao Zhang
- Department of General Surgery, Xinqiao Hospital of Army Medical University, Chongqing 400037, China
| | - Qi-Fa Luo
- Department of General Surgery, Xinqiao Hospital of Army Medical University, Chongqing 400037, China
| | - Wen-Sheng Wang
- Department of General Surgery, Xinqiao Hospital of Army Medical University, Chongqing 400037, China
| | - Jiang-Hong Chen
- Department of General Surgery, Xinqiao Hospital of Army Medical University, Chongqing 400037, China
| | - Chen-Yu Wang
- Department of General Surgery, Xinqiao Hospital of Army Medical University, Chongqing 400037, China
| | - Dan Ma
- Department of General Surgery, Xinqiao Hospital of Army Medical University, Chongqing 400037, China
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Dong C, Zhou W, Zang Y, Ding Y. Totally laparoscopic gastrectomy with natural orifice (vagina) specimen extraction in gastric cancer: Introduction of a new technique. J Minim Access Surg 2022; 18:484-486. [PMID: 35708393 PMCID: PMC9306110 DOI: 10.4103/jmas.jmas_328_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Radical excision by surgery is the main treatment method for gastric cancer and as the surgery develops, the laparoscopic treatment effect on gastric cancer is gradually being verified. The totally laparoscopic gastrectomy (TLG) with natural orifice specimen extraction surgery (NOSES) for gastric cancer has attracted people's attention by avoiding abdominal incision and further reducing surgical injury and provides ideas for the further development of minimally invasive surgical treatment on the basis of laparoscopy. Surgical technique of TLG with natural orifice (vagina) specimen extraction is detailed in the text. We have employed NOSES in 4 cases of TLG in the past year. The visual analogue scale score was low, and all patients had no complications during and after the operation. No recurrence or metastasis was found in the short-term follow-up. TLG with NOSES is feasible and has many advantages such as aesthetics, light post-operative pain.
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Affiliation(s)
- Changzheng Dong
- Department of Gastrointestinal Surgery, Jinan City People's Hospital, Jinan, Shandong Province, China
| | - Wei Zhou
- Department of Gastrointestinal Surgery, Jinan City People's Hospital, Jinan, Shandong Province, China
| | - Yifeng Zang
- Department of Gastrointestinal Surgery, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong Province, China
| | - Yinlu Ding
- Department of Gastrointestinal Surgery, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong Province, China
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Sumer F, Gundogan E, Kaplan K, Okut G, Kayaalp C. Transvaginal Specimen Extraction After Laparoscopic Gastrectomy for Tumors. Surg Laparosc Endosc Percutan Tech 2021; 32:247-251. [PMID: 34966150 DOI: 10.1097/sle.0000000000001031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 09/09/2021] [Indexed: 11/26/2022]
Abstract
AIM The aim was to evaluate the feasibility of transvaginal specimen extraction after laparoscopic gastrectomy for tumors. METHOD Inclusion criteria were females not planning to deliver a child and an accessible vaginal entry. Exclusion criteria were benign gastric pathologies and emergency cases. RESULTS There were 24 females with a mean age of 54.5±12.0. Subtotal, total, central, and vertical gastrectomies were implemented in 17, 4, 2, and 1 patients, respectively. There was no conversion to open or conventional laparoscopic surgery. Specimens were removed from the vagina in all cases successfully. Histopathologies were adenocarcinoma in 20, gastrointestinal stromal in 3, neuroendocrine tumors in 2 and high-grade dysplasia in the rest. Mean blood loss and duration of surgery were 122.5±163.4 (range: 10 to 800) ml. and 287.7±95.9 (range: 120 to 440) minutes, respectively. No patient required intraoperative blood transfusions. The median length of hospital stay was 7 days (range: 3 to 22). The mean tumor size was 7.8±6.5 (range: 0.5 to 24) cm. Fourteen of 24 cases were advanced gastric cancers. Mean dissected lymph node numbers in the patients with radical gastrectomy was 35.3±12.9 (range: 18 to 62). There were no early or late complications related to the specimen extraction and no wound-related problems were observed. CONCLUSIONS In the selected cases, transvaginal specimen extraction was feasible after laparoscopic gastric resections in patients with stomach tumors. As far as we know, this was the largest study on the transvaginal extraction of gastric tumors.
