VM33 - Laparoscopic Rectosigmoid Resection with Transanal Specimen Extraction

Purpose/Background: Several techniques have been described for transanal specimen extraction after colectomy, however the technique is not widely used. This technique has the benefit of improved cosmesis and may have reduced incisional pain after surgery. This video demonstrates this technique in case of a laparoscopic rectosigmoid resection for colonic endometriosis in a 43 year old female.

Methods/Interventions: The patient was taken for a laparoscopic rectosigmoid resection for endometriosis. A medial to lateral dissection was performed and adhesions between the sigmoid colon and the left fallopian tube were taken down. In order to remove an endometrial lesion in the cul-de-sac, the peritoneal reflection was incised anterior to the rectum and dissection was carried out beyond the level of the lesion. The sigmoid was divided with a stapler proximal to the lesions. The rectum was irrigated with betadine and then divided with a monopolar hook and ligature. The specimen was prepared for extraction by dividing the mesentery from the colon. A ringed forceps was inserted through the anus to extract the colon and mesentery separately. The anvil was then passed through the anus into the abdomen and the rectum was stapled closed. A side-to-end colorectal anastomosis was then performed in standard fashion and leak test and sigmoidoscopy was performed.

Results/Outcomes: Patient felt well postoperatively and was discharged home the same day. On outpatient follow-up, patient felt well and endorsed good bowel function with no incontinence or rectal pain.

Conclusion/Discussion: Transanal extraction of the specimen during laparoscopic colectomy for benign indications is safe and feasible. This technique can be considered in appropriate patients as part of a multimodal effort to promote early recovery after colectomy.