Abstract:
Background: Natural orifice specimen extraction is a laparoscopic
technique that reduces the procedure’s invasiveness.
Objective: We aimed to examine all the available data for the
transvaginal extraction of laparoscopic right-sided colonic
resections.
Data Sources: A systematic search was conducted using PubMed/
MEDLINE, Cochrane, Google Scholar, EBSCO, clinicaltrials.gov,
and congress abstract databases.
Study Selection: All case-control series, case series, and case reports
were included, irrespective of age, region, race, obesity, comorbidities,
or history of previous surgery. No restrictions were made
in terms of language, country, or journal.
Main Outcome Measures: Patient selection criteria and results of
the cumulative data.
Results: The search identified 10 studies including 90 cases. Most
patients were elderly (mean, 65.9; range, 29 to 87 y) and had
comorbid diseases (96%). 33.8% had a history of abdominopelvic
surgery. The mean body mass index was 25.7 kg/m2 (range, 18 to
50 kg/m2
). Most patients (83%) had malign or premalign (14%)
diseases and required regular or extended right hemicolectomies
(99%). The mean operating time and blood loss ranges were 193
(140 to 471) minutes and 62.4 (0 to 300) mL, respectively. Overall,
morbidities were seen in 18 patients (20%), and 3 of them were
related to the transvaginal extraction. There were no abdominal
wound related early or late complications. When compared with
laparoscopic colon resections with transabdominal extraction, the
procedure seems to result in decreased postoperative pain and
length of hospital stay.
Limitations: There are a limited number of comparative studies and
an absence of randomized studies.
Conclusions: Laparoscopic resection and transvaginal specimen
extraction is a promising technique for some right-sided colon
pathologies. For patient selection, an accessible vaginal port
(patient acceptance and a vagina that is not narrow) and an enmass
lesion of r8 cm were necessary. Malignancy, previous
abdominopelvic surgery, obesity, and old age were not considered
as contraindications.