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Affiliation(s)
- Fatih Sumer
- Department of Gastrointestinal Surgery, Inonu University, Malatya
| | - Ersin Gundogan
- Department of Gastrointestinal Surgery, Kayseri City Training and Research Hospital, Health Sciences University, Kayseri, Turkey
| | - Kuntay Kaplan
- Department of Gastrointestinal Surgery, Inonu University, Malatya
| | - Gökalp Okut
- Department of Gastrointestinal Surgery, Inonu University, Malatya
| | - Cuneyt Kayaalp
- Department of Gastrointestinal Surgery, Inonu University, Malatya
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Xu SZ, Cai JC. Laparoscopic-Assisted Natural Orifice Specimen Extraction Gastrectomy Using an Auxiliary Incision-free Tube for Gastric Cancer. J Surg Res 2021; 270:31-38. [PMID: 34628161 DOI: 10.1016/j.jss.2021.08.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 07/21/2021] [Accepted: 08/30/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Laparoscopic-assisted natural orifice specimen extraction (LA-NOSE) gastrectomy effectively avoids the need for an abdominal incision, unlike conventional laparoscopic gastrectomy. In this study, we documented our experience with LA-NOSE gastrectomy using an auxiliary incision-free tube (Cai tube, a homemade invention: ZL201410168748.2) in 9 gastric cancer patients and summarized the clinical results. METHODS From July 2018 to June 2020, a total of 9 patients with gastric cancer were recruited for this study. LA-NOSE gastrectomy (subtotal or total) using the auxiliary incision-free tube and D2 lymph node dissection were performed. Specimens were extracted through the anterior wall of the upper rectum in 4 male patients and the posterior fornix of the vagina in 5 female patients using the auxiliary incision-free tube. RESULTS All 9 patients underwent successful laparoscopic gastrectomy with NOSE using the auxiliary incision-free tube. No perioperative death, re-admission within 60 days post operation, natural orifice wound infection or tumor implantation was observed. The mean operating time was 365.3±41.7 min, and the mean estimated blood loss was 87.8±39.3 ml. The mean duration of hospital stay was 11.3±1.2 days, while the mean maximum pain score (visual analogue score, VAS) was 2.3±0.9 on postoperative day (POD) 1, and the mean time to ambulation was 1.3±0.5 days. The 60-day postoperative morbidity rate was 11.1% (1/9). After a mean follow-up of 14.7±9.6 months, there was no transrectal or transvaginal access-site recurrence, no anterior rectectomy or posterior fornix colpotomy-related complications, and no local recurrence or distant metastasis. CONCLUSIONS Our preliminary experience indicates that this new technique, LA-NOSE gastrectomy using the auxiliary incision-free tube, is feasible for selected patients with gastric cancer.
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Affiliation(s)
- Shu-Zhen Xu
- Department of Gastrointestinal Surgery, Zhongshan Hospital of Xiamen University, Xiamen Fujian, China; Institute of Gastrointestinal Oncology, Medical College of Xiamen University, Xiamen, Fujian, China; Xiamen Municipal Key Laboratory of Gastrointestinal Oncology, Xiamen, Fujian, China.
| | - Jian-Chun Cai
- Department of Gastrointestinal Surgery, Zhongshan Hospital of Xiamen University, Xiamen Fujian, China; Institute of Gastrointestinal Oncology, Medical College of Xiamen University, Xiamen, Fujian, China; Xiamen Municipal Key Laboratory of Gastrointestinal Oncology, Xiamen, Fujian, China.
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Ye SP, Zhu WQ, Huang ZX, Liu DN, Wen XQ, Li TY. Role of minimally invasive techniques in gastrointestinal surgery: Current status and future perspectives. World J Gastrointest Surg 2021; 13:941-952. [PMID: 34621471 PMCID: PMC8462081 DOI: 10.4240/wjgs.v13.i9.941] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 04/15/2021] [Accepted: 07/27/2021] [Indexed: 02/06/2023] Open
Abstract
In recent years, the incidence of gastrointestinal cancer has remained high. Currently, surgical resection is still the most effective method for treating gastrointestinal cancer. Traditionally, radical surgery depends on open surgery. However, traditional open surgery inflicts great trauma and is associated with a slow recovery. Minimally invasive surgery, which aims to reduce postoperative complications and accelerate postoperative recovery, has been rapidly developed in the last two decades; it is increasingly used in the field of gastrointestinal surgery and widely used in early-stage gastrointestinal cancer. Nevertheless, many operations for gastrointestinal cancer treatment are still performed by open surgery. One reason for this may be the challenges of minimally invasive technology, especially when operating in narrow spaces, such as within the pelvis or near the upper edge of the pancreas. Moreover, some of the current literature has questioned oncologic outcomes after minimally invasive surgery for gastrointestinal cancer. Overall, the current evidence suggests that minimally invasive techniques are safe and feasible in gastrointestinal cancer surgery, but most of the studies published in this field are retrospective studies and case-matched studies. Large-scale randomized prospective studies are needed to further support the application of minimally invasive surgery. In this review, we summarize several common minimally invasive methods used to treat gastrointestinal cancer and discuss the advances in the minimally invasive treatment of gastrointestinal cancer in detail.
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Affiliation(s)
- Shan-Ping Ye
- Department of General Surgery, The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
- Institute of Digestive Surgery, The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Wei-Quan Zhu
- Jiangxi Medical College of Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Zhi-Xiang Huang
- Jiangxi Medical College of Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Dong-Ning Liu
- Department of General Surgery, The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Xiang-Qiong Wen
- Jiangxi Medical College of Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Tai-Yuan Li
- Department of General Surgery, The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
- Institute of Digestive Surgery, The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
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Ahmad NZ, Swayamjoti R, Flashman K, Naqvi SAH, Khan J. A Case Series of Laparoscopic Colorectal Resections with Natural Orifice Specimen Extraction and Systematic Literature Review. Surg J (N Y) 2021; 7:e203-e208. [PMID: 34395873 PMCID: PMC8354358 DOI: 10.1055/s-0041-1733833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 04/06/2021] [Indexed: 11/05/2022] Open
Abstract
Background Minimal access surgery is associated with improved cosmetic and other short-term outcomes. Conventionally, an abdominal incision is made for specimen extraction. We assessed the feasibility of specimen extraction through one of the natural orifices and analyzed its impact on short-term outcomes. Methods A prospectively collected data were reviewed on consecutive patients who underwent natural orifice specimen extraction (NOSE) after laparoscopic colorectal surgery. The results were compared with a matched group who had transabdominal extraction (TAE) of the specimens. A systematic literature review was performed to compare our results. Results The combined median operating time for right and left colectomies was significantly higher in the NOSE group as compared with TAE group (260 vs. 150). There was no mortality in either group and no conversions to TAE in the NOSE group. No local metastasis or major iatrogenic injuries were reported at the time of retrieval. The results were comparable to those of a meta-analysis of randomized controlled trials. Conclusion The results of NOSE are comparable to those of TAEs. The absence of a minilaparotomy for specimen extraction may lead to a speedy recovery and better cosmesis.
