Transvaginal Specimen Extraction at Laparoscopy Without Concomitant Hysterectomy: Our Experience and Systematic Review of the Literature

Study Objective: The modality of surgical specimen extraction is extremely important in the setting of minimally invasive operations. To assess the feasibility, safety, and applicability of transvaginal specimen extraction through posterior colpotomy in women with uterus in situ, we present our 11-year experience with this technique and perform a systematic review of the available studies in the field of gynecologic laparoscopy. Design: A retrospective analysis and systematic review of the literature (Canadian Task Force classification II-2). Setting: A tertiary care center. Patients: Two hundred thirty women with uterus in situ undergoing minimally invasive surgery for gynecologic disease at our institution with transvaginal specimen removal in the period between 2001 and 2012. We then reviewed 17 studies, collecting data on a total of 899 transvaginal retrieval procedures. Interventions: Transvaginal specimen retrieval after operative laparoscopy. Measurements and Main Results: Overall, 259 retrieval procedures were performed in the 230 patients operated on at our institution (including extraction of adnexal specimens [n = 190], uterine myomectomies [n = 36], bowel resections [n = 17], and other En = 16]). All interventions were completed laparoscopically. Two (0.8%) women required secondary surgery because of postoperative intraperitoneal bleeding. Three additional (1.3%) minor postoperative complications were observed. No intra- and postoperative complications associated with the extraction technique occurred. In our literature review, a total of 58 (6.5%) complications were recorded. Only 1(0.1%) adverse event was related to the transvaginal extraction procedure. Conclusion: Our data suggest that transvaginal specimen retrieval after operative laparoscopy represents a safe, feasible, and applicable technique. Further research is needed to assess the real advantages of this natural orifice extraction procedure. (C) 2013 AAGL. All rights reserved.