Onur BAYRAKTAR, Eren ESEN, Fuat Barış BENGÜR, İlknur ERENLER BAYRAKTAR, Erman AYTAÇ, İsmail Ahmet BİLGİN, Bilgi BACA, Mete GÜNGÖR, Tayfun KARAHASANOĞLU, İsmail HAMZAOĞLU

MİNİMAL İNVAZİV KOLOREKTAL CERRAHİDE TRANSVAJİNAL SPESİMEN EKSTRAKSİYONU: ÜÇÜNCÜ BASAMAK BİR HASTANEDE İLK DENEYİM

Amaç: Bu çalışmanın amacı, ekibimizin laparoskopik ya da robotik kolorektal rezeksiyon sonrasında transvajinal spesimen çıkartma ile ilgili ilk deneyimini sunmaktır.Hastalar ve yöntem: Ocak 2010-Nisan 2015 tarihleri arasında, robotik veya laparoskopik kolorektal rezeksiyon sonrası transvajinal olarak rezeksiyon örneği çıkarılmış on kadın hasta, kısa ve orta dönem ameliyat sonrası sonuçları açısından değerlendirildi.Bulgular: 10 olgu dahil edildi. Operasyonlar, robotik rektal kanser rezeksiyonu n=6 , transvers kolon tümör için laparoskopik total kolektomi n = 1 , Crohn hastalığı için tek port laparoskopik transumbilikal sağ kolektomi n = 1 , endometriyozis için laparoskopik rektal rezeksiyon n = 2 idi. Bir hastada postoperatif 7. günde vajinal kanama görüldü, vajinal tampon ile kanama kontrolü sağlandı. Bir hastada üriner enfeksiyon görüldü, antibiyoterapi ile tedavisi sağlandı. Postoperatif medyan hastanede kalış süresi 5 gündü. Mortalite gözlenmedi.Sonuç: Kolorektal rezeksiyondan sonra transvajinal spesimen çıkartma yapılabilir ve bu yolla ilave cilt insizyonu ve buna bağlı potansiyel komplikasyonlar önlenebilir

Transvaginal Specimen Extraction In Minimally Invasive Colorectal Resections: Initial Experience of a Tertiary Referral Hospital

Purpose: The aim of the present this study is to present the initial experience of a single team on specimen extraction from the vagina after laparoscopic or robotic colorectal resections.Patients and methods: Between January 2010 and April 2015, ten female patients whose resection specimens had been extracted transvaginally after robotic or laparosopic colorectal resections were evaluated in terms of short and mid term postoperative outcomes. Results: 10 cases were included. The operations were robotic rectal resections for cancer n=6 , laparoscopic total colectomy for transverse colon tumor n=1 , single port laparoscopic transumbilical right colectomy for Crohn’s disease n=1 , laparoscopic rectal resection for endometriosis n=2 . In one patient, a vaginal bleeding occurred on postoperative day 7 and a vaginal tampon was inserted and the bleeding was stopped. One patient had a urinary tract infection, it was treated with proper antibiotic therapy. The median postoperative hospital stay was 5 days. No mortality occurred.Conclusion: Transvaginal specimen extraction is feasible after colorectal resection and could prevent additional skin incision and its potential complications

Keywords:

Transvaginal specimen extraction, natural orifice specimen extraction, minimally invasive surgery, laparoscopic colorectal surgery, robotic surgery,

PDF

___

Jacobs M, Verdeja JC, Goldstein HD. Minimally invasive colon resection. Surg Laparosc Endosc 1991;1:144-50.

Zorron R. Natural orifice surgery applied for colorectal disease. World J Gastrointest Surg 2010;2:35-8. [CrossRef]

Chukwumah C, Zorron R, Marks JM, Ponsky JL. Current status of natural orifice translumenal endoscopic surgery (NOTES). Curr Probl Surg 2010;47:630-68. [CrossRef]

Palanivelu C, Rangarajan M, Jategaonkar PA, Anand NV. An innovative technique for colorectal specimen retrieval: a new era of “natural orifice specimen extraction” (N.O.S.E). Dis Colon Rectum. 2008;51:1120-4. [CrossRef]

Ooi BS, Quah HM, Fu CW, Eu KW. Laparoscopic high anterior resection with natural orifice specimen extraction (NOSE) for early rectal cancer. Tech Coloproctol. 2009;13:61-4. [CrossRef]

Karahasanoglu T, Hamzaoglu I, Baca B, Aytac E, Kirbiyik E. Impact of increased body mass index on laparoscopic surgery for rectal cancer. Eur Surg Res 2011;46:87-93. [CrossRef]

Karahasanoglu T, Hamzaoglu I, Baca B, Aytac E, Erguner I, Uras C. Robotic surgery for rectal cancer: Initial experience from 30 consecutive patients. J Gastrointestinal Surg 2011 2012;16:401-7. [CrossRef]

Karahasanoglu T, Hamzaoglu I, Aytac E, Baca B. Transvaginal assisted totally laparoscopic single-port right colectomy. J Laparoendosc Adv Surg Tech A. 2011;21:255-7. [CrossRef]

Hamzaoglu I, Karahasanoglu T, Baca B, Karatas A, Aytac E, Kahya AS. Single -port laparoscopic sphincter-saving mesorectal excision for rectal cancer: report of the first 4 human cases. Arch Surg 2011;146:75-81. [CrossRef]

Chapter in book 4: Bowers SP, Hunter JG. Contraindications to Laparoscopy. In Whelan RL, Fleshman JW, Fowler DL, eds. The SAGES Manual of Perioperative Care in Minimally Invasive Surgery (Whelan, the Sages Manual) New York: Springer, 2006 pp 25-32.

Lacy AM, García-Valdecasas JC, Delgado S, Castells A, Taurá P, Piqué JM et al. Laparoscopy-assisted colectomy versus open colectomy for treatment of non-metastatic colon cancer: a randomised trial. Lancet 2002;359:2224-9. [CrossRef]

Mamazza J, Schlachta CM, Seshadri PA, Cadeddu MO, Poulin EC. Needlescopic surgery. A logical evolution from conventional laparoscopic surgery. Surg Endosc 2001;15:1208-12. [CrossRef]

Zornig C, Emmermann A, von Waldenfels HA, Felixmuller C. Colpotomy for specimen removal in laparoscopic surgery. Chirurg 1994;65:883–5.

Ghezzi F, Raio L, Mueller MD, Gyr T, Buttarelli M, Franchi M. Vaginal extraction of the pelvic masses following operative laparoscopy. Surg Endosc 2002;16:1691-6. [CrossRef]

Boni L, Tenconi S, Beretta P, Cromi A, Dionigi G, Rovera F et al. Laparoscopic colorectal resections with transvaginal specimen extraction for severe endometriosis. Surg Oncol 2007;16:5157-60. [CrossRef]

Ihedioha U, Mackay G, Leung E, Molloy RG, O’Dwyer PJ. Laparoscopic colorectal resection does not reduce incisional hernia rates when compared with open colorectal resection. Surg Endosc 2008;22:689- 92. [CrossRef]

Winslow ER, Fleshman JW, Birnbaum EH, Brunt LM. Wound complications of laparoscopic vs open colectomy. Surg Endosc 2002;16:1420-5. [CrossRef]