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Affiliation(s)
- Nasir Zaheer Ahmad
- Department of General Surgery, University Hospital Limerick, Limerick, Ireland
| | - Ray Swayamjoti
- Department of Colorectal Surgery, Queen Alexandra Hospital, Portsmouth, United Kingdom
| | - Karen Flashman
- Department of Colorectal Surgery, Queen Alexandra Hospital, Portsmouth, United Kingdom
| | | | - Jim Khan
- Department of Colorectal Surgery, Queen Alexandra Hospital, Portsmouth, United Kingdom
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Meng H, Liu J, Xu H, Wang S, Rong Y, Xu Y, Yu G. Proctotomy leak following laparoscopic total gastrectomy with transrectal specimen extraction for gastric cancer: a case report. BMC Surg 2021; 21:218. [PMID: 33906630 PMCID: PMC8077703 DOI: 10.1186/s12893-021-01217-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 04/20/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite increasing acceptance in colorectal surgery, natural orifice specimen extraction (NOSE) surgery for the treatment of gastric cancer is still in its infancy, especially via the transrectal approach, which was barely reported. So little is known about its complications. Here we report the first case of proctotomy leak after transrectal NOSE gastrectomy, and our experience in preventive interventions. CASE PRESENTATION A 62-year-old male patient complaining of upper abdominal pain who underwent open distal gastrectomy for gastric cancer one year ago was diagnosed with recurrent gastric cancer by gastroscopic biopsy. We performed laparoscopic total gastrectomy with transrectal specimen extraction on the patient. The operation was completed in a total laparoscopic approach and the specimen was extracted through a 3 cm longitudinal incision in the anterior wall of the upper rectum, then interrupted sutures were used for full-thickness closure of the rectal incision. The operative time was 470 min and intra-operative blood loss was 100 mL. The postoperative pathological examination showed pT1bN0M0 gastric adenocarcinoma. The patient developed proctotomy leak on the 10th postoperative day. We analyzed the causes of this rare complication and put forward a series of technical improvements. After failure of conservative treatment, a diverting ileostomy was created and the patient eventually recovered. We successfully prevented proctotomy leak in the subsequent 20 transrectal NOSE gastrectomies using improved techniques. CONCLUSIONS Proctotomy leak after transrectal specimen extraction should be considered among the complications of NOSE surgery and can be prevented by technical precautions.
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Affiliation(s)
- Haipeng Meng
- Department of General Surgery, Cheeloo College of Medicine, Qilu Hospital (Qingdao), Shandong University, 758 Hefei Road, 266035, Qingdao, Shandong, China
| | - Jinchao Liu
- Department of Gastrointestinal Surgery, Zibo Municipal Hospital, 255400, Zibo, Shandong, China
| | - Hui Xu
- Department of Anesthesiology, Zibo Municipal Hospital, 255400, Zibo, Shandong, China
| | - Song Wang
- Department of Gastrointestinal Surgery, Zibo Municipal Hospital, 255400, Zibo, Shandong, China
| | - Yu Rong
- Department of Gastrointestinal Surgery, Zibo Municipal Hospital, 255400, Zibo, Shandong, China
| | - Yanling Xu
- Department of Respiratory Medicine, Cheeloo College of Medicine, Qilu Hospital (Qingdao), Shandong University, 758 Hefei Road, 266035, Qingdao, Shandong, China
| | - Gang Yu
- Department of General Surgery, Cheeloo College of Medicine, Qilu Hospital (Qingdao), Shandong University, 758 Hefei Road, 266035, Qingdao, Shandong, China. .,Department of Gastrointestinal Surgery, Zibo Municipal Hospital, 255400, Zibo, Shandong, China.
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Alshiek J, Marroquin J, Shobeiri SA. Vaginal ultrasound-guided Pouch of Douglas robotic entry in a live ovine model and human female cadaveric specimens. J Robot Surg 2021; 16:73-79. [PMID: 33576913 DOI: 10.1007/s11701-021-01203-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 01/18/2021] [Indexed: 10/22/2022]
Abstract
We aimed to determine whether intraoperative ultrasound is a feasible tool for visualization of the pouch of Douglas (POD) to facilitate a safe vaginal entry for direct robotic vaginal trocar insertion for pelvic floor surgery. Endovaginal ultrasound-guided needle insertion of a trocar into the POD was performed in six fresh frozen female cadavers and a live sheep animal model. Using an endovaginal probe the POD was identified as a fluid-filled space clear of bowel or adhesions, then a Veress needle was also used to confirm POD localization. Access to the POD was achieved using a robotic trocar designed for this purpose. The animal study was approved by the Ethics Committee of Asaf-Harofe hospital. Direct visualization during laparoscopy in cadavers and open cadaveric dissections confirmed safe POD entry and accurate trocar placement. This method was found feasible in the development of a safe vaginal entry in both the animal and cadaveric model, possibly negating the need for laparoscopic umbilical observation.
