Clinical outcome of laparoscopic right hemicolectomy with transvaginal resection, anastomosis, and retrieval of specimen

PURPOSE: The goal of this study is to evaluate the technical feasibility, safety, and clinical outcomes of totally laparoscopic colectomy with transvaginal anastomosis and extraction of specimen in female patients with right-sided colon cancer. METHODS: A review of prospectively collected database at the Kyungpook National University Hospital from April 2007 to December 2007 revealed a series of 14 consecutive patients affected by right colon cancer were operated by use of the totally laparoscopic colectomy with transvaginal anastomosis and extraction of specimen approach. For this approach, the bowel was fully mobilized and a D3 lymphadenectomy was performed with established laparoscopic technique, followed by transvaginal anastomosis and removal of the resected specimen. Data regarding clinicopathological outcomes, surgical morbidity, and short-term oncologic results were analyzed. RESULTS: No case required an open conversion, but in 2 patients the planned transvaginal retrieval of the specimen was aborted because of inadequate posterior colpotomy. The median operative time was 150.0 minutes (range, 110-330 min) and the median blood loss was 50.0 mL (range, 20.0-115 mL). The median tumor size was 4.0 cm and the number of harvested lymph nodes was 36.0 (range, 13-65). There was no surgical mortality or major morbidity, except one case of postoperative ileus that was conservatively managed. No patient experienced complications directly associated the transvaginal approach; nor did any patient have infection or prolonged spotting from the extraction site postoperatively. Recovery after the procedure was rapid and the median hospital stay was 7.0 days (range, 6-12 d). With a median follow-up 34 months, one patient experienced distant metastasis (7.1%). CONCLUSIONS: In selected cases, totally laparoscopic colectomy with transvaginal anastomosis and extraction of specimen is feasible and reproducible and may be an alternative technique for treatment of women with right colon cancer. This approach may provide both an attractive way to increase patient comfort and a bridge to "pure" natural orifice colon surgery.