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01-06-2016 | Invited Review

Transvaginal specimen removal in minimally invasive surgery

Authors: Panagiotis Kallidonis, Vasilis Panagopoulos, Iason Kyriazis, Marinos Vasilas, Evangelos Liatsikos

Published in: World Journal of Urology | Issue 6/2016

Abstract

The demand for urological surgical treatment associated with better cosmesis, lower morbidity rates and shorter hospitalization constantly grows. The transvaginal route has been proposed in an attempt to avoid long abdominal incisions for the removal of the large laparoscopic specimens. Moreover, the transvaginal NOTES approach represents a promising evolution of laparoscopic surgery to a more “minimally invasive” alternative. The current review summarizes the available experience in the literature in transvaginal conventional laparoscopy and NOTES in urology, gynecology and general surgery. The clinical outcome is presented. The most important issues associated with the transvaginal approach are the complications and the postoperative sexual function. These issues are presented.

Chou LY, Sheu BC, Chang DY, Huang SC, Chen SY, Hsu WC, Chang WC (2010) Comparison between transumbilical and transabdominal ports for the laparoscopic retrieval of benign adnexal masses: a randomized trial. Eur J Obstet Gynecol Reprod Biol 153(2):198–202. doi:10.1016/j.ejogrb.2010.07.029 PubMedCrossRef

Kanis MJ, Momeni M, Zakashansky K, Chuang L, Hayes MP (2013) Five-millimeter balloon trocar site herniation: report of two cases and review of literature. J Minim Invasive Gynecol 20(5):723–726. doi:10.1016/j.jmig.2013.04.012 PubMedCrossRef

Shin JH, Howard FM (2012) Abdominal wall nerve injury during laparoscopic gynecologic surgery: incidence, risk factors, and treatment outcomes. J Minim Invasive Gynecol 19(4):448–453. doi:10.1016/j.jmig.2012.03.009 PubMedCrossRef

Gill IS, Cherullo EE, Meraney AM, Borsuk F, Murphy DP, Falcone T (2002) Vaginal extraction of the intact specimen following laparoscopic radical nephrectomy. J Urol 167(1):238–241PubMedCrossRef

Liatsikos E, Kyriazis I, Kallidonis P, Do M, Dietel A, Stolzenburg JU (2012) Pure single-port laparoscopic surgery or mix of techniques? World J Urol 30(5):581–587. doi:10.1007/s00345-011-0766-0 PubMedCrossRef

Georgiopoulos I, Kallidonis P, Kyriazis I, Adonakis G, Stolzenburg JU, Schwentner C, Liatsikos E (2014) Hybrid transvaginal nephrectomy: development of our technique. Urology 84(1):99–104. doi:10.1016/j.urology.2014.01.055 PubMedCrossRef

Dray X, Marteau P (2009) The future of gastrointestinal therapeutic endoscopy: NOTES. Gastroenterol Clin Biol 33(8–9):758–766. doi:10.1016/j.gcb.2009.07.010 PubMedCrossRef

Bazzi WM, Stroup SP, Cohen SA, Sisul DM, Liss MA, Masterson JH, Kopp RP, Gudeman SR, Leeflang E, Palazzi KL, Ramamoorthy S, Kane CJ, Horgan S, Derweesh IH (2013) Comparison of transrectal and transvaginal hybrid natural orifice transluminal endoscopic surgery partial nephrectomy in the porcine model. Urology 82(1):84–89. doi:10.1016/j.urology.2013.03.007 PubMedCrossRef

Zorron R, Palanivelu C, Galvao Neto MP, Ramos A, Salinas G, Burghardt J, DeCarli L, Henrique Sousa L, Forgione A, Pugliese R, Branco AJ, Balashanmugan TS, Boza C, Corcione F, D’Avila Avila F, Arturo Gomez N, Galvao Ribeiro PA, Martins S, Filgueiras M, Gellert K, Wood Branco A, Kondo W, Inacio Sanseverino J, de Sousa JA, Saavedra L, Ramirez E, Campos J, Sivakumar K, Rajan PS, Jategaonkar PA, Ranagrajan M, Parthasarathi R, Senthilnathan P, Prasad M, Cuccurullo D, Muller V (2010) International multicenter trial on clinical natural orifice surgery–NOTES IMTN study: preliminary results of 362 patients. Surg Innov 17(2):142–158. doi:10.1177/1553350610370968 PubMedCrossRef

10.

