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Clin Colon Rectal Surg 2023; 36(01): 047-051
DOI: 10.1055/s-0042-1758352
Review Article

Extraction Site in Minimally Invasive Colorectal Surgery

Jennifer L. Paruch
1   Department of Colon and Rectal Surgery, Ochsner Medical Center, New Orleans, Louisiana
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Abstract

The widespread adoption of minimally invasive colorectal surgery has led to improved patient recovery and outcomes. Specimen extraction sites remain a major source of pain and potential postoperative morbidity. Careful selection of the extraction site incision may allow surgeons to decrease postoperative pain, infectious complications, or rates of hernia formation. Options include midline, paramedian, transverse, Pfannenstiel, and natural orifice sites. Patient, disease, and surgeon-related factors should all be considered when choosing a site. This article will review different options for specimen extraction sites.

Keywords

extraction site - laparoscopic colectomy - robotic colectomy


Publication History

Article published online:
13 January 2023

© 2022. Thieme. All rights reserved.

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  • References

  • 1 Jacobs M, Verdeja JC, Goldstein HS. Minimally invasive colon resection (laparoscopic colectomy). Surg Laparosc Endosc 1991; 1 (03) 144-150
    PubMedGoogle Scholar
  • 2 Sajid MS, Bhatti MI, Sains P, Baig MK. Specimen retrieval approaches in patients undergoing laparoscopic colorectal resections: a literature-based review of published studies. Gastroenterol Rep (Oxf) 2014; 2 (04) 251-261
    CrossrefPubMedGoogle Scholar
  • 3 Lee L, Mata J, Droeser RA. et al. Incisional hernia after midline versus transverse specimen extraction incision: a randomized trial in patients undergoing laparoscopic colectomy. Ann Surg 2018; 268 (01) 41-47
    CrossrefPubMedGoogle Scholar
  • 4 Burger JWA, Van Riet M, Jeekel J. Abdominal incisions: techniques and postoperative complications. Scand J Surg 2002; 91 (04) 315-321
    CrossrefPubMedGoogle Scholar
  • 5 Kisielinski K, Conze J, Murken AH, Lenzen NN, Klinge U, Schumpelick V. The Pfannenstiel or so called “bikini cut”: still effective more than 100 years after first description. Hernia 2004; 8 (03) 177-181
    CrossrefPubMedGoogle Scholar
  • 6 LaChapelle CR, Whitney S, Aalberg J. et al. Analysis of outcomes by extraction site following subtotal colectomy in ulcerative colitis: a retrospective cohort study. J Gastrointest Surg 2020; 24 (04) 933-938
    CrossrefPubMedGoogle Scholar
  • 7 Bickenbach KA, Karanicolas PJ, Ammori JB. et al. Up and down or side to side? A systematic review and meta-analysis examining the impact of incision on outcomes after abdominal surgery. Am J Surg 2013; 206 (03) 400-409
    CrossrefPubMedGoogle Scholar
  • 8 Brown SR, Goodfellow PB. Transverse verses midline incisions for abdominal surgery. Cochrane Database Syst Rev 2005; 2011 (04) CD005199
    PubMedGoogle Scholar
  • 9 Cano-Valderrama O, Sanz-López R, Domínguez-Serrano I. et al. Extraction-site incisional hernia after laparoscopic colorectal surgery: should we carry out a study about prophylactic mesh closure?. Surg Endosc 2020; 34 (09) 4048-4052
    CrossrefPubMedGoogle Scholar
  • 10 Tan WS, Chew MH, Ho KS, Yatim JB, Lai JSF, Tang CL. Short and long-term outcomes of a randomised controlled trial of vertical periumbilical wound versus transverse left iliac fossa wound for specimen retrieval in laparoscopic anterior resections. Surg Endosc 2015; 29 (09) 2720-2727
    CrossrefPubMedGoogle Scholar
  • 11 Benlice C, Stocchi L, Costedio MM, Gorgun E, Kessler H. Impact of the specific extraction-site location on the risk of incisional hernia after laparoscopic colorectal resection. Dis Colon Rectum 2016; 59 (08) 743-750
    CrossrefPubMedGoogle Scholar
  • 12 Aluja-Jaramillo F, Cifuentes-Sandoval S, Gutiérrez FR, Bhalla S, Menias CO. Pre- and postsurgical imaging findings of abdominal wall hernias based on the European Hernia Society (EHS) classification. Abdom Radiol (NY) 2021; 46 (11) 5055-5071
    CrossrefPubMedGoogle Scholar
  • 13 Samia H, Lawrence J, Nobel T, Stein S, Champagne BJ, Delaney CP. Extraction site location and incisional hernias after laparoscopic colorectal surgery: should we be avoiding the midline?. Am J Surg 2013; 205 (03) 264-267 , discussion 268
    CrossrefPubMedGoogle Scholar
