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Transgastric large-organ extraction: the initial human experience.

Takayuki Dotai¹, Alisa M Coker, Luciano Antozzi

¹The Center for the Future of Surgery, University of California San Diego, 9500 Gilman Drive, MET Building, CFS, La Jolla, CA 92093, USA. tadotai@ucsd.edu

Surgical Endoscopy

|July 19, 2012

Summary

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Transoral remnant extraction (TORE) for laparoscopic sleeve gastrectomy (LSG) minimizes trocar site complications without affecting outcomes. This natural orifice surgery approach offers a safer alternative for large specimen extraction in bariatric procedures.

Area of Science:

Minimally invasive surgery
Surgical innovation
Bariatric surgery

Background:

Laparoscopic surgery often requires enlarged port sites for specimen extraction, increasing risks of infection and hernia.
Natural orifice surgery (NOTES) offers a solution by minimizing these complications, especially for large specimens.
Transgastric techniques have been applied to various procedures, including laparoscopic sleeve gastrectomy (LSG).

Purpose of the Study:

To describe the details and assess the feasibility of transoral remnant extraction (TORE) for LSG.
To compare the outcomes of TORE-assisted LSG with conventional LSG regarding specimen extraction and complications.

Main Methods:

A retrospective comparison of 18 patients undergoing LSG with TORE and 10 patients undergoing conventional LSG.

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Procedures were compared for patient demographics, operative time, hospital stay, excess weight loss (EWL), and trocar site complications.

TORE involves transgastric retrieval of the resected stomach specimen through a gastrotomy, followed by laparoscopic closure.

Main Results:

No significant differences were observed in patient profiles, operative time, hospital stay, or EWL between the TORE and non-TORE groups.
All specimens in the TORE group were extracted safely and easily.
Four non-TORE cases required extended trocar sites, with two developing panniculitis, while the TORE group had no trocar site complications.

Conclusions:

Transoral remnant extraction (TORE) is a safe and feasible technique for LSG, requiring standard laparoscopic and endoscopic skills.
TORE offers a significant advantage over traditional LSG by minimizing trocar site complications.
Transgastric organ extraction via TORE shows potential for other large-organ laparoscopic procedures.