Page 65 - World Journal of Laparoscopic Surgeons

WJOLS

Pouch of Douglas: A Noble Route for Surgical Specimen Retrieval
Table 3: Laparoscopic procedures and intraoperative details abscess diagnosed by ultrasound on 1st month follow-
Type of procedure up, managed conservatively with injectable antibiotics.
(Total no = 100) No Percentage Postoperative 10 cm VAS score out of 100 in only 5% had
U/L ovarian cystectomy 15 15 pain (1–2 cm) at 24 hours; 95% of the patients had no
B/L ovarian cystectomy 5 5
U/L ovariotomy 5 5 complaint of dyspareunia on the 3rd month follow-up
Myomectomy 5 5 and 5% were lost to follow-up.
U/L salpingectomy 20 20 Studies comparing traditional laparoscopic
B/L salpingectomy 8 8 approaches with transumbilical specimen retrieval vs
M/L salpingo-oophorectomy 20 20 transvaginal approaches have demonstrated that it is a
B/L salpingo-oophorectomy 10 10 safe, feasible, and applicable technique. Further research
Appendicectomy 2 2 is needed to assess the real advantages of this natural
Mean SD Range orifice extraction procedure. Furthermore, studies have
7
Estimated blood loss, mL 20 12 10–100 demonstrated no increased risk of postoperative infec-
Operative time, min 60 40 40–120 8
Specimen retrieval time, min 15 8 5–30 tion or incidence of sexual dysfunction or pelvic pain.
Twenty-two women who had undergone laparoscopic
posterior colpotomy at initial operative laparoscopy and
Table 4: Pain score on 10 cm VAS later underwent a second laparoscopic procedure were
Postoperative time in hours (1–2 cm) N = 100 Percentage evaluated for adhesion formation. It does not appear that
1 hour 20 20
3 hours 10 10 tissue removal via laparoscopic colpotomy predisposes
24 hours 5 5 reproductive-age women to postoperative adnexal adhe-
9
sion formation. Theoretical complications that could be
attributed to culdotomy include rectal injury, injury to the
Removal through primary port needs change of 10 to bladder and ureters, hemorrhage, vaginal cuff hematoma,
5 mm scope to visualize leads to increase the operative vaginal scarring, and postoperative pelvic infections.
time. Enlargement of port site leads to intraoperative These complications are rare when the transvaginal
vessel injury and postoperative pain, bad scar, and hernia route is used. 10
2-4
formation. Minilaparotomy spoils the whole purpose
of laparoscopy. CONCLUSION
Transvaginal route is a natural route of tissue retrieval
5
explained more than 100 long years back. Though it A pouch of Douglas approach after puncturing with
has not been explored much by gynecologist in laparo- 10 mm trocar and cannula for specimen removal after
scopic surgery for specimen retrieval in apprehension of laparoscopic resection of pelvic masses offers the advan-
potential injury to bowel, bladder, infection, and sexual tage of being safe, easy to perform, less time consuming,
dysfunction, but nowadays, it has emerged as a preferred less postoperative pain, with minimal spillage, good cos-
site of tissue extraction as a procedure of natural orifice metic result, and patient satisfaction without prolonging
transluminal endoscopic surgery among surgeon. 6 the operative time.
We tried a new method of opening the pouch of
Douglas by puncturing with 10 mm trocar and cannula REFERENCES
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World Journal of Laparoscopic Surgery, January-April 2018;11(1):29-32 31