Specimen extraction and anvil placement methods in laparoscopic colorectal surgery: A single surgeon’s experience

Abstract

Aim: In minimally invasive surgery, incisions made for specimen extraction or anvil placement affect morbidity. The aim of this study was to analyze and share the experience of a single surgeon in laparoscopic colorectal surgery, specimen extraction, and anvil placement. Material and Methods: Patients who underwent laparoscopic colorectal surgery were evaluated retrospectively. Patient characteristics, operative data, specimen extraction site, and anvil placement methods were assessed. Postoperative complications, length of hospital stay, and outpatient follow-up data were analyzed. Results: A total of 27 patients were included in the study. The group included 6 females and 21 males with a mean age of 64.1±11.6 years. Mean body mass index was 28.9±5.8. Surgery was performed due to colorectal cancer in 20 patients, familial adenomatous polyposis in 3 patients, villous adenoma in 3 patients, and ulcerative colitis in 1 patient. Mean length of hospital stay was 8.8±7 days and mean follow-up time was 13.4±7.7 months. Mean operative time was 188.9±47.1 minutes and total blood loss was 67.4±46.1 mL. Additional abdominal wall incisions were made for specimen extraction in 15 patients (56%). Natural orifice specimen extraction was performed in 10 patients (37%), while the ostomy site was used for specimen extraction in 2 patients (7%). In thirteen patients (48%) the additional abdominal wall incision was used for anvil placement. Of the remaining patients, the anvil was inserted through the transanal route in 3 patients (11%), ileostomy site in 2 patients (7%), and trocar site in 1 patient (4%). An anvil was not used for 8 patients (30%). Conclusion: Specimen extraction and anvil placement in laparoscopic colorectal surgery can be achieved using different techniques, and the use of natural orifices and ostomy sites during the procedure is beneficial. Further research into this subject is needed.