Abstract
A 61-year-old woman was diagnosed with right inguinal lymph node and splenic metastasis of ovarian serous cystadenocarcinoma. We performed right inguinal lymph node dissection and total laparoscopic splenectomy in the supine position followed by transvaginal specimen extraction (TVSE). First, using three ports, we extracted the right inguinal lymph node. We repaired the posterior wall of the inguinal canal using a mesh plug. We added two ports and displaced the spleen from the retroperitoneum and lifted it using a snake retractor, disconnecting the hilum using an automatic suturing device. Next, the posterior wall of the vagina was intraperitoneally incised. And an Alexis® laparoscopic system was inserted into the vagina. The cap maintained aeroperitoneum, a collection bag was inserted in the abdominal cavity via the vagina, and the spleen was collected. When the spleen was removed from the body, partial fragmentation of the organ was required in the bag. Organ fragmentation was performed only within the bag, and we made sure not to tear the bag. The vaginal wound was laparoscopically sutured. The patient had no operative complications and was able to actively ambulate at the first day after surgery due to a slight postoperative pain. Total laparoscopic splenectomy with TVSE in the supine position may be a safe and feasible method for selected female patients. This technique enables minimally invasive surgery for female patients with splenic disease.
Highlights
Complete laparoscopic splenectomy is defined as a surgical technique in which all surgical maneuvers are performed through ports [1]
To explore an even less invasive form of laparoscopic surgery, “natural orifice transluminal endoscopic surgery” (NOTES), in which the surgical maneuvers and organ extraction are performed through natural orifices without creating abdominal wounds, has been attempted [2, 3]
transvaginal specimen extraction (TVSE) being a technique under development, we generally perform TVSE only for carcinomas diagnosed in the absence of lymph node metastasis and serosa infiltration
Summary
Complete laparoscopic splenectomy is defined as a surgical technique in which all surgical maneuvers are performed through ports [1]. We describe a case in which we performed splenectomy in the supine position and extracted the specimen transvaginally to avoid abdominal incision. A cystic lesion of 28 mm in diameter in the spleen and an enlarged lymph node of 16 mm in diameter in the right external iliac region were observed using abdominal computed tomography (CT; Fig. 1a). There was a hard lymph node in the right groin near the inferior epigastric artery and vein and a whitish tumor in the lower pole of the spleen. The cap maintained aeroperitoneum, a collection bag (Endo CatchTM, Covidien, MA, USA) was inserted in the abdominal cavity via the vagina, and the spleen was collected (Fig. 4b). The extracted inguinal lymph node exhibited a histology similar to the previous ovarian cancer, and it was diagnosed as a metastasis of the ovarian cancer
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