Laparoscopic right colon resection with transvaginal extraction

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.