Journal of Graduate Medical Education, Dec 1, 2009
Objective To validate standardized instructions for the creation, implementation, and performance... more Objective To validate standardized instructions for the creation, implementation, and performance assessment of a low-fidelity model for Pfannenstiel incision.
Pelvic organ prolapse accounts for 300,000 surgeries annually in the U.S., but little is known ab... more Pelvic organ prolapse accounts for 300,000 surgeries annually in the U.S., but little is known about the comparative efficacy of surgical techniques or the role of perioperative pelvic floor therapy. In the Operations and Pelvic Muscle Training in the Management of Apical Support Loss (OPTIMAL) trial, 374 women with vaginal prolapse and stress urinary incontinence were randomized first to perioperative behavioral therapy …
BACKGROUND: Previous studies comparing robotic-assisted laparoscopic surgery to traditional lapar... more BACKGROUND: Previous studies comparing robotic-assisted laparoscopic surgery to traditional laparoscopic or open surgery in gynecologic oncology have been retrospective. To our knowledge, no prospective randomized trials have thus far been performed on endometrial cancer. OBJECTIVE: We sought to prospectively compare traditional and robotic-assisted laparoscopic surgery for endometrial cancer. STUDY DESIGN: This was a randomized controlled trial. From December 2010 through October 2013, 101 endometrial cancer patients were randomized to hysterectomy, bilateral salpingo-oophorectomy, and pelvic lymphadenectomy either by robotic-assisted laparoscopic surgery or by traditional laparoscopy. The primary outcome measure was overall operation time. The secondary outcome measures included total time spent in the operating room, and surgical outcome (number of lymph nodes harvested, complications, and recovery). The study was powered to show at least a 25% difference in the operation time using 2-sided significance level of .05. The differences between the traditional laparoscopy and the robotic surgery groups were tested by Pearson c 2 test, Fisher exact test, or Mann-Whitney test. RESULTS: In all, 99 patients were eligible for analysis. The median operation time in the traditional laparoscopy group (n ¼ 49) was 170 (range 126-259) minutes and in the robotic surgery group (n ¼ 50) was 139 (range 86-197) minutes, respectively (P < .001). The total time spent in the operating room was shorter in the robotic surgery group (228 vs 197 minutes, P < .001). In the traditional laparoscopy group, there were 5 conversions to laparotomy vs none in the robotic surgery group (P ¼ .027). There were no differences as to the number of lymph nodes removed, bleeding, or the length of postoperative hospital stay. Four (8%) vs no (0%) patients (P ¼ .056) had intraoperative complications and 5 (10%) vs 11 (22%) (P ¼ .111) had major postoperative complications in the traditional and robotic surgery groups, respectively. CONCLUSION: In patients with endometrial cancer, robotic-assisted laparoscopic surgery was faster to perform than traditional laparoscopy. Also total time spent in the operation room was shorter in the robotic surgery group and all conversions to laparotomy occurred in the traditional laparoscopy group. Otherwise, the surgical outcome was similar between the groups. Robotic surgery offers an effective and safe alternative in the surgical treatment of endometrial cancer.
Current Obstetrics and Gynecology Reports, Apr 4, 2012
Endometrial polyps are localized intrauterine overgrowths of endometrial glands and stroma covere... more Endometrial polyps are localized intrauterine overgrowths of endometrial glands and stroma covered by a surface epithelium. They occur singularly or in multiples, may be sessile or pedunculated, and range from a few millimeters to several centimeters in size. They are common, present in 7.8%-41% of women. Their detection has increased with the advent of high-resolution transvaginal sonography, saline-infusion ultrasonography, and hysteroscopy. Polyps are encountered in both premenopausal and postmenopausal women. Many women are asymptomatic, while others present with abnormal bleeding patterns. Most polyps are benign, but hyperplastic and malignant polyps also may occur. Appropriate management of endometrial polyps includes observation, medication, and surgery. Treatment of these lesions should be tailored to each patient based on their symptoms, menopausal status, risk of malignancy, and fertility desires.