Ghezzi F, Cromi A, Uccella S, Bogani G, Serati M, Bolis P (2012) Transumbilical versus transvaginal retrieval of surgical specimens at laparoscopy: a randomized trial. Am J Obstet Gynecol 207(2):112.e1–112.e6. doi:10.1016/j.ajog.2012.05.016 CrossRef

11.

de Castro Abreu AL, Ukimura O, Desai MM (2014) Editorial comment. Urology 84(1):104–105. doi:10.1016/j.urology.2014.01.056 PubMedCrossRef

12.

Breda G, Silvestre P, Giunta A, Xausa D, Tamai A, Gherardi L (1993) Laparoscopic nephrectomy with vaginal delivery of the intact kidney. Eur Urol 24(1):116–117PubMed

13.

Serrano-Ysern A, Lopez A, Mendez F, Perez L, Acosta J (2008) Laparoscopic nephrectomy with laparoscopically assisted transvaginal extraction of intact kidney. Boletin de la Asociacion Medica de Puerto Rico 100(1):81–85PubMed

14.

Gurluler E, Berber I, Cakir U, Gurkan A (2014) Transvaginal route for kidney extraction in laparoscopic donor nephrectomy. J Soc Laparoendosc Surg. doi:10.4293/jsls.2014.00156

15.

Zou X, Zhang G, Xue Y, Yuan Y, Xiao R, Wu G, Wang X, Wu Y, Long D, Yang J, Xu H, Liu F, Liu M (2014) Transumbilical multiport laparoscopic nephrectomy with specimen extraction through the vagina. Urol Int 92(4):407–413. doi:10.1159/000356099 PubMedCrossRef

16.

Piros L, Langer RM (2012) Laparoscopic donor nephrectomy techniques. Curr Opin Organ Transplant 17(4):401–405. doi:10.1097/MOT.0b013e3283552065 PubMedCrossRef

17.

Eroglu A, Sener C, Tabandeh B, Tilif S, Okcuoglu Kadioglu Z, Kacar S (2013) Transvaginal laparoscopic donor nephrectomy. Transplant Proc 45(3):881–882. doi:10.1016/j.transproceed.2013.02.078 PubMedCrossRef

18.

Kishore TA, Shetty A, Balan T, John MM, Iqbal M, Jose J, Vinodan K (2013) Laparoscopic donor nephrectomy with transvaginal extraction: initial experience of 30 cases. J Endourol 27(11):1361–1365. doi:10.1089/end.2013.0412 PubMedCrossRef

19.

Gettman MT, Lotan Y, Napper CA, Cadeddu JA (2002) Transvaginal laparoscopic nephrectomy: development and feasibility in the porcine model. Urology 59(3):446–450PubMedCrossRef

20.

Kaouk JH, Haber GP, Goel RK, Crouzet S, Brethauer S, Firoozi F, Goldman HB, White WM (2010) Pure natural orifice translumenal endoscopic surgery (NOTES) transvaginal nephrectomy. Eur Urol 57(4):723–726. doi:10.1016/j.eururo.2009.10.027 PubMedCrossRef

21.

Aminsharifi A, Taddayun A, Shakeri S, Hashemi M, Abdi M (2009) Hybrid natural orifice transluminal endoscopic surgery for nephrectomy with standard laparoscopic instruments: experience in a canine model. J Endourol 23(12):1985–1989. doi:10.1089/end.2009.0255 PubMedCrossRef

22.

Perretta S, Allemann P, Asakuma M, Cahill R, Dallemagne B, Marescaux J (2009) Feasibility of right and left transvaginal retroperitoneal nephrectomy: from the porcine to the cadaver model. J Endourol 23(11):1887–1892. doi:10.1089/end.2008.0682 PubMedCrossRef

23.

Sanchez-Margallo FM, Perez FJ, Sanchez MA, Bachiller J, Juarez A, Serrano A, Ribal MJ, Alcaraz A (2012) Transvaginal NOTES-assisted laparoscopic nephrectomy: a survival study in a sheep model. Surg Endosc 26(4):926–932. doi:10.1007/s00464-011-1969-6 PubMedCrossRef

24.