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Affiliation(s)
- Jonia Alshiek
- Department of Obstetrics and Gynecology, Hillel Yafe Hospital, Hadera, Israel.,Department of Obstetrics and Gynecology, INOVA Women's Hospital, Virginia Commonwealth University, Professor, Biomedical Engineering, George Mason University, 3300 Gallows Road, Second Floor South Tower, Falls Church, VA, 22042-3307, USA.,Department of Bioengineering, George Mason University, Fairfax, VA, USA
| | - Joanna Marroquin
- Department of Obstetrics and Gynecology, INOVA Women's Hospital, Virginia Commonwealth University, Professor, Biomedical Engineering, George Mason University, 3300 Gallows Road, Second Floor South Tower, Falls Church, VA, 22042-3307, USA
| | - S Abbas Shobeiri
- Department of Obstetrics and Gynecology, INOVA Women's Hospital, Virginia Commonwealth University, Professor, Biomedical Engineering, George Mason University, 3300 Gallows Road, Second Floor South Tower, Falls Church, VA, 22042-3307, USA. .,Department of Bioengineering, George Mason University, Fairfax, VA, USA.
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Guan X, Liu Z, Parvaiz A, Longo A, Saklani A, Shafik AA, Cai JC, Ternent C, Chen L, Kayaalp C, Sumer F, Nogueira F, Gao F, Han FH, He QS, Chun HK, Huang CM, Huang HY, Huang R, Jiang ZW, Khan JS, da JM, Pereira C, Nunoo-Mensah JW, Son JT, Kang L, Uehara K, Lan P, Li LP, Liang H, Liu BR, Liu J, Ma D, Shen MY, Islam MR, Samalavicius NE, Pan K, Tsarkov P, Qin XY, Escalante R, Efetov S, Jeong SK, Lee SH, Sun DH, Sun L, Garmanova T, Tian YT, Wang GY, Wang GJ, Wang GR, Wang XQ, Chen WTL, Yong Lee W, Yan S, Yang ZL, Yu G, Yu PW, Zhao D, Zhong YS, Wang JP, Wang XS. International consensus on natural orifice specimen extraction surgery (NOSES) for gastric cancer (2019). Gastroenterol Rep (Oxf) 2020; 8:5-10. [PMID: 32104581 PMCID: PMC7034234 DOI: 10.1093/gastro/goz067] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 11/16/2019] [Accepted: 11/21/2019] [Indexed: 02/06/2023] Open
Abstract
At present, natural orifice specimen extraction surgery (NOSES) has attracted more and more attention worldwide, because of its great advantages including minimal cutaneous trauma and post-operative pain, fast post-operative recovery, short hospital stay, and positive psychological impact. However, NOSES for the treatment of gastric cancer (GC) is still in its infancy, and there is great potential to improve its theoretical system and clinical practice. Especially, several key points including oncological outcomes, bacteriological concerns, indication selection, and standardized surgical procedures are raised with this innovative technique. Therefore, it is necessary to achieve an international consensus to regulate the implementation of GC-NOSES, which is of great significance for healthy and orderly development of NOSES worldwide.
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Affiliation(s)
- Xu Guan
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P. R. China
| | - Zheng Liu
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P. R. China
| | | | - Antonio Longo
- European Center of Coloproctology and Pelvic Diseases-Multimedica Hospital, Milan, Italy
| | - Avanish Saklani
- Department of GI Surgical Oncology, Tata Memorial Hospital, Mumbai, India
| | - Ali A Shafik
- Department of Colorectal Surgery, Cairo University, Cairo, Egypt
| | - Jian-Chun Cai
- Department of Gastrointestinal Surgery, Zhongshan Hospital of Xiamen University, Xiamen, Fujian, P. R. China
| | - Charles Ternent
- Section of Colon and Rectal Surgery, Creighton University School of Medicine, Omaha, NE, USA
| | - Lin Chen
- Department of General Surgery, Chinese People’s Liberation Army General Hospital, Beijing, P. R. China
| | - Cuneyt Kayaalp
- Department of Gastrointestinal Surgery, Inonu University, Malatya, Turkey
| | - Fatih Sumer
- Department of Gastrointestinal Surgery, Inonu University, Malatya, Turkey
| | | | - Feng Gao
- Department of Colorectal Cancer Surgery, the Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, P. R. China
| | - Fang-Hai Han
- Department of Gastroenterological Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P. R. China
| | - Qing-Si He
- Department of General Surgery, Shandong University Qilu Hospital, Jinan, Shandong, P. R. China
| | - Ho-Kyung Chun
- Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Chang-Ming Huang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, P. R. China
| | - Hai-Yang Huang
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P. R. China
| | - Rui Huang
- Department of Colorectal Cancer Surgery, the Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, P. R. China
| | - Zhi-Wei Jiang
- Department of General Surgery, Jiangsu Province Hospital of Traditional Chinese Medicine, Nanjing, Jiangsu, P. R. China
| | - Jim S Khan
- Department of Colorectal Surgery, Portsmouth, Hospitals NHS, Trust, Queen Alexandra Hospital, Portsmouth, UK
| | | | - Costa Pereira
- Department of Surgery, Hospital de Braga, Braga, Portugal
| | | | - Jung Tack Son
- Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Liang Kang
- Department of Colorectal Surgery, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, P. R. China
| | - Keisuke Uehara
- Division of Surgical Oncology, Department of Surgery, Nagoya University School of Medicine, Nagoya, Japan
| | - Ping Lan
- Department of Colorectal Surgery, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, P. R. China
| | - Le-Ping Li
- Department of Gastrointestinal Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, P. R. China
| | - Han Liang
- Department of Gastric Cancer, Tianjin Medical University Cancer Institute & Hospital, Tianjin, P. R. China
