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Disclosures Consultant and Course Director: Applied Medical Covidien Woke at 4 am to watch royal wedding
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Transvaginal Extraction: Feasible
Howard Ross, MD, FACS, FASCRSChief, Colon and Rectal Surgery
Riverview Medical CenterClinical Associate Professor of Surgery UMDNJ
Disclosures• Consultant
and Course Director:– Applied
Medical– Covidien
• Woke at 4 am to watch royal wedding
Natural Orifice Surgery
50% of Population Have a Vagina
Transvaginal Extraction
Transvaginal Extraction
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, MarescauxJ. Colorectal Dis. 2011 Jun;13(6):e104-11.
An Innovative Technique for ColorectalSpecimen Retrieval: A New Era
of “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.
Transvaginal Extraction of the Specimen After TotalLaparoscopic Right Hemicolectomy With
Intracorporeal 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 ReportsLead Author
Country Op Type Disease n Complication Year
Dozois USA JPouch Vag hys
FAP 1 None 2008
Garcia Florez
Spain LAR RSO(Alexis ring)
Colon Ca 1 None 2010
McKenzie (Pigazzi)
USA R Colectomy
2 Cancer2 polyp
4 None (sbo unrelated)
2010
Park S Korea R colectomy
Colon Ca 14 2 aborted extractions d/t colpotomy issues
2010
Case Controlled StudyLaparoscopic 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. JunBritish Journal of Surgery 2011; 98: 710–715
Trans-Vaginal Extraction
For Discussion
• Patient Selection• Process to begin
– IRB, Ethics• Who should try?