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WJOL S
WJOLS

10.5005/jp-journals-10007-1329
Pouch of Douglas: A Noble Route for Surgical Specimen Retrieval
RESEARCH ARTICLE

Pouch of Douglas: A Noble Route for Surgical Specimen

Retrieval in Laparoscopic Pelvic Mass Surgery

2
1 Abhipsa Mishra, Sujit Behera

ABSTRACT INTRODUCTION
Aim: To evaluate the feasibility and surgical outcome of sur- With the advent of laparoscopic surgery, the major
gical specimen retrieval through the pouch of Douglas by an challenge has been to find the easy and safe method of
innovative way of puncturing the same with a 10 mm trocar and
cannula in 100 consecutive women undergoing laparoscopic tissue retrieval from the surgical site. Retrieval of small
gynecological procedures for a pelvic mass. specimen with massive hemoperitoneum and retrieval of
Materials and methods: A prospective study over a period medium-to-large specimen sometimes leads to struggle
of 2 years from June 2012 to June 2014; 100 cases of pelvic for hours and ultimately it becomes frustrating for the
mass (small-to-large) surgeries were done laparoscopically and surgeon. The conventional method remains the enlarge-
specimens removed through pouch of Douglas by our own new ment of a 5-mm ancillary port-site incision to 10 mm, or
method of puncturing the same with 10 mm trocar and cannula
and putting the mass in endobag and removing with a grasper. more, or through 10 mm primary port. The use of larger
Parameters studied were indications, operative time, blood loss, entries does not only implicate cosmetic drawbacks jeop-
spillage, postoperative pain, long-term complications. ardizing the whole purpose of minimal access surgery
Results: In 96% of cases, surgical specimens were retrieved but can also increase the chance of injuries involving the
successfully, with minimal spillage without any intraoperative or inferior epigastric vessels (the most common vascular
postoperative complication. Though the rest 4% were retrieved complication accounting for more than 3 per 1,000 events
successfully, 2% had laceration but they were managed intra- 1
operatively, 2% had postoperative abscess formation managed during operative laparoscopies). Moreover, enlargement
conservatively. Only 5% had pain in vagina at 24 hours on 10 cm and stretching of port-site incisions have the potential
2
visual analog scale (VAS); 95% cases had no complaint of dys- to increase the risk of incisional hernia formation, post-
pareunia on 3rd month follow-up and 5% were lost to follow-up. operative pain, and infection. Whole of the surgeon’s
Conclusion: A pouch of Douglas approach for specimen effort goes in vein when these complications happen.
removal by our new method after laparoscopic resection of Removal through pouch of Douglas under vision is one
pelvic masses offers the advantage of less postoperative of the natural orifice transluminal endoscopic methods,
pain, with minimal spillage, good cosmetic result, and patient
satisfaction without prolonging the operative time. although this route of specimen extraction has not been
explored by many suspicious of expected injury to bowel,
Clinical significance: Tissue retrieved through pouch of
Douglas after puncturing with 10 mm trocar with cannula bladder, vessel, and dyspareunia. Opening of pouch of
under vision is a safe, feasible, less time-consuming method Douglas can be done by direct bold incision vaginally
in laparoscopic pelvic mass surgery. It avoids the enlargement or with the help of monopolar hook on the bulging part
of operative port site. of vagina after inserting a colpotomizer. We tried a new
Keywords: Incisional hernia, Laparoscopic, NOTES, Port closure. method of puncturing the pouch of Douglas by10 mm
How to cite this article: Mishra A, Behera S. Pouch of Douglas: trocar cannula under vision at the apex of triangle formed
A Noble Route for Surgical Specimen Retrieval in Laparoscopic by two uterosacral ligament and retrieved the specimen
Pelvic Mass Surgery. World J Lap Surg 2018;11(1):29-32. by tooth grasping forceps (Fig. 1).
Source of support: Nil
Conflict of interest: None MATERIALS AND METHODS
The study was a prospective study which was conducted
in the Department of Gynecology, KIMS Hospital, from
2
1 Assistant Professor, Consultant
June 2012 to June 2014.
1 Department of Obstetrics and Gynecology, Kalinga Institute of
Medical Sciences, Bhubaneswar, Odisha, India
Inclusion Criteria
2 Department of Obstetrics and Gynecology, Sparsh Hospital &
Critical Care Pvt Ltd, Bhubaneshwar, Odisha, India • Reproductive-age group women (18–45 years)
Corresponding Author: Abhipsa Mishra, Assistant Professor • Adnexal mass (3–20 cm)
Department of Obstetrics and Gynecology, Kalinga Institute • Benign in nature
of Medical Sciences, Bhubaneswar, Odisha, India, e-mail: Ultrasound investigation was performed before surgery
dramgyn@yahoo.co.in
to evaluate the morphology and size of the adnexal mass.
World Journal of Laparoscopic Surgery, January-April 2018;11(1):29-32 29