| | - Bing-Rong Liu
- Department of Gastroenterology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, P. R. China
| | - Juan Liu
- Department of Obstetrics and Gynecology, Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, P. R. China
| | - Dan Ma
- Department of General Surgery, Xinqiao, Hospital, Third Military Medical University, Chongqing, P. R. China
| | - Ming-Yin Shen
- Department of Surgery, China Medical University Hospital, Taichung, Taiwan, China
| | | | | | - Kai Pan
- Department of Gastrointestinal Surgery, Shenzhen People’s Hospital & Second Clinical Medical College of Jinan University, Shenzhen, Guangdong, P. R. China
| | - Petr Tsarkov
- Clinic of Colorectal and Minimally Invasive Surgery, Sechenov First Moscow State Medical University, Moscow, Russia
| | - Xin-Yu Qin
- Department of General Surgery, Zhongshan, Hospital, Fudan University, Shanghai, P. R. China
| | - Ricardo Escalante
- Universidad Central de Venezuela, Centro, Medico Loira, Caracas, Venezuela
| | - Sergey Efetov
- Colorectal Surgery Department, Sechenov First Moscow State Medical University, Moscow, Russia
| | | | - Suk-Hwan Lee
- Department of Surgery, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, South Korea
| | - Dong-Hui Sun
- Department of Gastric and Colorectal Surgery, Jilin University First Hospital, Changchun, Jilin, P. R. China
| | - Li Sun
- Department of Gynecologic Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P. R. China
| | - Tatiana Garmanova
- Clinic of Colorectal and Minimally Invasive Surgery, Sechenov First Moscow State Medical University, Moscow, Russia
| | - Yan-Tao Tian
- Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P. R. China
| | - Gui-Yu Wang
- Department of Colorectal Cancer Surgery, the Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, P. R. China
| | - Guo-Jun Wang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, P. R. China
| | - Guo-Rong Wang
- Department of General Surgery, Shanxi, Provincial, People’s, Hospital, The, Third Affiliated, Hospital, Medical College, Xi’an Jiao Tong University, Xi’an, Shaanxi, P. R. China
| | - Xiao-Qiang Wang
- Department of General Surgery, Shanxi, Provincial, People’s, Hospital, The, Third Affiliated, Hospital, Medical College, Xi’an Jiao Tong University, Xi’an, Shaanxi, P. R. China
| | | | - Woo Yong Lee
- Department of surgery, Samsung Medical Center, Sungkyunkwan University, Seoul, South Korea
| | - Su Yan
- Department of Gastrointestinal Surgery, Qinghai University Affiliated Hospital, Xining, Qinghai, P. R. China
| | - Zu-Li Yang
- Department of Gastrointestinal Surgery, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, P. R. China
| | - Gang Yu
- Department of General Surgery, Qilu Hospital of Shandong University (Qingdao), Qingdao, Shandong, P. R. China
| | - Pei-Wu Yu
- Department of General Surgery, Center of Minimal Invasive Gastrointestinal Surgery, Southwest, Hospital, Army Medical University (Third Military Medical University), Chongqing, P. R. China
| | - Dan Zhao
- Department of Gynecologic Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P. R. China
| | - Yun-Shi Zhong
- Endoscopy Center and Endoscopy Research Institute, Zhongshan, Hospital, Fudan University, Shanghai, P. R. China
| | - Jian-Ping Wang
- Department of Colorectal Surgery, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, P. R. China
| | - Xi-Shan Wang
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P. R. China
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Sun P, Wang XS, Liu Q, Luan YS, Tian YT. Natural orifice specimen extraction with laparoscopic radical gastrectomy for distal gastric cancer: A case report. World J Clin Cases 2019; 7:4314-4320. [PMID: 31911913 PMCID: PMC6940342 DOI: 10.12998/wjcc.v7.i24.4314] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Revised: 11/11/2019] [Accepted: 11/20/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND This article introduces the surgical method and early experience in performing totally laparoscopic radical gastrectomy with transrectal specimen extraction for gastric cancer, and we evaluate the short-term effects and feasibility of this new procedure for gastric cancer in a 64-year-old male patient. This approach may provide new possibilities for gastric natural orifice specimen extraction (NOSE) surgery. In addition, we believe that this new procedure may further relieve pain, speed up recovery, and cause minimal physiological and psychological impact. CASE SUMMARY We performed NOSE gastrectomy in a male patient. Tumor resection, digestive tract reconstruction, and lymph node dissection were performed totally laparoscopically; the specimen was extracted from the natural orifice of the rectum-anus. This procedure reduced damage to the abdominal wall and decreased postoperative pain. We successfully performed radical gastrectomy without conversion and complications. Total operative time and blood loss were 176 min and 50 mL, respectively. The patient resumed normal activities of daily living on day 1 without pain, and passed flatus within 48 h. Postoperative hospital stay was 10 d. The number of resected lymph nodes was 0/43. During the follow-up, no stricture or anastomotic leakage was detected. Three months postoperatively, colonoscopy showed full recovery of the rectum without stricture or scar contracture. Computed tomography and laboratory test results showed no signs of tumor recurrence. There was no visible scar on the abdominal wall. CONCLUSION It is safe and reliable to perform totally laparoscopic radical gastrectomy with transrectal specimen extraction for distal gastric cancer patients.
