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Transvaginal Extraction: Feasible. Howard Ross, MD, FACS, FASCRS Chief, Colon and Rectal Surgery Riverview Medical Center Clinical Associate Professor of Surgery UMDNJ. Disclosures. Consultant and Course Director: Applied Medical Covidien Woke at 4 am to watch royal wedding.

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Transvaginal Extraction: Feasible


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slide1

Transvaginal Extraction: Feasible

Howard Ross, MD, FACS, FASCRS

Chief, Colon and Rectal Surgery

Riverview Medical Center

Clinical Associate Professor of Surgery UMDNJ

disclosures
Disclosures

Consultant and Course Director:

Applied Medical

Covidien

Woke at 4 am to watch royal wedding

published results
Published Results
  • Studies Small
  • Selected patients
  • As of February 2011:
    • 23 articles
    • 130 patients
  • Complications Related to Transvaginal Extraction
    • Rectovaginal fistula
    • Pelvic Seroma

Diana M, Perretta S, Wall J, Costantino FA, Leroy J, Demartines N, Marescaux

J. Colorectal Dis. 2011 Jun;13(6):e104-11.

slide8
An Innovative Technique for ColorectalSpecimen Retrieval: A New Eraof “Natural Orifice Specimen Extraction”(N.O.S.E)
  • Laparoscopic restorative proctocolectomy
  • 7 patients 2004-2007
  • Familial adenomatous polyposis with cancer
  • Posterior vaginal vault was opened with an ultracision shears, endobag placed in the vagina
    • All vaginal wounds healed
    • No vaginal metastasis
    • 1 DVT, 1 anastamotic leak

Palanivelu C, Rangarajan M, Jategaonkar PA, Anand NV.

Dis Colon Rectum. 2008 Jul;51(7):1120-4. Epub 2008 May 15.

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Transvaginal Extraction of the Specimen After TotalLaparoscopic Right Hemicolectomy WithIntracorporeal Anastomosis
  • First US report
  • 88 yr old woman, 4 cm cecal cancer
  • 3-cm transvaginal posterior colpotomy
  • No complications

Franklin ME Jr, Kelley H, Kelley M, Brestan L, Portillo G, Torres J

Surg Laparosc Endosc PercutanTech. 2008 Jun;18(3):294-8.

case controlled study
Case Controlled Study

Laparoscopic Right Colectomy

vs.

Laparoscopic R Colectomy with natural orifice specimen extraction (NOSE)

  • 34 Patients Each Group
  • NOSE patients less pain POD 1 and POD 3 (0.01)
    • Visual analogue and blinded observer
  • Improved Cosmesis
  • No morbidity difference

J. S. Park, G.-S. Choi, H. J. Kim, S. Y. Park and S. H. Jun

British Journal of Surgery 2011; 98: 710–715

for discussion
For Discussion
  • Patient Selection
  • Process to begin
    • IRB, Ethics
  • Who should try?