Aron M, Berger AK, Stein RJ, Kamoi K, Brandina R, Canes D, Sotelo R, Desai MM, Gill IS (2009) Transvaginal nephrectomy with a multichannel laparoscopic port: a cadaver study. BJU Int 103(11):1537–1541. doi:10.1111/j.1464-410X.2009.08612.x PubMedCrossRef

25.

Kaouk JH, White WM, Goel RK, Brethauer S, Crouzet S, Rackley RR, Moore C, Ingber MS, Haber GP (2009) NOTES transvaginal nephrectomy: first human experience. Urology 74(1):5–8. doi:10.1016/j.urology.2009.03.030 PubMedCrossRef

26.

Kaouk JH, Khalifeh A, Laydner H, Autorino R, Hillyer SP, Panumatrassamee K, Modlin C, Goldman HB (2012) Transvaginal hybrid natural orifice transluminal surgery robotic donor nephrectomy: first clinical application. Urology 80(6):1171–1175. doi:10.1016/j.urology.2012.08.061 PubMedCrossRef

27.

Branco AW, Branco Filho AJ, Kondo W, Noda RW, Kawahara N, Camargo AA, Stunitz LC, Valente J, Rangel M (2008) Hybrid transvaginal nephrectomy. Eur Urol 53(6):1290–1294. doi:10.1016/j.eururo.2007.10.053 PubMedCrossRef

28.

Alcaraz A, Peri L, Molina A, Goicoechea I, Garcia E, Izquierdo L, Ribal MJ (2010) Feasibility of transvaginal NOTES-assisted laparoscopic nephrectomy. Eur Urol 57(2):233–237. doi:10.1016/j.eururo.2009.09.025 PubMedCrossRef

29.

Sotelo R, de Andrade R, Fernandez G, Ramirez D, Di Grazia E, Carmona O, Moreira O, Berger A, Aron M, Desai MM, Gill IS (2010) NOTES hybrid transvaginal radical nephrectomy for tumor: stepwise progression toward a first successful clinical case. Eur Urol 57(1):138–144. doi:10.1016/j.eururo.2009.04.031 PubMedCrossRef

30.

Porpiglia F, Fiori C, Morra I, Scarpa RM (2011) Transvaginal natural orifice transluminal endoscopic surgery-assisted minilaparoscopic nephrectomy: a step towards scarless surgery. Eur Urol 60(4):862–866. doi:10.1016/j.eururo.2010.09.038 PubMedCrossRef

31.

Perretta S, Allemann P, Asakuma M, Dallemagne B, Marescaux J (2009) Adrenalectomy using natural orifice translumenal endoscopic surgery (NOTES): a transvaginal retroperitoneal approach. Surg Endosc 23(6):1390. doi:10.1007/s00464-009-0367-9 PubMedCrossRef

32.

Zou X, Zhang G, Xiao R, Yuan Y, Wu G, Wang X, Long D, Wu Y, Liu M, Xue Y, Zhang X (2011) Transvaginal natural orifice transluminal endoscopic surgery (NOTES)-assisted laparoscopic adrenalectomy: first clinical experience. Surg Endosc 25(12):3767–3772. doi:10.1007/s00464-011-1786-y PubMedCrossRef

33.

Hirota M, Nakajima K, Hara J, Takahashi T, Yamasaki M, Tsutsui T, Kobayashi E, Kurokawa Y, Miyata H, Takiguchi S, Mori M, Doki Y (2012) A case of simultaneous transvaginal NOTES gastrectomy and vaginal hysterectomy in a patient with gastric submucosal tumor and uterine prolapse. Asian J Endosc Surg 5(4):168–171. doi:10.1111/j.1758-5910.2012.00153.x PubMedCrossRef

34.

Ramalingam M, King J, Jaacks L (2013) Transvaginal specimen extraction after combined laparoscopic splenectomy and hysterectomy: introduction to NOSE (Natural Orifice Specimen Extraction) in a community hospital. Int J Surg Case Rep 4(12):1138–1141. doi:10.1016/j.ijscr.2013.07.039 PubMedPubMedCentralCrossRef

35.