Anterior vaginal prolapse (cystocele) repair is the most common surgical treatment for pelvic-org... more Anterior vaginal prolapse (cystocele) repair is the most common surgical treatment for pelvic-organ prolapse in U.S. women. Recurrence rates of ≥40%
Sacrocolpopexy is the gold standard for surgical repair of vaginal prolapse, and it can be perfor... more Sacrocolpopexy is the gold standard for surgical repair of vaginal prolapse, and it can be performed laparoscopically with lower morbidity and shorter hospital stays than can open abdominal surgery. The laparoscopic approach, however, requires suturing and knot-tying skills that can be difficult to master. Many experts advocate robotic-assisted laparoscopy despite limited comparative data. Now, investigators at a single U.S. center have conducted a randomized trial to compare conventional laparoscopic and robotic-assisted …
Minimally invasive surgical procedures offer lower patient morbidity and faster returns to normal... more Minimally invasive surgical procedures offer lower patient morbidity and faster returns to normal activities, arguably lowering overall costs compared with traditional open procedures. The position of the American Association of Gynecologic Laparoscopists is that most hysterectomies for benign disease should be performed vaginally or laparoscopically and that use of these approaches should be facilitated. Results of two studies support this concept. The first study was a cohort review of hysterectomies that were performed for benign and malignant disease in either 2006 or 2009 at a major teaching hospital in Boston (in 2006, a division of …
Ovarian masses requiring surgery are uncommon during girlhood and adolescence, and evidence-based... more Ovarian masses requiring surgery are uncommon during girlhood and adolescence, and evidence-based guidelines are limited. Only about 10% of these masses are malignant and require aggressive treatment — for benign lesions, ovary-conserving cystectomy is preferred over oophorectomy. In a retrospective study of patterns of surgical management of benign adnexal masses in girls and teens age ≤18, investigators used a nationwide hospital discharge database to analyze characteristics of patients, physicians, surgical approaches, and hospitals …
Treatment options for stress urinary incontinence consist of pelvic-floor muscle training (physio... more Treatment options for stress urinary incontinence consist of pelvic-floor muscle training (physiotherapy) and/or surgery; however, success rates vary for both approaches and direct comparisons have been limited. Dutch investigators conducted a 12-month, multicenter, randomized trial to compare physiotherapy with midurethral-sling surgery (retropubic or transobturator polypropylene tape) for moderate-to-severe stress-predominant urinary incontinence in 417 women. Crossing over between groups was permitted. Among women in …
Pelvic organ prolapse accounts for 300,000 surgeries annually in the U.S., but little is known ab... more Pelvic organ prolapse accounts for 300,000 surgeries annually in the U.S., but little is known about the comparative efficacy of surgical techniques or the role of perioperative pelvic floor therapy. In the Operations and Pelvic Muscle Training in the Management of Apical Support Loss (OPTIMAL) trial, 374 women with vaginal prolapse and stress urinary incontinence were randomized first to perioperative behavioral therapy …
Risks associated with gynecologic surgery involving laparoscopic electric morcellation (in which ... more Risks associated with gynecologic surgery involving laparoscopic electric morcellation (in which fibroid or uterine tissue is cut into small pieces to
Initial results of the Colpopexy and Urinary Reduction Efforts (CARE) trial (JW Womens Health 200... more Initial results of the Colpopexy and Urinary Reduction Efforts (CARE) trial (JW Womens Health 2006 Jun 6) showed that, at 2 years, open abdominal
An estimated one in five U.S. women undergoes surgical repair for pelvic organ prolapse, and one ... more An estimated one in five U.S. women undergoes surgical repair for pelvic organ prolapse, and one quarter of these women develop new-onset urinary
Compared with traditional open surgery, minimally invasive gynecologic procedures are associated ... more Compared with traditional open surgery, minimally invasive gynecologic procedures are associated with decreased morbidity, shorter hospital stays, and lower cost (JW Womens Health Jun 16 2011). In two recent studies, researchers examined the costs and benefits of robotic hysterectomy for endometrial cancer. Outcomes and costs for 143 women who underwent robotic hysterectomies at a Canadian tertiary cancer center between 2007 and 2010 were compared with a historical cohort of 160 who underwent laparotomies (133) or traditional laparoscopic …
Surgical Laparoscopy, Endoscopy & Percutaneous Techniques, 2011
Background: In laparoscopic-assisted colon surgery, an abdominal incision is needed to remove the... more Background: In laparoscopic-assisted colon surgery, an abdominal incision is needed to remove the specimen and perform an anastomosis. We adopted the technique of totally laparoscopic right hemicolectomy and transvaginal extraction in women who required right colon resection. Methods: Over a 2-year period, 14 women were scheduled for totally laparoscopic right hemicolectomy with intracorporeal anastomosis and transvaginal colon removal. The indications for surgery included malignant (n = 9) and benign (n = 5) right-side colon pathology. The procedure was accomplished laparoscopically in all patients. In 1 patient, the transvaginal removal was not possible because of a large tumor mass. The American Society of Anesthesiology was III in 13 and II in 1 patient. The mean body mass index was 31.65. Seventy-eight percent of patients had undergone abdominal surgery previously. The mean size of the lesion was 3.75 cm (range, 1.8 to 8.0 cm) and the mean number of lymph nodes was 18.7 (range, 8 to 37). All margins in the resected specimens were macroscopically and microscopically free of any tumor. One patient needed reoperation for intra-abdominal bleeding, whereas 3 patients developed postoperative ileus. Discussion: Laparoscopic right hemicolectomy and transvaginal extraction is a safe and effective procedure that can be added to the armamentarium of surgeons performing laparoscopic colon surgery. This technique may provide both an attractive way to reduce abdominal wall morbidity and a bridge to pure natural orifice transluminal endoscopic surgery for colon surgery.
