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Sashimi NOTES--extraction of bulky specimens in no-scar operations
Wolfram Lamadé1, Fabian Rieber, Colin Friedrich
1Department of Surgery, Dr. Margarete Fischer-Bosch-Institute for Clinical Pharmacology, Robert-Bosch-Krankenhaus, Stuttgart, Germany. wolfram.lamade@rbk.de
Abstract:
A major obstacle in no-scar surgery is the extraction of large, bulky or rigid specimen. Thus, a method is needed that allows for extraction of large specimens without situs contamination in women and men. It should enable safe treatment of infectious or malignant disease while preserving pathologic workup. Five patients suffering from diverticulitis with expected bulky and rigid specimen were enrolled into this early series. Preparation was performed transumbilically in single-port technique. To prevent new scar formation, the incision was limited to the base of the umbilicus without extension onto the sound abdominal skin. A functionally and topologically extracorporeal compartment was created within the abdomen by introduction and insufflation of a tear-proof impermeable retrieval bag. The specimen was sliced in a controlled fashion inside the compartment along a pre-marked geometry. Controlled specimen dissection in a dedicated intraabdominal resection compartment was feasible. The dissected specimen could be retrieved through the 1.5 cm umbilical incision without spillage of material. The geometry of the extracted organ was reconstructed in detail allowing for uncompromised pathological workup. Extraction of bulky and rigid specimen is possible through natural orifices by the proposed controlled dissection method enabling the pathologist to reconstruct anatomical affiliation.
Insights
No-scar surgery can now extract large specimens using a novel intra-abdominal dissection technique. This method ensures no situs contamination and preserves pathological analysis, advancing minimally invasive procedures.
Area of Science:
- Minimally Invasive Surgery
- Surgical Oncology
- Pathology
Background:
- Extraction of large specimens poses a challenge in no-scar surgery.
- Current methods risk situs contamination and compromise pathological evaluation.
- A technique for safe, scarless extraction of bulky specimens is needed.
Purpose of the Study:
- To present a novel method for extracting large, bulky specimens through a single umbilical incision without scar formation.
- To evaluate the feasibility of controlled intra-abdominal specimen dissection and retrieval.
- To ensure the integrity of the specimen for comprehensive pathological workup.
Main Methods:
- A tear-proof retrieval bag was insufflated within the abdomen to create an extracorporeal compartment.
- Specimens were dissected within this compartment along a pre-marked geometry.
- Transumbilical single-port technique was used with a limited incision.
- Controlled dissection and retrieval were performed in five patients with diverticulitis.
Main Results:
- The technique allowed for controlled dissection and extraction of bulky, rigid specimens.
- Specimen retrieval was achieved through a 1.5 cm umbilical incision without material spillage.
- Pathological workup was uncompromised, with detailed reconstruction of organ geometry possible.
Conclusions:
- Controlled intra-abdominal dissection within a retrieval bag enables scarless extraction of large specimens.
- This method facilitates safe treatment of conditions like diverticulitis while preserving specimen integrity for pathology.
- The technique offers a viable solution for challenging specimen extraction in no-scar surgery.
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