Department of General and Oncologic Surgery, City of Hope National Medical Center, 1500 East Duarte Road, Duarte, CA 91010-3000, USA.
Surg Endosc. 2010 Aug;24(8):2048-52. doi: 10.1007/s00464-009-0870-z. Epub 2010 Jan 28.
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.
开腹和腹腔镜结肠切除术相关的早期和迟发性伤口并发症持续存在，是一个重大的健康负担。此外，随着对经自然腔道内镜外科（NOTES）的兴趣不断增加，桥接技术可能有助于减轻与NOTES 相关的学习曲线。作者介绍了他们在 4 例患者中应用的经阴道标本取出的完全腹腔镜右半结肠切除术的技术和短期结果。
根据机构审查委员会批准的方案，对前瞻性维持的腹腔镜结肠切除术数据库中的 4 例连续患者进行分析。回顾了临床病理特征和短期结果。
所有患者均为无盆腔手术史的女性。2 例因癌症和 2 例因腺瘤性息肉进行了四孔腹腔镜右半结肠切除术和腔内吻合术。所有病例均可行经阴道取出。平均手术时间为 212.25 分钟。无患者发生与阴道切开术相关的并发症；也没有患者在术后阴道取出部位出现疼痛或引流。中位住院时间为 4.5 天。1 例患者发生与取出部位无关的肠梗阻。标本平均长度为 27cm，平均淋巴结检出数为 15.75 个。
经阴道取出的完全腹腔镜右半结肠切除术似乎是安全可行的。该技术既可以提供一种减少腹壁发病率的有吸引力的方法，也可以作为NOTES 结肠手术的桥梁。