Although almost 9 years have passed since the FDA approved the da Vinci Surgical System for use i... more Although almost 9 years have passed since the FDA approved the da Vinci Surgical System for use in gynecologic surgery, questions and controversy about
To validate standardized instructions for the creation, implementation, and performance assessmen... more To validate standardized instructions for the creation, implementation, and performance assessment of a low-fidelity model for Pfannenstiel incision. The Pfannenstiel model used at the University of Florida-Jacksonville was broken down into composite steps and constructed by obstetrics-gynecology faculty from across the country. The model was then utilized at participants' home institutions and evaluated with respect to realism of the model, ability to replicate the simulation, appropriateness of the skills checklists, and perceived utility of a publication of similarly catalogued simulation modules for use in obstetrics-gynecology training programs. The model was correctly constructed by 94.7% (18 of 19) participants and 72.2% (13 of 18) completed a post construction/post simulation survey indicating a high degree of perceived educational utility, feasibility of construction, and desire for additional catalogued modules. A low-fidelity simulation model was developed, successful...
Endometrial polyps are localized intrauterine overgrowths of endometrial glands and stroma covere... more Endometrial polyps are localized intrauterine overgrowths of endometrial glands and stroma covered by a surface epithelium. They occur singularly or in multiples, may be sessile or pedunculated, and range from a few millimeters to several centimeters in size. They are common, present in 7.8%-41% of women. Their detection has increased with the advent of high-resolution transvaginal sonography, saline-infusion ultrasonography, and hysteroscopy. Polyps are encountered in both premenopausal and postmenopausal women. Many women are asymptomatic, while others present with abnormal bleeding patterns. Most polyps are benign, but hyperplastic and malignant polyps also may occur. Appropriate management of endometrial polyps includes observation, medication, and surgery. Treatment of these lesions should be tailored to each patient based on their symptoms, menopausal status, risk of malignancy, and fertility desires.
In laparoscopic-assisted colon surgery, an abdominal incision is needed to remove the specimen an... more In laparoscopic-assisted colon surgery, an abdominal incision is needed to remove the specimen and perform an anastomosis. We adopted the technique of totally laparoscopic right hemicolectomy and transvaginal extraction in women who required right colon resection. Over a 2-year period, 14 women were scheduled for totally laparoscopic right hemicolectomy with intracorporeal anastomosis and transvaginal colon removal. The indications for surgery included malignant (n=9) and benign (n=5) right-side colon pathology. The procedure was accomplished laparoscopically in all patients. In 1 patient, the transvaginal removal was not possible because of a large tumor mass. The American Society of Anesthesiology was III in 13 and II in 1 patient. The mean body mass index was 31.65. Seventy-eight percent of patients had undergone abdominal surgery previously. The mean size of the lesion was 3.75 cm (range, 1.8 to 8.0 cm) and the mean number of lymph nodes was 18.7 (range, 8 to 37). All margins in the resected specimens were macroscopically and microscopically free of any tumor. One patient needed reoperation for intra-abdominal bleeding, whereas 3 patients developed postoperative ileus. Laparoscopic right hemicolectomy and transvaginal extraction is a safe and effective procedure that can be added to the armamentarium of surgeons performing laparoscopic colon surgery. This technique may provide both an attractive way to reduce abdominal wall morbidity and a bridge to pure natural orifice transluminal endoscopic surgery for colon surgery.