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Affiliation(s)
- Peng Sun
- Department of Colorectal Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
- Department of General Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin 150081, Heilongjiang Province, China
| | - Xi-Shan Wang
- Department of Colorectal Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
- Department of General Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin 150081, Heilongjiang Province, China
| | - Qi Liu
- Department of Colorectal Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Yu-Song Luan
- Department of Colorectal Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Yan-Tao Tian
- Department of Pancreatic and Gastric Surgery, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
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Lee B, Choi Y, Cho JY, Yoon YS, Han HS. Laparoscopic segment 4 resection including middle hepatic vein with vaginal extraction of the specimen. Surg Oncol 2019; 32:46-47. [PMID: 31739131 DOI: 10.1016/j.suronc.2019.10.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 10/07/2019] [Accepted: 10/24/2019] [Indexed: 11/17/2022]
Affiliation(s)
- Boram Lee
- Department of Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, South Korea
| | - YoungRok Choi
- Department of Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, South Korea.
| | - Jai Young Cho
- Department of Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, South Korea
| | - Yoo-Seok Yoon
- Department of Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, South Korea
| | - Ho-Seong Han
- Department of Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, South Korea
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Comparison of a Postoperative Pain in Laparoscopy-Assisted Distal Gastrectomy and Totally Laparoscopic Distal Gastrectomy according to the Location of the Mini-Laparotomy Site. THE JOURNAL OF MINIMALLY INVASIVE SURGERY 2019; 22:49-50. [PMID: 35602767 PMCID: PMC8980156 DOI: 10.7602/jmis.2019.22.2.49] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 06/05/2019] [Accepted: 06/05/2019] [Indexed: 11/08/2022]
Abstract
This study compared the postoperative pain associated with the location of the mini-laparotomy sites in gastric cancer patients who underwent a laparoscopic-assisted distal gastrectomy (LADG) or total laparoscopic distal gastrectomy (TLDG). The present study did not observe any benefit for TLDG with a pfannenstiel incision groups in terms of pain, only cosmetic benefits. Therefore, it will be necessary to identify the merits to overcome this problem and broaden the clinical applications in the future.
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16
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Lirici MM, Romeo V, Simonelli L, Tierno S, Vitelli CE. Minimizing the Access Trauma of Laparoscopic Sleeve Gastrectomy: the Transoral Specimen Extraction Technique. Obes Surg 2016; 26:229-33. [PMID: 26475029 DOI: 10.1007/s11695-015-1943-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Laparoscopic sleeve gastrectomy has become a popular stand-alone procedure among bariatric surgeons. Recently, Natural Orifice Specimen Extraction laparoscopic surgery has been introduced to avoid minilaparotomy, possibly reducing postoperative pain, hospital stay, and improving QoL and cosmetics. Operative steps and preliminary results of NOSE sleeve gastrectomy are described and reported. METHODS Five patients underwent NOSE LSG from November 2014 to March 2015. Selection criteria were as follows: age <60 years, ASA score ≤III, BMI <50. Operative steps are the same of standard LSG, but the stomach transection that starts higher on the greater curvature. A 2–3 cm width opening is created on the exceeding antrum and the resected stomach sutured to the calibration probe tip, which is pull back allowing transoral specimen extraction. The exceeding antrum is stapler-trimmed, allowing breach closure and completion of tubulization. RESULTS Mean age was 41.6 years (median 43), average weight was 123.6 Kg (median 114), mean BMI 43.6 Kg/m2 (median 44). Mean operation time was 72 min (median 75). Mean and median postoperative stay were 4.6 and 5. No intraoperative nor postoperative complications occurred. Postoperative day 1 mean and median VAS pain score at were 1.4 and 1, respectively. Follow-up ranged 1–5 months (mean and median 3), average weight loss was 19.8 Kg (median 19), and excess weight loss 36.2 % (median 32 %). CONCLUSIONS NOSE LSG potential advantages are as follows: improved cosmetics, decreased postoperative pain, possible incisional hernia rate reduction. No objective data are available to confirm these theoretical benefits; larger observational studies and RCTs are mandatory before clinical validation.
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Clark LE, Menderes G, Tower AM, Silasi DA, Azodi M. A Simple Approach to Specimen Retrieval via Posterior Colpotomy Incision. JSLS 2016; 19:JSLS.2015.00222. [PMID: 25901107 PMCID: PMC4396057 DOI: 10.4293/jsls.2014.00222] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Introduction: Posterior colpotomy incision for specimen retrieval is infrequently used in gynecologic laparoscopic surgery unless a concomitant hysterectomy is performed. We aim to describe a simple and unique technique for creating the colpotomy incision and to describe intraoperative and postoperative outcomes. Methods: Fifty patients underwent adnexal specimen retrieval through a posterior colpotomy incision. After devascularization and detachment of the adnexal specimen, the posterior cul-de-sac was visualized. The colpotomy incision was created by introducing a 12- or 15-mm laparoscopic trocar through the vagina into the posterior vaginal fornix under direct visualization. Specimens were placed into laparoscopic bags and removed through the vagina. The colpotomy incision was closed vaginally. Charts were reviewed for intraoperative and postoperative outcomes. Results: Twenty-nine women underwent adnexal surgery for an adnexal mass, 14 women underwent surgery for pelvic pain, and 7 women underwent adnexal surgery for primary prevention of malignancy. The specimens removed ranged in size from 2 to 16 cm (mean 5.7). The mean time patients were under anesthesia was 103 minutes (SD 57.3). There were no operative complications related to the colpotomy incision and no cases of postoperative vaginal cellulitis or pelvic infection were reported. Only 1 woman with a prior vaginal delivery reported dyspareunia postoperatively. Conclusion: This simple technique for posterior colpotomy incision can easily be added to the gynecologic surgeon's armamentarium and can be safely used for most women.
