Abstract
BackgroundThe last procedure performed by the surgeon in laparoscopic surgery is to extract the specimen through the smallest incision possible. This experiment aimed to explore the maximum diameter of specimens that can be extracted through auxiliary incisions of different lengths and shapes by in vitro physical experiments.Materials and methodsWe used the abdominal wall with the muscle layer, fixed on a square wooden frame, to simulate the human abdominal wall. Then, specimen extraction ports were made with circular, inverted Y-shaped and straight-line incisions of different sizes and lengths, and specimens of different sizes were made from tissues of different species. These specimens were extracted from different incisions with a force gauge. The tension value (N) was measured, and records were made of the length or diameter of the smallest auxiliary incision through which a given specimen could pass, as well as the largest specimen diameter that could pass through an incision of a given size. This experiment provides us with preliminary experience-based knowledge of how to choose the appropriate auxiliary incision for surgical specimen extraction according to the diameter of the specimen.ResultsThe maximum diameters of specimens that could be extracted with circular ostomy diameters of 2.4, 2.7 and 3.3 cm were 4.0, 4.5 and 6.0 cm, respectively. Specimens with diameters of 6.0, 8.0 and 10.0 cm could be extracted through inverted Y-shaped incisions with a length around the umbilicus of 1 cm and an extension length of 1.0, 3.0, and 4.0 cm, respectively. Moreover, these same specimens could be extracted through inverted Y-shaped incisions with a length around the umbilicus of 2 cm and extension lengths of 0.0, 1.0 and 2.0 cm. Tough tissue specimens (made from chicken gizzards) with diameters of 1.0, 2.0, 4.0 and 6.0 cm, respectively, could be removed through straight-line incisions measuring 1.0, 2.0, 3.0 and 4.0 cm in length.ConclusionAlong with preoperative imaging, surgical planning and trocar position, the shape and length of auxiliary incisions can be used to improve the extraction of specimens via laparoscopic surgery.
Highlights
The last procedure performed by the surgeon in laparoscopic surgery is to extract the specimen through the smallest incision possible
Along with preoperative imaging, surgical planning and trocar position, the shape and length of auxiliary incisions can be used to improve the extraction of specimens via laparoscopic surgery
For intra-abdominal tumors, especially large specimens, surgical specimens are often removed through an auxiliary abdominal incision, it need to be removed through an auxiliary incision, and the surgeon must consider cosmetic appearance, minimization of trauma and complications, preservation of tumor integrity and the needs of the procedure itself
Summary
The last procedure performed by the surgeon in laparoscopic surgery is to extract the specimen through the smallest incision possible This experiment aimed to explore the maximum diameter of specimens that can be extracted through auxiliary incisions of different lengths and shapes by in vitro physical experiments. In the field of gynecological surgery, it is feasible to perform mini-laparoscopy and single-site robotic surgery, where the surgical specimen can be removed at the end by in-bag transvaginal extraction instead of an external auxiliary abdominal incision These techniques improve the cosmetic results in some gynecologic oncology surgery while ensuring complete specimen removal and good patient outcomes [4,5,6,7]. No study has investigated the relationship between the size of the abdominal wall stoma or the length of the auxiliary incision and the diameter of specimens that can pass through the incision
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