Journal of Graduate Medical Education, Dec 1, 2009
Objective To validate standardized instructions for the creation, implementation, and performance... more Objective To validate standardized instructions for the creation, implementation, and performance assessment of a low-fidelity model for Pfannenstiel incision.
Pelvic organ prolapse accounts for 300,000 surgeries annually in the U.S., but little is known ab... more Pelvic organ prolapse accounts for 300,000 surgeries annually in the U.S., but little is known about the comparative efficacy of surgical techniques or the role of perioperative pelvic floor therapy. In the Operations and Pelvic Muscle Training in the Management of Apical Support Loss (OPTIMAL) trial, 374 women with vaginal prolapse and stress urinary incontinence were randomized first to perioperative behavioral therapy …
BACKGROUND: Previous studies comparing robotic-assisted laparoscopic surgery to traditional lapar... more BACKGROUND: Previous studies comparing robotic-assisted laparoscopic surgery to traditional laparoscopic or open surgery in gynecologic oncology have been retrospective. To our knowledge, no prospective randomized trials have thus far been performed on endometrial cancer. OBJECTIVE: We sought to prospectively compare traditional and robotic-assisted laparoscopic surgery for endometrial cancer. STUDY DESIGN: This was a randomized controlled trial. From December 2010 through October 2013, 101 endometrial cancer patients were randomized to hysterectomy, bilateral salpingo-oophorectomy, and pelvic lymphadenectomy either by robotic-assisted laparoscopic surgery or by traditional laparoscopy. The primary outcome measure was overall operation time. The secondary outcome measures included total time spent in the operating room, and surgical outcome (number of lymph nodes harvested, complications, and recovery). The study was powered to show at least a 25% difference in the operation time using 2-sided significance level of .05. The differences between the traditional laparoscopy and the robotic surgery groups were tested by Pearson c 2 test, Fisher exact test, or Mann-Whitney test. RESULTS: In all, 99 patients were eligible for analysis. The median operation time in the traditional laparoscopy group (n ¼ 49) was 170 (range 126-259) minutes and in the robotic surgery group (n ¼ 50) was 139 (range 86-197) minutes, respectively (P < .001). The total time spent in the operating room was shorter in the robotic surgery group (228 vs 197 minutes, P < .001). In the traditional laparoscopy group, there were 5 conversions to laparotomy vs none in the robotic surgery group (P ¼ .027). There were no differences as to the number of lymph nodes removed, bleeding, or the length of postoperative hospital stay. Four (8%) vs no (0%) patients (P ¼ .056) had intraoperative complications and 5 (10%) vs 11 (22%) (P ¼ .111) had major postoperative complications in the traditional and robotic surgery groups, respectively. CONCLUSION: In patients with endometrial cancer, robotic-assisted laparoscopic surgery was faster to perform than traditional laparoscopy. Also total time spent in the operation room was shorter in the robotic surgery group and all conversions to laparotomy occurred in the traditional laparoscopy group. Otherwise, the surgical outcome was similar between the groups. Robotic surgery offers an effective and safe alternative in the surgical treatment of endometrial cancer.
Current Obstetrics and Gynecology Reports, Apr 4, 2012
Endometrial polyps are localized intrauterine overgrowths of endometrial glands and stroma covere... more Endometrial polyps are localized intrauterine overgrowths of endometrial glands and stroma covered by a surface epithelium. They occur singularly or in multiples, may be sessile or pedunculated, and range from a few millimeters to several centimeters in size. They are common, present in 7.8%-41% of women. Their detection has increased with the advent of high-resolution transvaginal sonography, saline-infusion ultrasonography, and hysteroscopy. Polyps are encountered in both premenopausal and postmenopausal women. Many women are asymptomatic, while others present with abnormal bleeding patterns. Most polyps are benign, but hyperplastic and malignant polyps also may occur. Appropriate management of endometrial polyps includes observation, medication, and surgery. Treatment of these lesions should be tailored to each patient based on their symptoms, menopausal status, risk of malignancy, and fertility desires.