Su H, Yen CF, Wu KY, Han CM, Lee CL (2012) Hysterectomy via transvaginal natural orifice transluminal endoscopic surgery (NOTES): feasibility of an innovative approach. Taiwan J Obstet Gynecol 51(2):217–221. doi:10.1016/j.tjog.2012.04.009 PubMedCrossRef

36.

Lee CL, Wu KY, Su H, Wu PJ, Han CM, Yen CF (2014) Hysterectomy by transvaginal natural orifice transluminal endoscopic surgery (NOTES): a series of 137 patients. J Minim Invasive Gynecol 21(5):818–824. doi:10.1016/j.jmig.2014.03.011 PubMedCrossRef

37.

Yang YS, Kim SY, Hur MH, Oh KY (2014) Natural orifice transluminal endoscopic surgery-assisted versus single-port laparoscopic-assisted vaginal hysterectomy: a case-matched study. J Minim Invasive Gynecol 21(4):624–631. doi:10.1016/j.jmig.2014.01.005 PubMedCrossRef

38.

Tsin DA, Colombero LT, Lambeck J, Manolas P (2007) Minilaparoscopy-assisted natural orifice surgery. J Soc Laparoendosc Surg 11(1):24–29

39.

Uccella S, Cromi A, Bogani G, Casarin J, Serati M, Ghezzi F (2013) Transvaginal specimen extraction at laparoscopy without concomitant hysterectomy: our experience and systematic review of the literature. J Minim Invasive Gynecol 20(5):583–590. doi:10.1016/j.jmig.2013.02.022 PubMedCrossRef

40.

Goldfarb HA, Fanarjian NJ (2001) Laparoscopic-assisted vaginal myomectomy: a case report and literature review. J Soc Laparoendosc Surg 5(1):81–85

41.

Ou CS, Harper A, Liu YH, Rowbotham R (2002) Laparoscopic myomectomy technique. Use of colpotomy and the harmonic scalpel. J Reprod Med 47(10):849–853PubMed

42.

Yang YS, Hur MH, Oh KY, Kim SY (2013) Transvaginal natural orifice transluminal endoscopic surgery for adnexal masses. J Obstet Gynaecol Res 39(12):1604–1609. doi:10.1111/jog.12108 PubMedCrossRef

43.

Teng FY, Muzsnai D, Perez R, Mazdisnian F, Ross A, Sayre JW (1996) A comparative study of laparoscopy and colpotomy for the removal of ovarian dermoid cysts. Obstet Gynecol 87(6):1009–1013PubMedCrossRef

44.

Yoshiki N, Okawa T, Kubota T (2012) Hybrid transvaginal and transumbilical laparoendoscopic adnexal surgery. J Laparoendosc Adv Surg Tech Part A 22(10):992–995. doi:10.1089/lap.2012.0175 CrossRef

45.

Tunuguntla HS, Gousse AE (2004) Female sexual dysfunction following vaginal surgery: myth or reality? Curr Urol Rep 5(5):403–411PubMedCrossRef

46.

Tunuguntla HS, Gousse AE (2006) Female sexual dysfunction following vaginal surgery: a review. J Urol 175(2):439–446. doi:10.1016/s0022-5347(05)00168-0 PubMedCrossRef

47.

Jayaraman S, Schlachta CM (2009) Transgastric and transperineal natural orifice translumenal endoscopic surgery (NOTES) in an appendectomy test bed. Surg Innov 16(3):223–227. doi:10.1177/1553350609342076 PubMedCrossRef

48.

Allemann P, Perretta S, Asakuma M, Dallemagne B, Mutter D, Marescaux J (2009) Multimedia manuscript. NOTES retroperitoneal transvaginal distal pancreatectomy. Surg Endosc 23(4):882–883. doi:10.1007/s00464-008-0297-y PubMedCrossRef

49.

Nakajima K, Takahashi T, Souma Y, Shinzaki S, Yamada T, Yoshio T, Nishida T (2008) Transvaginal endoscopic partial gastrectomy in porcine models: the role of an extra endoscope for gastric control. Surg Endosc 22(12):2733–2736. doi:10.1007/s00464-008-0122-7 PubMedCrossRef

50.

