gms | German Medical Science

Introduction: The aim of the single incision laparoscopic (SIL) colectomy is the reduction of the surgical trauma. Since dissection can be carried out through a small incision, specimen retrieval finally requires enlargement of the surgical orifice to minimize the squeezing of the speciment. Hybrid techniques combining the transvaginal or the transanal approach were already described. Herein we report on our experience and considerations of specimen retrieval utilizing three different routes using a strong retrieval bag.

Materials and methods: Small skin incisions in 130 transumbilical SIL colorectal resections did not allow specimen retrieval without enlargement of the incision. As an alternative we used the transvaginal (2 patients) and transrectal (2 patients) route, respectively. Intra- and postoperative complications, pain (VAS, medication) and patient´s satisfaction were evaluated. A strong bag was used for retrieval the speciment and collecting the fluid, squeezed out by harvesting the colonic segments.

Results: Changing the retrieval site from the navel to the vagina or the anus requires additional technical support. This adds more than 20 minutes to the overall procedural time. No perioperative complication was observed. However, patients report on almost no pain after the transvaginal or transrectal approach. Squeezing of the specimen at any site is of no concern since all colonic segments are harvested within a strong retrieval bag. The collected fluids show the appearance of inflammatory and tumor cells.

Conclusion: Depending on the size of specimen and gender of the patient the retrieval is feasible through the umbilicus, the vagina or the rectum. Pros and Cons are under debate. Most important is the harvesting of the speciment within a retrieval bag.