Laparoscopic Right Hemicolectomy With Transvaginal Colon Extraction Using a Laparoscopic Posterior Colpotomy: A 2-year Series From a Single Institution

Background: In laparoscopic-assisted colon surgery, an abdominal incision is needed to remove the specimen and perform an anastomosis. We adopted the technique of totally laparoscopic right hemicolectomy and transvaginal extraction in women who required right colon resection. Methods: Over a 2-year period, 14 women were scheduled for totally laparoscopic right hemicolectomy with intracorporeal anastomosis and transvaginal colon removal. The indications for surgery included malignant (n = 9) and benign (n = 5) right-side colon pathology. Results: The procedure was accomplished laparoscopically in all patients. In 1 patient, the transvaginal removal was not possible because of a large tumor mass. The American Society of Anesthesiology was III in 13 and II in 1 patient. The mean body mass index was 31.65. Seventy-eight percent of patients had undergone abdominal surgery previously. The mean size of the lesion was 3.75 cm (range, 1.8 to 8.0 cm) and the mean number of lymph nodes was 18.7 (range, 8 to 37). All margins in the resected specimens were macroscopically and microscopically free of any tumor. One patient needed reoperation for intra-abdominal bleeding, whereas 3 patients developed postoperative ileus. Discussion: Laparoscopic right hemicolectomy and transvaginal extraction is a safe and effective procedure that can be added to the armamentarium of surgeons performing laparoscopic colon surgery. This technique may provide both an attractive way to reduce abdominal wall morbidity and a bridge to pure natural orifice transluminal endoscopic surgery for colon surgery.