Palanivelu C, Rajan PS, Rangarajan M, Parthasarathi R, Senthilnathan P, Prasad M (2008) Transvaginal endoscopic appendectomy in humans: a unique approach to NOTES–world’s first report. Surg Endosc 22(5):1343–1347. doi:10.1007/s00464-008-9811-5 PubMedCrossRef

51.

Wada N, Tanabe M, Kataoka F, Kitagawa Y (2013) Transvaginal hybrid natural orifice translumenal endoscopic surgery appendectomy. Nihon Geka Gakkai zasshi 114(6):308–311PubMed

52.

Wood SG, Dabu-Bondoc S, Dai F, Mikhael H, Vadivelu N, Roberts KE (2014) Comparison of immediate postoperative pain after transvaginal versus traditional laparoscopic cholecystectomy. Surg Endosc 28(4):1141–1145. doi:10.1007/s00464-013-3294-8 PubMedCrossRef

53.

Bulian DR, Knuth J, Cerasani N, Sauerwald A, Lefering R, Heiss MM (2013) Transvaginal/transumbilical hybrid-NOTES-versus 3-trocar needlescopic cholecystectomy: short-term results of a randomized clinical trial. Ann Surg. doi:10.1097/sla.0000000000000218

54.

van den Boezem PB, Velthuis S, Lourens HJ, Cuesta MA, Sietses C (2014) Single-incision and NOTES cholecystectomy, are there clinical or cosmetic advantages when compared to conventional laparoscopic cholecystectomy? A case-control study comparing single-incision, transvaginal, and conventional laparoscopic technique for cholecystectomy. World J Surg 38(1):25–32. doi:10.1007/s00268-013-2221-4 PubMedCrossRef

55.

Kilian M, Raue W, Menenakos C, Wassersleben B, Hartmann J (2011) Transvaginal-hybrid vs. single-port-access vs. ‘conventional’ laparoscopic cholecystectomy: a prospective observational study. Langenbeck’s Arch Surg 396(5):709–715. doi:10.1007/s00423-011-0769-8 CrossRef

56.

Zornig C, Siemssen L, Emmermann A, Alm M, von Waldenfels HA, Felixmuller C, Mofid H (2011) NOTES cholecystectomy: matched-pair analysis comparing the transvaginal hybrid and conventional laparoscopic techniques in a series of 216 patients. Surg Endosc 25(6):1822–1826. doi:10.1007/s00464-010-1473-4 PubMedCrossRef

57.

Ogredici O, Linke GR, Lamm S, Rosenthal R, Zerz A, Steinemann DC (2014) Routine cholangiography during rigid-hybrid transvaginal natural orifice transluminal endoscopic cholecystectomy. Surg Endosc 28(3):910–917. doi:10.1007/s00464-013-3246-3 PubMedCrossRef

58.

Pollard JS, Fung AK, Ahmed I (2012) Are natural orifice transluminal endoscopic surgery and single-incision surgery viable techniques for cholecystectomy? J Laparoendosc Adv Surg Tech Part A 22(1):1–14. doi:10.1089/lap.2011.0341 CrossRef

59.

Wood SG, Solomon D, Panait L, Bell RL, Duffy AJ, Roberts KE (2013) Transvaginal cholecystectomy: effect on quality of life and female sexual function. JAMA Surg 148(5):435–438. doi:10.1001/jamasurg.2013.108 PubMedCrossRef

60.

Vereczkei A, Illenyi L, Arany A, Szabo Z, Toth L, Horvath OP (2003) Transvaginal extraction of the laparoscopically removed spleen. Surg Endosc 17(1):157. doi:10.1007/s00464-002-4509-6 PubMedCrossRef

61.

Almau Trenard H, Mejias Gonzalez J, Arellano Coraggio J (2011) Notes-hybrid: splenectomy (transvaginal/umbilical). Acta Gastroenterol Latinoam 41(3):221–224PubMed

62.

Targarona EM, Gomez C, Rovira R, Pernas JC, Balague C, Guarner-Argente C, Sainz S, Trias M (2009) NOTES-assisted transvaginal splenectomy: the next step in the minimally invasive approach to the spleen. Surg Innov 16(3):218–222. doi:10.1177/1553350609345488 PubMedCrossRef

63.