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Affiliation(s)
- Lindsay E Clark
- Department of Obstetrics and Gynecology, Bridgeport Hospital, Yale New Haven Health Systems, Bridgeport, CT
| | - Gulden Menderes
- Department of Obstetrics and Gynecology, Bridgeport Hospital, Yale New Haven Health Systems, Bridgeport, CT
| | - Amanda M Tower
- Department of Obstetrics and Gynecology, Bridgeport Hospital, Yale New Haven Health Systems, Bridgeport, CT
| | - Dan-Arin Silasi
- Department of Obstetrics and Gynecology, Bridgeport Hospital, Yale New Haven Health Systems, Bridgeport, CT
| | - Masoud Azodi
- Department of Obstetrics and Gynecology, Bridgeport Hospital, Yale New Haven Health Systems, Bridgeport, CT
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Zhang S, Jiang ZW, Wang G, Feng XB, Liu J, Zhao J, Li JS. Robotic gastrectomy with transvaginal specimen extraction for female gastric cancer patients. World J Gastroenterol 2015; 21:13332-13338. [PMID: 26715817 PMCID: PMC4679766 DOI: 10.3748/wjg.v21.i47.13332] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2015] [Revised: 07/07/2015] [Accepted: 09/14/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To describe the application of complete robotic gastrectomy with transvaginal specimen extraction (TVSE) for gastric cancer patients.
METHODS: Between July and November 2014, eight female patients who were diagnosed with gastric adenocarcinoma underwent a TVSE following a full robot-sewn gastrectomy. According to the tumor location, the patients were allocated to two different groups; two patients received robotic total gastrectomy with TVSE and the other six received robotic distal gastrectomy with TVSE.
RESULTS: Surgical procedures were successfully performed in all eight cases without conversion. The mean age was 55.3 (range, 42-69) years, and the mean body mass index was 23.2 (range, 21.6-26.0) kg/m2. The mean total operative time and blood loss were 224 (range, 200-298) min and 62.5 (range, 50-150) mL, respectively. The mean postoperative hospital stay was 3.6 (range, 3-5) d. The mean number of lymph nodes resected was 23.6 (range, 17-27). None was readmitted within 30 d of postoperation. During the follow-up, no stricture developed nor was any anastomotic leakage detected.
CONCLUSION: It is possible to perform a TVSE following a full robot-sewn gastrectomy with standard D2 lymph node resection for female gastric cancer patients.
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Total laparoscopic subtotal gastrectomy with transvaginal specimen extraction is feasible in advanced gastric cancer. Int J Surg Case Rep 2015; 16:56-8. [PMID: 26413924 PMCID: PMC4643334 DOI: 10.1016/j.ijscr.2015.08.043] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Revised: 08/29/2015] [Accepted: 08/30/2015] [Indexed: 02/07/2023] Open
Abstract
PURPOSE Natural orifice specimen extraction (NOSE) is an ever-evolving advanced laparoscopic technique. NOSE minimizes surgical injury, involving a low risk of wound complications, fewer incisional hernias, faster recovery and less postoperative pain. Laparoscopic gastrectomy combined with NOSE is a procedure that can potentiate the advantages of both minimal invasive techniques. We aim to demonstrate the feasibility of laparoscopic subtotal gastrectomy with transvaginal specimen extraction in advanced gastric cancer. CASE A 72-year-old woman with a 2cm adenocarcinoma in gastric antrum was treated by laparoscopic subtotal gastrectomy and lymph node dissection. A totally laparoscopic Roux-en-Y gastrojejunostomy was constructed. Specimen was extracted through the posterior fornix of vagina without difficulty. Histopathology confirmed pT3pN0 tumor. After a 10-month follow-up the patient was asymptomatic and getting adjuvant chemoradiotherapy. CONCLUSIONS Transvaginal specimen extraction after laparoscopic gastric resection for advanced gastric cancer is a feasible procedure. It is offered to selected patients and of course only to female patients. Natural orifice surgery may provide faster recovery and decrease the wound related complications which may cause a delay on postoperative adjuvant chemo-radio therapies. We have presented, as far as we know, the first human case of a transvaginal extraction of an advanced gastric cancer after laparoscopic gastrectomy.
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Sagae UE, Orso IRB, Matsumoto HM, Herman P. Scarless hepatectomy: natural orifice specimen extraction after left lateral sectionectomy. ABCD-ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA 2015; 27:291-3. [PMID: 25626942 PMCID: PMC4743225 DOI: 10.1590/s0102-67202014000400015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Accepted: 09/16/2014] [Indexed: 01/22/2023]
Abstract
BACKGROUND The use of laparoscopy in liver surgery is well established and considered as the gold standard for small resections. The laparoscopic resections have lower morbidity and better cosmetic results, but still require an incision to remove the surgical specimen. The possibility of remove the specimen through natural orifices and avoid an abdominal incision may further improve the benefits offered by minimally invasive procedures. AIM To describe the technique of transvaginal extraction of the specimen after laparoscopic liver left lateral sectionectomy. METHOD The laparoscopic liver resection is performed in a standard fashion. After completing the resection, the specimen is placed into a retrieval plastic bag. To perform de extraction, a vaginal colpotomy is performed, guided by a 12 mm trocar introduced through the vagina. Then the extraction bag is removed pulling the bag through the extended incision in the posterior wall of the vagina. After the extraction, the colpotomy incision is closed laparoscopically. RESULTS This technique was performed in a 74-year-old woman with a 3 cm lesion between liver segments 2 and 3. She had a fast and uneventful recovery. CONCLUSION This technique appears to be feasible, safe and avoid the complications of an abdominal incision.
