Department of Surgery, Institute of Gastroenterology, Nagaoka Chuo General Hospital, 2041 Kawasaki-cho, Nagaoka, Niigata, 940-8653, Japan,
Surg Endosc. 2013 Dec;27(12):4734-40. doi: 10.1007/s00464-013-3120-3. Epub 2013 Aug 16.
Natural orifice specimen extraction (NOSE) has been developed as a means of decreasing the incidence of surgical wound complications. However, NOSE performed using a conventional multiport technique has been reported previously. The current authors performed totally laparoscopic anterior resection with transvaginal specimen extraction (TVSE) using the reduced-port surgery (RPS) technique. The Alexis wound retractor (Applied Medical, Rancho Santa Margarita, CA, USA) and Free Access (Top Corporation, Tokyo, Japan) were attached to the transvaginal route for transvaginal assistance and smooth specimen extraction. The authors documented this simple and safe technique and its short-term results.
Data were prospectively collected for five patients who underwent totally laparoscopic anterior resection with TVSE for colorectal cancer between June 2012 and December 2012. A multiport access device (GelPOINT advanced-access platform; Applied Medical) was inserted into the navel, and a 5-mm port was inserted into the right lower quadrant to be used as a drain site. Transverse transvaginal posterior colpotomy then was performed. One ring of an Alexis ring pair was inserted into the peritoneal cavity through the vagina. The other white ring was placed outside of the vagina and then covered with a Free Access to maintain the pneumoperitoneum for insertion of a 12-mm port. Lymph node dissection and transection of the distal colon were performed with transvaginal assistance. The specimen then was extracted transvaginally. After the Alexis had been removed, the vaginal incision was closed transvaginally. End-to-end colorectal anastomosis was performed using the double-stapling technique.
Transvaginal extraction was completed in all five cases. The median operation time was 235 min. One case was complicated by chyloperitoneum. The median hospital stay was 6 days. Only one patient required intravenous analgesics once on postoperative day 1. All the patients remained disease free.
Totally laparoscopic anterior resection using TVSE with RPS appears to be feasible, safe, and oncologically acceptable for selected cases.
自然腔道标本提取（NOSE）已被开发为降低手术切口并发症发生率的一种手段。然而，以前已经报道过使用传统多孔技术进行的 NOSE。目前的作者使用经阴道标本提取（TVSE）的完全腹腔镜前切除术（RPS）技术进行了完全腹腔镜前切除术。 Alexis 伤口牵开器（Applied Medical，Rancho Santa Margarita，CA，USA）和 Free Access（Top Corporation，Tokyo，Japan）连接到经阴道途径，用于经阴道辅助和顺利提取标本。作者记录了这种简单而安全的技术及其短期结果。
2012 年 6 月至 2012 年 12 月期间，对 5 例接受 TVSE 治疗结直肠癌的完全腹腔镜前切除术患者的数据进行了前瞻性收集。将多端口接入设备（GelPOINT 高级接入平台；Applied Medical）插入脐部，在右下象限插入 5mm 端口，用作引流部位。然后进行横向经阴道后阴道切开术。 Alexis 环对的一个环被插入阴道内的腹腔。另一个白色环放在阴道外，然后用 Free Access 覆盖，以维持气腹，插入 12mm 端口。在经阴道辅助下进行淋巴结清扫和远端结肠横断。然后经阴道提取标本。 Alexis 取出后，阴道切口经阴道关闭。使用双吻合器技术进行端端结直肠吻合术。
所有 5 例均完成经阴道提取。中位手术时间为 235 分钟。1 例并发乳糜腹。中位住院时间为 6 天。只有 1 例患者在术后第 1 天需要静脉内镇痛一次。所有患者均无疾病残留。
对于选定的病例，使用 RPS 的 TVSE 进行完全腹腔镜前切除术似乎是可行的、安全的和肿瘤学上可接受的。