  • 14 Navaratnam AV, Ariyaratnam R, Smart NJ, Parker M, Motson RW, Arulampalam TH. Incisional hernia rate after laparoscopic colorectal resection is reduced with standardisation of specimen extraction. Ann R Coll Surg Engl 2015; 97 (01) 17-21
    CrossrefPubMedGoogle Scholar
  • 15 Brown RF, Brockhaus K, Rajkumar D, Battaglia MA, Cleary RK. Postoperative pain after enhanced recovery pathway robotic colon and rectal surgery: does specimen extraction site matter?. Dis Colon Rectum 2021; 64 (06) 735-743
    CrossrefPubMedGoogle Scholar
  • 16 DeSouza A, Domajnko B, Park J, Marecik S, Prasad L, Abcarian H. Incisional hernia, midline versus low transverse incision: what is the ideal incision for specimen extraction and hand-assisted laparoscopy?. Surg Endosc 2011; 25 (04) 1031-1036
    CrossrefPubMedGoogle Scholar
  • 17 Li W, Benlice C, Stocchi L, Kessler H, Gorgun E, Costedio M. Does stoma site specimen extraction increase postoperative ileostomy complication rates?. Surg Endosc 2017; 31 (09) 3552-3558
    CrossrefPubMedGoogle Scholar
  • 18 Chough I, Zaghiyan K, Ovsepyan G, Fleshner P. It is not just cosmesis: straight laparoscopy with stoma site extraction improves outcomes in ulcerative colitis patients undergoing total colectomy. Am Surg 2019; 85 (10) 1194-1197
    CrossrefPubMedGoogle Scholar
  • 19 Famiglietti F, Wolthuis AM, De Coster J, Vanbrabant K, D'Hoore A, de Buck van Overstraeten A. Impact of single-incision laparoscopic surgery on postoperative analgesia requirements after total colectomy for ulcerative colitis: a propensity-matched comparison with multiport laparoscopy. Colorectal Dis 2019; 21 (08) 953-960
    CrossrefPubMedGoogle Scholar
  • 20 Cheng CC, Hsu YR, Chern YJ. et al. Minimally invasive right colectomy with transrectal natural orifice extraction: could this be the next step forward?. Tech Coloproctol 2020; 24 (11) 1197-1205
    CrossrefPubMedGoogle Scholar
  • 21 Christoforidis D, Clerc D, Demartines N. Transrectal specimen extraction after laparoscopic left colectomy: a case-matched study. Colorectal Dis 2013; 15 (03) 347-353
    CrossrefPubMedGoogle Scholar
  • 22 Tasende MM, Delgado S, Jimenez M. et al. Minimal invasive surgery: NOSE and NOTES in ulcerative colitis. Surg Endosc 2015; 29 (11) 3313-3318
    CrossrefPubMedGoogle Scholar
  • 23 Eshuis EJ, Voermans RP, Stokkers PCF, van Berge Henegouwen MI, Fockens P, Bemelman WA. Laparoscopic resection with transcolonic specimen extraction for ileocaecal Crohn's disease. Br J Surg 2010; 97 (04) 569-574
    CrossrefPubMedGoogle Scholar
  • 24 Gardenbroek TJ, Eshuis EJ, van Acker GJD, Tanis PJ, Bemelman WA. Alternative specimen extraction techniques after laparoscopic emergency colectomy in inflammatory bowel disease. Surg Endosc 2012; 26 (02) 408-412
    CrossrefPubMedGoogle Scholar
  • 25 Wolthuis AM, Fieuws S, Van Den Bosch A, de Buck van Overstraeten A, D'Hoore A. Randomized clinical trial of laparoscopic colectomy with or without natural-orifice specimen extraction. Br J Surg 2015; 102 (06) 630-637
    CrossrefPubMedGoogle Scholar
  • 26 Wolthuis AM, de Buck van Overstraeten A, D'Hoore A. Laparoscopic natural orifice specimen extraction-colectomy: a systematic review. World J Gastroenterol 2014; 20 (36) 12981-12992
    CrossrefPubMedGoogle Scholar
  • 27 Chang SC, Chen HC, Chen YC. et al. Long-term oncologic outcomes of laparoscopic anterior resections for cancer with natural orifice versus conventional specimen extraction: a case-control study. Dis Colon Rectum 2020; 63 (08) 1071-1079
    CrossrefPubMedGoogle Scholar
  • 28 Deerenberg EB, Harlaar JJ, Steyerberg EW. et al. Small bites versus large bites for closure of abdominal midline incisions (STITCH): a double-blind, multicentre, randomised controlled trial. Lancet 2015; 386 (10000): 1254-1260
    CrossrefPubMedGoogle Scholar
  • 29 Wrenn SM, Cepeda-Benito A, Ramos-Valadez DI, Cataldo PA. Patient perceptions and quality of life after colon and rectal surgery: What do patients really want?. Dis Colon Rectum 2018; 61 (08) 971-978
    CrossrefPubMedGoogle Scholar
  • 30 Singh R, Omiccioli A, Hegge S, McKinley C. Does the extraction-site location in laparoscopic colorectal surgery have an impact on incisional hernia rates?. Surg Endosc 2008; 22 (12) 2596-2600
    CrossrefPubMedGoogle Scholar
  • 31 Harr JN, Juo YY, Luka S, Agarwal S, Brody F, Obias V. Incisional and port-site hernias following robotic colorectal surgery. Surg Endosc 2016; 30 (08) 3505-3510
    CrossrefPubMedGoogle Scholar