Transvaginal Extraction: Feasible

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Disclosures Consultant and Course Director: Applied Medical Covidien Woke at 4 am to watch royal wedding

Transcript of Transvaginal Extraction: Feasible

  • Transvaginal Extraction: FeasibleHoward Ross, MD, FACS, FASCRSChief, Colon and Rectal SurgeryRiverview Medical CenterClinical Associate Professor of Surgery UMDNJ

  • DisclosuresConsultant and Course Director:Applied MedicalCovidienWoke at 4 am to watch royal wedding

  • Natural Orifice Surgery

  • 50% of Population Have a Vagina

  • Transvaginal Extraction

  • Transvaginal Extraction

  • Published ResultsStudies SmallSelected patientsAs of February 2011:23 articles130 patientsComplications Related to Transvaginal ExtractionRectovaginal fistulaPelvic 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 Eraof Natural Orifice Specimen Extraction(N.O.S.E)Laparoscopic restorative proctocolectomy 7 patients 2004-2007Familial adenomatous polyposis with cancerPosterior vaginal vault was opened with an ultracision shears, endobag placed in the vaginaAll vaginal wounds healedNo vaginal metastasis1 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 WithIntracorporeal AnastomosisFirst US report88 yr old woman, 4 cm cecal cancer3-cm transvaginal posterior colpotomyNo 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 Reports

    Lead AuthorCountryOp TypeDiseasenComplicationYearDozoisUSAJPouch Vag hysFAP1None2008Garcia FlorezSpainLAR RSO(Alexis ring)Colon Ca1None2010McKenzie (Pigazzi)USAR Colectomy2 Cancer2 polyp4None (sbo unrelated)2010ParkS KoreaR colectomyColon Ca142 aborted extractions d/t colpotomy issues2010

  • Case Controlled StudyLaparoscopic Right Colectomy vs. Laparoscopic R Colectomy with natural orifice specimen extraction (NOSE)

    34 Patients Each GroupNOSE patients less pain POD 1 and POD 3 (0.01)Visual analogue and blinded observerImproved CosmesisNo morbidity difference

    J. S. Park, G.-S. Choi, H. J. Kim, S. Y. Park and S. H. JunBritish Journal of Surgery 2011; 98: 710715

  • Trans-Vaginal Extraction

  • For DiscussionPatient SelectionProcess to beginIRB, EthicsWho should try?