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Vaginal Extraction of Specimen in Laparoscopic Surgery: Technique and Considerations скачать в хорошем качестве

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Vaginal Extraction of Specimen in Laparoscopic Surgery: Technique and Considerations
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Vaginal Extraction of Specimen in Laparoscopic Surgery: Technique and Considerations

Vaginal extraction of specimens in laparoscopic surgery is an effective technique to remove large tissue masses while minimizing abdominal incisions. This approach is particularly useful in **gynecological, colorectal, and general laparoscopic surgeries**, offering advantages such as reduced postoperative pain, shorter recovery time, and better cosmetic outcomes. Indications *Gynecological Surgeries:* Total laparoscopic hysterectomy (TLH), myomectomy, oophorectomy. *Colorectal Surgeries:* Sigmoidectomy, anterior resection, right hemicolectomy. *General Surgery:* Appendectomy (for large mucocele), cholecystectomy (in selected cases). Preoperative Considerations *Patient Selection:* Vaginal extraction is suitable for patients with adequate vaginal capacity and no contraindications such as severe vaginal stenosis or pelvic infections. *Specimen Size and Integrity:* The specimen should be appropriately morcellated or contained within an endobag to prevent contamination. *Anesthesia and Positioning:* Patients are placed in a *lithotomy position* to allow easy vaginal access if required. Surgical Technique *1. Preparation of the Vaginal Route* Ensure *bladder is catheterized* to prevent injury. A *vaginal retractor* or speculum may be used to expose the posterior fornix. In TLH cases, the vaginal vault is already open after colpotomy. *2. Colpotomy for Specimen Extraction* If colpotomy has not been performed, a *small incision* is made in the posterior vaginal fornix using monopolar or harmonic energy. The incision should be large enough to accommodate the specimen but small enough to allow easy closure. *3. Specimen Containment and Retrieval* *Use of Endobag:* The specimen is placed in a retrieval bag intra-abdominally to avoid spillage and contamination. *Gradual Extraction:* The bag is gently pulled through the vaginal incision using graspers or fingers. *Morcellation (if necessary):* Large specimens may require in-bag morcellation before extraction. *4. Closure of Vaginal Incision* The vaginal vault is closed using *absorbable sutures* (Vicryl 2-0 or equivalent) in a continuous or interrupted manner. Ensure *hemostasis is achieved* before completing the closure. Postoperative Care *Early Ambulation:* Reduces the risk of thromboembolism. *Vaginal Hygiene:* Patients should avoid intercourse or douching for a few weeks to allow proper healing. *Follow-up:* Monitor for signs of infection, hematoma, or vaginal vault dehiscence. Advantages of Vaginal Extraction *Smaller abdominal incisions* leading to better cosmetic outcomes. *Reduced postoperative pain* and faster recovery. *Lower risk of incisional hernia* compared to mini-laparotomy. Conclusion Vaginal extraction of specimens in laparoscopic surgery is a safe and effective technique that enhances patient recovery and surgical outcomes. Proper patient selection, meticulous surgical technique, and adequate closure of the vaginal vault ensure optimal results with minimal complications.

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