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Affiliation(s)
| | | | | | - Paulo Herman
- Faculdade de Medicina, Universidade de São Paulo
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Antonakis PT, Ashrafian H, Isla AM. Laparoscopic gastric surgery for cancer: Where do we stand? World J Gastroenterol 2014; 20:14280-14291. [PMID: 25339815 PMCID: PMC4202357 DOI: 10.3748/wjg.v20.i39.14280] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Revised: 03/06/2014] [Accepted: 05/29/2014] [Indexed: 02/07/2023] Open
Abstract
Gastric cancer poses a significant public health problem, especially in the Far East, due to its high incidence in these areas. Surgical treatment and guidelines have been markedly different in the West, but nowadays this debate is apparently coming to an end. Laparoscopic surgery has been employed in the surgical treatment of gastric cancer for two decades now, but with controversies about the extent of resection and lymphadenectomy. Despite these difficulties, the apparent advantages of the laparoscopic approach helped its implementation in early stage and distal gastric cancer, with an increase on the uptake for distal gastrectomy for more advanced disease and total gastrectomy. Nevertheless, there is no conclusive evidence about the laparoscopic approach yet. In this review article we present and analyse the current status of laparoscopic surgery in the treatment of gastric cancer.
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Laparoscopic gastric resection with natural orifice specimen extraction for postulcer pyloric stenosis. Wideochir Inne Tech Maloinwazyjne 2014; 9:282-5. [PMID: 25097701 PMCID: PMC4105667 DOI: 10.5114/wiitm.2014.41622] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2013] [Revised: 10/28/2013] [Accepted: 11/05/2013] [Indexed: 12/21/2022] Open
Abstract
Although natural orifice specimen extraction is now relatively widely performed, there have been no reports on gastric resection with specimen extraction through the transgastric route for peptic ulcer disease. A hybrid technique of the laparoscopic and endoscopic approach is presented in the case of a 58-year old male patient. Preoperative gastric fibroscopy showed postulcer pyloric and antral stenosis. Laparoscopic exploration confirmed gastric enlargement. Laparoscopic two-thirds gastrectomy was performed. The staple line suture of the residual stomach was excised and the specimen was extracted through the esophagus and mouth with a gastroscope. Finally, the residual stomach was closed again using linear endostaplers. Reconstruction was performed according to the Roux-en-Y method. Gastric resection using natural orifice specimen extraction (NOSE) may be a feasible operative procedure. The NOSE with the combination of standard laparoscopy and specimen extraction through a natural orifice can be considered as a bridge to natural orifice translumenal endoscopic surgery.
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Uccella S, Cromi A, Bogani G, Casarin J, Serati M, Ghezzi F. Transvaginal Specimen Extraction at Laparoscopy Without Concomitant Hysterectomy: Our Experience and Systematic Review of the Literature. J Minim Invasive Gynecol 2013; 20:583-90. [PMID: 23623269 DOI: 10.1016/j.jmig.2013.02.022] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Revised: 02/20/2013] [Accepted: 02/21/2013] [Indexed: 01/31/2023]
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Abstract
Rather than being an end point in and of itself, NOTES offers an approach that encompasses the potential use of a natural orifice in conjunction with flexible instruments as a less invasive and more cosmetically appealing method of performing certain surgical procedures. Gastric surgery through natural orifices is one of the cutting-edge procedures in the evolving field of NOTES. The potential indications for NOTES involve a wide spectrum of upper gastrointestinal diseases, including achalasia, reflux disease, submucosal tumors, cancer, and morbid obesity. Although NOTES is becoming more widely used, most studies still involve only small numbers of patients, and the design of larger series and comparative trials to evaluate the early indications and results of NOTES is needed.
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Laparoscopic hybrid NOTES liver resection for metastatic colorectal cancer. Surg Laparosc Endosc Percutan Tech 2012; 22:e5-7. [PMID: 22318081 DOI: 10.1097/sle.0b013e31823f7596] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Abdominal wound extraction site continues to be a major source of morbidity after laparoscopic-assisted surgery. METHODS A 59-year-old African American woman with a past history of T3N2M1 colon cancer, who underwent laparoscopic sigmoid colectomy and wedge liver resection (segment IV A) followed by adjuvant chemotherapy was our subject for this study. Twelve months later, she was found to have a positron emission tomography positive liver lesion of 6.5 cm at the left lateral liver segment. A combined laparoscopic-transvaginal approach was used. Four 5-mm trocars were used. The liver parenchyma was divided using the harmonic scalpel, whereas the left hepatic vein was transected using the laparoscopic transvaginal vascular stapler. The specimen was placed in an endobag and extracted transvaginally. The specimen size was 14×8×3.5 cm and that of the lesion was 6.5×5.7×4 cm. The patient was discharged on postoperative day 2. RESULTS Operative time was 120 minutes and blood loss was minimal. The patient was discharged on postoperative day 2. No postoperative complications were found after 30 days. CONCLUSIONS Laparoscopic-assisted natural orifice transluminal endoscopic surgery results in quicker recovery, less postoperative pain, and potential wound-related complications. This technique is safe and effective with excellent aesthetic results. (Video, Supplemental Digital Content 1, http://links.lww.com/SLE/A54).
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