Totally laparoscopic right colectomy with transvaginal specimen extraction: the authors' initial institutional experience
Totally laparoscopic right colectomy with transvaginal specimen extraction: the authors' initial institutional experience
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DOI：
10.1007/s00464-009-0870-z
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发表时间：
2010-08-01
影响因子：
3.1
通讯作者：
Pigazzi, Alessio
中科院分区：
文献类型：
--
作者：
McKenzie, Shaun;Baek, Jeong-Heum;Pigazzi, Alessio
与开腹和腹腔镜结肠切除术相关的早期和延迟伤口并发症的持续存在仍然是一个重大的健康负担。此外，随着对自然腔道经腔内镜手术（NOTES）的兴趣持续增长，桥接技术可能有助于减弱与NOTES相关的学习曲线。作者介绍了他们的技术和短期结果，完全腹腔镜右结肠切除术与经阴道标本提取在一系列的四个病人。四个连续的病人从前瞻性维护腹腔镜结肠切除术数据库进行了分析，根据机构审查委员会批准的协议。所有患者均为既往无盆腔手术史的女性，对其临床病理特征和近期疗效进行回顾性分析。在两例癌症和两例腺瘤性息肉患者中，进行了四套管腹腔镜右结肠切除术和结肠内吻合术。所有病例均可经阴道取出。平均手术时间为212.25分钟。没有患者发生阴道切开术相关并发症;也没有患者术后疼痛或拔牙部位引流。平均住院时间为4.5天。1例患者发生了与拔牙部位无关的肠梗阻。平均标本长度27 cm，平均淋巴结清扫数15.75个。完全腹腔镜右半结肠切除术联合经阴道淋巴结清扫术是安全可行的。这项技术可以提供一个有吸引力的方式，以减少腹壁发病率和桥梁，以NOTES结肠手术。
The persistence of early and delayed wound complications related to both open and laparoscopic colectomy remains a significant health burden. Furthermore, as interest in natural orifice translumenal endosurgery (NOTES) continues to grow, bridging techniques may help to attenuate the learning curve associated with NOTES. The authors present their technique and short-term outcomes for totally laparoscopic right colectomy with transvaginal specimen extraction in a series of four patients.Four consecutive patients from a prospectively maintained laparoscopic colectomy database were analyzed under an institutional review board-approved protocol. Clinicopathologic characteristics and short-term outcomes were reviewed.All the patients were women with no prior pelvic surgery. A four-trocar laparoscopic right colectomy with intracorporeal anastomosis was performed for cancer in two cases and for adenomatous polyp in two cases. Transvaginal extraction was possible in all cases. The average operating room time was 212.25 min. No patient experienced complications associated with the colpotomy; nor did any patient have pain or drainage from the extraction site postoperatively. The median hospital stay was 4.5 days. One patient experienced a bowel obstruction unrelated to the extraction site. The mean specimen length was 27 cm, and the mean number of lymph nodes retrieved was 15.75.Totally laparoscopic right colectomy with transvaginal extraction appears to be safe and feasible. This technique may provide both an attractive way to reduce abdominal wall morbidity and a bridge to NOTES colon surgery.