Anterior vaginal prolapse (cystocele) repair is the most common surgical treatment for pelvic-org... more Anterior vaginal prolapse (cystocele) repair is the most common surgical treatment for pelvic-organ prolapse in U.S. women. Recurrence rates of ≥40%
Sacrocolpopexy is the gold standard for surgical repair of vaginal prolapse, and it can be perfor... more Sacrocolpopexy is the gold standard for surgical repair of vaginal prolapse, and it can be performed laparoscopically with lower morbidity and shorter hospital stays than can open abdominal surgery. The laparoscopic approach, however, requires suturing and knot-tying skills that can be difficult to master. Many experts advocate robotic-assisted laparoscopy despite limited comparative data. Now, investigators at a single U.S. center have conducted a randomized trial to compare conventional laparoscopic and robotic-assisted …
Minimally invasive surgical procedures offer lower patient morbidity and faster returns to normal... more Minimally invasive surgical procedures offer lower patient morbidity and faster returns to normal activities, arguably lowering overall costs compared with traditional open procedures. The position of the American Association of Gynecologic Laparoscopists is that most hysterectomies for benign disease should be performed vaginally or laparoscopically and that use of these approaches should be facilitated. Results of two studies support this concept. The first study was a cohort review of hysterectomies that were performed for benign and malignant disease in either 2006 or 2009 at a major teaching hospital in Boston (in 2006, a division of …
Ovarian masses requiring surgery are uncommon during girlhood and adolescence, and evidence-based... more Ovarian masses requiring surgery are uncommon during girlhood and adolescence, and evidence-based guidelines are limited. Only about 10% of these masses are malignant and require aggressive treatment — for benign lesions, ovary-conserving cystectomy is preferred over oophorectomy. In a retrospective study of patterns of surgical management of benign adnexal masses in girls and teens age ≤18, investigators used a nationwide hospital discharge database to analyze characteristics of patients, physicians, surgical approaches, and hospitals …
Treatment options for stress urinary incontinence consist of pelvic-floor muscle training (physio... more Treatment options for stress urinary incontinence consist of pelvic-floor muscle training (physiotherapy) and/or surgery; however, success rates vary for both approaches and direct comparisons have been limited. Dutch investigators conducted a 12-month, multicenter, randomized trial to compare physiotherapy with midurethral-sling surgery (retropubic or transobturator polypropylene tape) for moderate-to-severe stress-predominant urinary incontinence in 417 women. Crossing over between groups was permitted. Among women in …
Pelvic organ prolapse accounts for 300,000 surgeries annually in the U.S., but little is known ab... more Pelvic organ prolapse accounts for 300,000 surgeries annually in the U.S., but little is known about the comparative efficacy of surgical techniques or the role of perioperative pelvic floor therapy. In the Operations and Pelvic Muscle Training in the Management of Apical Support Loss (OPTIMAL) trial, 374 women with vaginal prolapse and stress urinary incontinence were randomized first to perioperative behavioral therapy …
Risks associated with gynecologic surgery involving laparoscopic electric morcellation (in which ... more Risks associated with gynecologic surgery involving laparoscopic electric morcellation (in which fibroid or uterine tissue is cut into small pieces to
Initial results of the Colpopexy and Urinary Reduction Efforts (CARE) trial (JW Womens Health 200... more Initial results of the Colpopexy and Urinary Reduction Efforts (CARE) trial (JW Womens Health 2006 Jun 6) showed that, at 2 years, open abdominal
An estimated one in five U.S. women undergoes surgical repair for pelvic organ prolapse, and one ... more An estimated one in five U.S. women undergoes surgical repair for pelvic organ prolapse, and one quarter of these women develop new-onset urinary
Compared with traditional open surgery, minimally invasive gynecologic procedures are associated ... more Compared with traditional open surgery, minimally invasive gynecologic procedures are associated with decreased morbidity, shorter hospital stays, and lower cost (JW Womens Health Jun 16 2011). In two recent studies, researchers examined the costs and benefits of robotic hysterectomy for endometrial cancer. Outcomes and costs for 143 women who underwent robotic hysterectomies at a Canadian tertiary cancer center between 2007 and 2010 were compared with a historical cohort of 160 who underwent laparotomies (133) or traditional laparoscopic …
Surgical Laparoscopy, Endoscopy & Percutaneous Techniques, 2011
Background: In laparoscopic-assisted colon surgery, an abdominal incision is needed to remove the... more Background: In laparoscopic-assisted colon surgery, an abdominal incision is needed to remove the specimen and perform an anastomosis. We adopted the technique of totally laparoscopic right hemicolectomy and transvaginal extraction in women who required right colon resection. Methods: Over a 2-year period, 14 women were scheduled for totally laparoscopic right hemicolectomy with intracorporeal anastomosis and transvaginal colon removal. The indications for surgery included malignant (n = 9) and benign (n = 5) right-side colon pathology. The procedure was accomplished laparoscopically in all patients. In 1 patient, the transvaginal removal was not possible because of a large tumor mass. The American Society of Anesthesiology was III in 13 and II in 1 patient. The mean body mass index was 31.65. Seventy-eight percent of patients had undergone abdominal surgery previously. The mean size of the lesion was 3.75 cm (range, 1.8 to 8.0 cm) and the mean number of lymph nodes was 18.7 (range, 8 to 37). All margins in the resected specimens were macroscopically and microscopically free of any tumor. One patient needed reoperation for intra-abdominal bleeding, whereas 3 patients developed postoperative ileus. Discussion: Laparoscopic right hemicolectomy and transvaginal extraction is a safe and effective procedure that can be added to the armamentarium of surgeons performing laparoscopic colon surgery. This technique may provide both an attractive way to reduce abdominal wall morbidity and a bridge to pure natural orifice transluminal endoscopic surgery for colon surgery.
