Laparoscopic right hemicolectomy with specimen extraction according to NOSE Method

Abstract

Objectives. To evaluate the immediate and long-Term results of surgical treatment of patients with simultaneous diseases of the abdominal and pelvic organs after laparoscopic right hemicolectomy with the specimen extraction transvaginelly according to the natural orifice organs specimen extraction (NOSE) method. Methods. The article details the first clinical case: The patient with the tumour of the colon and uterus myoma nodes, and therefore, she was subjected to a simultaneous laparoscopic operation - hysterectomy, right hemicolectomy with extraction of resected specimen transvaginally with intracorporal anastomosis fistulization. At the first stage hysterectomy was performed, right hemicolectomy was carried out using the original combined latero-medial technique. Within 3 years 5 similar surgical procedures had been done and the results are presented in this article. Results. Mean operative time was 133+12,9 min. Intraoperative blood loss did not exceed 90-100 ml. The length of the vascular pedicle (indersected iliac colic artery) was 9±1 cm. The fascia of colon was saved in all 5 cases. No intraoperative complication was observed. Postoperative complications were registered in 2 cases: The development of functional complication - dyspareunia was noted in 1 case. The development of this complication was associated with the violation of treatment guidelines - abstinence from sexual intercourse after an operation is advisable for 2 months. This complication was cured with vaginal suppositories within 2 weeks after the first symptoms appearance. One case of acute urinary retention was observed on the second day after surgery (after the urinary catheter removal). There was a need to set a urinary catheter within 12 hours. The level of postoperative pain ranged from 0 to 1. Conclusion. Transvaginal access is considered to be an ideal way to extract the resected specimen due to anatomical and physiological features of the given area during the colon operations.