Department of Surgery, Institute of Gastroenterology, Nagaoka Chuo General Hospital, 2041 Kawasaki-cho, Nagaoka, Niigata, 940-8653, Japan.
Tech Coloproctol. 2022 Sep;26(9):755-760. doi: 10.1007/s10151-022-02636-7. Epub 2022 May 23.
Natural orifice specimen extraction (NOSE) has been developed as a means of decreasing the incidence of surgical wound complications. We refined the procedure for totally laparoscopic colectomy with transvaginal specimen extraction using the reduced port surgery technique with the ultimate goal of attenuating damage to the abdominal wall. We herein report this innovative technique and its short- and long-term outcomes.
We prospectively collected data on seven patients who underwent totally laparoscopic colectomy using transvaginal specimen extraction with a 10-mm-long abdominal incision for right-sided colon cancer from January 2014 to December 2021. Two 5-mm ports were used in the procedure without laparotomy. Transverse transabdominal posterior colpotomy was then performed. We introduced a GelPOINT Mini advanced access platform (Applied Medical, Rancho Santa Margarita, CA, USA) into the transvaginal route for the insertion of a laparoscope, forceps, and stapling device. Lymph node dissection and transection of the ileum and distal colon were performed with transvaginal assistance. A specimen was then extracted transvaginally. Intracorporeal functional end-to-end anastomosis was conducted using a linear stapler through the vagina. After the removal of GelPOINT Mini, the vaginal incision was closed transvaginally.
Seven patients successfully underwent this procedure. Median operative time was 219 min (range 174-255 min), median blood loss was 23 ml (range 10-37 ml), median number of harvested lymph nodes was 21 (range 17-35 lymph nodes) and median margins were 17.0 cm (range 9.0-25.0 cm) for the proximal margin and 9.5 cm (range 5.0-13.0 cm) for the distal margin. There were no complications more severe than Clavien-Dindo Grade II and there was no mortality. The median frequency of use intravenous analgesics from postoperative day 1 to discharge was once. Two patients did not require analgesics. A node-positive patient developed recurrence at the lung and paraaortic lymph nodes.
This procedure 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。我们使用微创端口手术技术对经阴道标本提取的全腹腔镜结肠切除术进行了改进，最终目的是减轻腹壁损伤。本文报告了这一创新技术及其短期和长期结果。
我们前瞻性收集了 2014 年 1 月至 2021 年 12 月期间 7 例接受经阴道标本提取的全腹腔镜右半结肠癌切除术患者的数据。该手术仅使用 2 个 5mm 端口，无需剖腹。然后进行横向经腹后阴道切开术。我们将 GelPOINT Mini 高级通道平台（Applied Medical，Rancho Santa Margarita，CA，USA）引入经阴道途径，用于插入腹腔镜、夹具和吻合器。经阴道辅助进行淋巴结清扫和回肠及远端结肠横断。然后经阴道提取标本。通过阴道插入直线吻合器进行腔内功能性端端吻合。移除 GelPOINT Mini 后，经阴道关闭阴道切口。
7 例患者成功完成了该手术。中位手术时间为 219 分钟（范围 174-255 分钟），中位出血量为 23 毫升（范围 10-37 毫升），中位采集的淋巴结数为 21 个（范围 17-35 个淋巴结），近端切缘中位距离为 17.0cm（范围 9.0-25.0cm），远端切缘中位距离为 9.5cm（范围 5.0-13.0cm）。无严重程度超过 Clavien-Dindo Ⅱ级的并发症，无死亡病例。从术后第 1 天到出院，中位静脉内镇痛药物使用频率为 1 次。2 例患者无需镇痛药物。1 例淋巴结阳性患者出现肺和腹主动脉旁淋巴结复发。
对于选定病例，该手术似乎是可行、安全和肿瘤学上可接受的。