Although almost 9 years have passed since the FDA approved the da Vinci Surgical System for use i... more Although almost 9 years have passed since the FDA approved the da Vinci Surgical System for use in gynecologic surgery, questions and controversy about
To validate standardized instructions for the creation, implementation, and performance assessmen... more To validate standardized instructions for the creation, implementation, and performance assessment of a low-fidelity model for Pfannenstiel incision. The Pfannenstiel model used at the University of Florida-Jacksonville was broken down into composite steps and constructed by obstetrics-gynecology faculty from across the country. The model was then utilized at participants' home institutions and evaluated with respect to realism of the model, ability to replicate the simulation, appropriateness of the skills checklists, and perceived utility of a publication of similarly catalogued simulation modules for use in obstetrics-gynecology training programs. The model was correctly constructed by 94.7% (18 of 19) participants and 72.2% (13 of 18) completed a post construction/post simulation survey indicating a high degree of perceived educational utility, feasibility of construction, and desire for additional catalogued modules. A low-fidelity simulation model was developed, successful...
Endometrial polyps are localized intrauterine overgrowths of endometrial glands and stroma covere... more Endometrial polyps are localized intrauterine overgrowths of endometrial glands and stroma covered by a surface epithelium. They occur singularly or in multiples, may be sessile or pedunculated, and range from a few millimeters to several centimeters in size. They are common, present in 7.8%-41% of women. Their detection has increased with the advent of high-resolution transvaginal sonography, saline-infusion ultrasonography, and hysteroscopy. Polyps are encountered in both premenopausal and postmenopausal women. Many women are asymptomatic, while others present with abnormal bleeding patterns. Most polyps are benign, but hyperplastic and malignant polyps also may occur. Appropriate management of endometrial polyps includes observation, medication, and surgery. Treatment of these lesions should be tailored to each patient based on their symptoms, menopausal status, risk of malignancy, and fertility desires.
In laparoscopic-assisted colon surgery, an abdominal incision is needed to remove the specimen an... more In laparoscopic-assisted colon surgery, an abdominal incision is needed to remove the specimen and perform an anastomosis. We adopted the technique of totally laparoscopic right hemicolectomy and transvaginal extraction in women who required right colon resection. Over a 2-year period, 14 women were scheduled for totally laparoscopic right hemicolectomy with intracorporeal anastomosis and transvaginal colon removal. The indications for surgery included malignant (n=9) and benign (n=5) right-side colon pathology. The procedure was accomplished laparoscopically in all patients. In 1 patient, the transvaginal removal was not possible because of a large tumor mass. The American Society of Anesthesiology was III in 13 and II in 1 patient. The mean body mass index was 31.65. Seventy-eight percent of patients had undergone abdominal surgery previously. The mean size of the lesion was 3.75 cm (range, 1.8 to 8.0 cm) and the mean number of lymph nodes was 18.7 (range, 8 to 37). All margins in the resected specimens were macroscopically and microscopically free of any tumor. One patient needed reoperation for intra-abdominal bleeding, whereas 3 patients developed postoperative ileus. Laparoscopic right hemicolectomy and transvaginal extraction is a safe and effective procedure that can be added to the armamentarium of surgeons performing laparoscopic colon surgery. This technique may provide both an attractive way to reduce abdominal wall morbidity and a bridge to pure natural orifice transluminal endoscopic surgery for colon surgery.
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