Mofid H, Emmermann A, Alm M, Zornig C (2013) Transvaginal specimen removal after laparoscopic distal pancreatic resection. Langenbeck’s Arch Surg 398(7):1001–1005. doi:10.1007/s00423-013-1092-3 CrossRef

64.

Noguera JF, Dolz C, Cuadrado A, Olea JM, Vilella A (2008) Transvaginal liver resection (NOTES) combined with minilaparoscopy. Revista espanola de enfermedades digestivas: organo oficial de la Sociedad Espanola de Patologia Digestiva 100(7):411–415

65.

Nakajima K, Nishida T, Takahashi T, Souma Y, Hara J, Yamada T, Yoshio T, Tsutsui T, Yokoi T, Mori M, Doki Y (2009) Partial gastrectomy using natural orifice translumenal endoscopic surgery (NOTES) for gastric submucosal tumors: early experience in humans. Surg Endosc 23(12):2650–2655. doi:10.1007/s00464-009-0474-7 PubMedCrossRef

66.

McKenzie S, Baek JH, Wakabayashi M, Garcia-Aguilar J, Pigazzi A (2010) Totally laparoscopic right colectomy with transvaginal specimen extraction: the authors’ initial institutional experience. Surg Endosc 24(8):2048–2052. doi:10.1007/s00464-009-0870-z PubMedCrossRef

67.

Boni L, Tenconi S, Beretta P, Cromi A, Dionigi G, Rovera F, Dionigi R, Ghezzi F (2007) Laparoscopic colorectal resections with transvaginal specimen extraction for severe endometriosis. Surg Oncol 16(Suppl 1):S157–S160. doi:10.1016/j.suronc.2007.10.003 PubMedCrossRef

68.

Ghezzi F, Cromi A, Ciravolo G, Rampinelli F, Braga M, Boni L (2008) A new laparoscopic-transvaginal technique for rectosigmoid resection in patients with endometriosis. Fertil Steril 90(5):1964–1968. doi:10.1016/j.fertnstert.2007.09.002 PubMedCrossRef

69.

Karahasanoglu T, Hamzaoglu I, Aytac E, Baca B (2011) Transvaginal assisted totally laparoscopic single-port right colectomy. J Laparoendosc Adv Surg Tech Part A 21(3):255–257. doi:10.1089/lap.2010.0438 CrossRef

70.

Augustin G, Majerovic M, Luetic T (2013) Uterine perforation as a complication of surgical abortion causing small bowel obstruction: a review. Arch Gynecol Obstet 288(2):311–323. doi:10.1007/s00404-013-2749-4 PubMedCrossRef

71.

Chhabra S, Hegde P (2013) Spontaneous transvaginal bowel evisceration. Indian J Urol IJU J Urol Soc India 29(2):139–141. doi:10.4103/0970-1591.114038 CrossRef

72.

Faivre E, Surroca MM, Deffieux X, Pages F, Gervaise A, Fernandez H (2010) Vaginal myomectomy: literature review. J Minim Invasive Gynecol 17(2):154–160. doi:10.1016/j.jmig.2009.12.007 PubMedCrossRef

73.

Aimore Bonin E, Claus CM, Torres MF, Campos AC, Cavazzola LT, de Paula Loureiro M (2013) Evaluation of bacterial contamination after “pure” (totally) transvaginal NOTES diagnostic peritoneoscopy with biopsies in swine: a comparative study with laparoscopy. Surg Endosc 27(2):421–427. doi:10.1007/s00464-012-2448-4 PubMedCrossRef

Title: Transvaginal specimen removal in minimally invasive surgery
Authors: Panagiotis Kallidonis
Vasilis Panagopoulos
Iason Kyriazis
Marinos Vasilas
Evangelos Liatsikos
Publication date: 01-06-2016
Publisher: Springer Berlin Heidelberg
Published in: World Journal of Urology / Issue 6/2016
Print ISSN: 0724-4983
Electronic ISSN: 1433-8726
DOI: https://doi.org/10.1007/s00345-016-1770-1

At a glance: The STEP trials

Springer Medicine

Transvaginal specimen removal in minimally invasive surgery

Abstract

At a glance: The STEP trials

Springer Medicine

Abstract

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