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Michel DEGUELDRE

Saint-Pierre University Hospital
Brussels, Belgium
MD, PhD
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Pure transanal laparoscopic repair of early rectovaginal fistula
Background: Rectovaginal fistula is an abnormal connection between the rectum and the vagina, with leakage of rectal contents through the vagina. Different surgeries have been attempted such as direct repair, plug placement, advancement flap, muscle interposition, colostomy, proctectomy or delayed pull-through colo-anal anastomosis. Recently, transanal minimally invasive surgery has been described amongst the surgical options.

Video: The authors present a pure transanal laparoscopic repair of early rectovaginal fistula in a 74-year-old lady, submitted 3 weeks before to a laparoscopic anterior resection of the rectum with ‘en bloc’ hysterectomy for rectal adenocarcinoma (pT4aN0M0). A protective ileostomy was performed at the time of rectal surgery, and the postoperative course was uneventful. After having positioned the patient in a gynecologic position, a new reusable transanal platform according to DAPRI (Karl Storz Endoskope, Tuttlingen, Germany) was adopted. The exploration of the lower rectum put in evidence a 2cm rectovaginal fistula, located at a 3 o’clock position and at a 12cm distance from the anal margin. Absorbable figure-of-8 sutures using Vicryl 2/0 were performed to close the defect. Thanks to the curves of the instruments, the surgeon worked under ergonomic positions, without clashing of the instruments’ tips and any conflict of the surgeon’s hands. At the end of the procedure, injection of methylene blue through the vagina did not show any passage of the product into the lower rectum.

Results: The operative time was 120 minutes and intraoperative bleeding was insignificant. The postoperative course was uneventful, and patient discharge was allowed after 6 days. Due to the reusable nature of all the material implemented, no supplementary cost was necessary. The gastrograffin enema after 2 months showed a complete healing of the fistula. As a result, the protective ileostomy was closed.
Conclusion: Rectovaginal fistula can be repaired through a pure transanal laparoscopy, which prevents complicated and demolition surgeries usually performed through the abdomen.
Surgical intervention
2 years ago
1438 views
96 likes
0 comments
04:58
Pure transanal laparoscopic repair of early rectovaginal fistula
Background: Rectovaginal fistula is an abnormal connection between the rectum and the vagina, with leakage of rectal contents through the vagina. Different surgeries have been attempted such as direct repair, plug placement, advancement flap, muscle interposition, colostomy, proctectomy or delayed pull-through colo-anal anastomosis. Recently, transanal minimally invasive surgery has been described amongst the surgical options.

Video: The authors present a pure transanal laparoscopic repair of early rectovaginal fistula in a 74-year-old lady, submitted 3 weeks before to a laparoscopic anterior resection of the rectum with ‘en bloc’ hysterectomy for rectal adenocarcinoma (pT4aN0M0). A protective ileostomy was performed at the time of rectal surgery, and the postoperative course was uneventful. After having positioned the patient in a gynecologic position, a new reusable transanal platform according to DAPRI (Karl Storz Endoskope, Tuttlingen, Germany) was adopted. The exploration of the lower rectum put in evidence a 2cm rectovaginal fistula, located at a 3 o’clock position and at a 12cm distance from the anal margin. Absorbable figure-of-8 sutures using Vicryl 2/0 were performed to close the defect. Thanks to the curves of the instruments, the surgeon worked under ergonomic positions, without clashing of the instruments’ tips and any conflict of the surgeon’s hands. At the end of the procedure, injection of methylene blue through the vagina did not show any passage of the product into the lower rectum.

Results: The operative time was 120 minutes and intraoperative bleeding was insignificant. The postoperative course was uneventful, and patient discharge was allowed after 6 days. Due to the reusable nature of all the material implemented, no supplementary cost was necessary. The gastrograffin enema after 2 months showed a complete healing of the fistula. As a result, the protective ileostomy was closed.
Conclusion: Rectovaginal fistula can be repaired through a pure transanal laparoscopy, which prevents complicated and demolition surgeries usually performed through the abdomen.
Transumbilical single incision laparoscopic left ovariectomy
Background: Transumbilical single incision laparoscopy has been reported to be a feasible and safe procedure to treat gynecologic diseases. This video presents a left ovariectomy performed in a patient with a symptomatic giant ovarian cyst.

Clinical case: A 56-year-old female with a body mass index of 20.5 kg/m2, was consulted for abdominal pain localized in the left iliac fossa. Preoperative work-up showed a left ovarian cyst of 12cm in diameter. The cyst appeared to be round, with smooth walls, homogenic liquid, and without intracystic proliferations. The procedure was performed using an 11mm reusable port for a 10mm, 30-degree standard length scope, and curved reusable instruments according to Dapri (Karl Storz Endoskope). The specimen was extracted through the umbilicus in a custom-made plastic bag.

Results: No conversion to open surgery nor additional ports were necessary. The laparoscopy lasted 37 minutes and the final umbilical incision length was 15mm. Pathological data revealed a serous cystadenoma. The patient was discharged on postoperative day 1. At 7-month follow-up, no late complications were found and the patient was asymptomatic.

Conclusions: Transumbilical single incision laparoscopy is beneficial for gynecologic diseases and this technique allow for a final scar of minimal size. The cost of the procedure is similar to that of multi-port laparoscopy.
Surgical intervention
7 years ago
3021 views
34 likes
0 comments
03:46
Transumbilical single incision laparoscopic left ovariectomy
Background: Transumbilical single incision laparoscopy has been reported to be a feasible and safe procedure to treat gynecologic diseases. This video presents a left ovariectomy performed in a patient with a symptomatic giant ovarian cyst.

Clinical case: A 56-year-old female with a body mass index of 20.5 kg/m2, was consulted for abdominal pain localized in the left iliac fossa. Preoperative work-up showed a left ovarian cyst of 12cm in diameter. The cyst appeared to be round, with smooth walls, homogenic liquid, and without intracystic proliferations. The procedure was performed using an 11mm reusable port for a 10mm, 30-degree standard length scope, and curved reusable instruments according to Dapri (Karl Storz Endoskope). The specimen was extracted through the umbilicus in a custom-made plastic bag.

Results: No conversion to open surgery nor additional ports were necessary. The laparoscopy lasted 37 minutes and the final umbilical incision length was 15mm. Pathological data revealed a serous cystadenoma. The patient was discharged on postoperative day 1. At 7-month follow-up, no late complications were found and the patient was asymptomatic.

Conclusions: Transumbilical single incision laparoscopy is beneficial for gynecologic diseases and this technique allow for a final scar of minimal size. The cost of the procedure is similar to that of multi-port laparoscopy.