title: Sashimi NOTES--extraction of bulky specimens in no-scar operations.
abstract: A major obstacle in no-scar surgery is the extraction of large, bulky or rigid specimen. Thus, a method is needed that allows for extraction of large specimens without situs contamination in women and men. It should enable safe treatment of infectious or malignant disease while preserving pathologic workup. Five patients suffering from diverticulitis with expected bulky and rigid specimen were enrolled into this early series. Preparation was performed transumbilically in single-port technique. To prevent new scar formation, the incision was limited to the base of the umbilicus without extension onto the sound abdominal skin. A functionally and topologically extracorporeal compartment was created within the abdomen by introduction and insufflation of a tear-proof impermeable retrieval bag. The specimen was sliced in a controlled fashion inside the compartment along a pre-marked geometry. Controlled specimen dissection in a dedicated intraabdominal resection compartment was feasible. The dissected specimen could be retrieved through the 1.5 cm umbilical incision without spillage of material. The geometry of the extracted organ was reconstructed in detail allowing for uncompromised pathological workup. Extraction of bulky and rigid specimen is possible through natural orifices by the proposed controlled dissection method enabling the pathologist to reconstruct anatomical affiliation.
authors.affiliation: Department of Surgery, Dr. Margarete Fischer-Bosch-Institute for Clinical Pharmacology, Robert-Bosch-Krankenhaus, Stuttgart, Germany. wolfram.lamade@rbk.de
authors.forename: Wolfram
authors.initials: W
authors.lastname: Lamadé
authors.forename: Fabian
authors.initials: F
authors.lastname: Rieber
authors.forename: Colin
authors.initials: C
authors.lastname: Friedrich
authors.forename: Tarkan
authors.initials: T
authors.lastname: Basar
authors.forename: Christoph
authors.initials: C
authors.lastname: Ulmer
authors.forename: Oliver
authors.initials: O
authors.lastname: Bannier
authors.forename: Klaus Peter
authors.initials: KP
authors.lastname: Thon
mesh_terms: D002921:Cicatrix / Q000517:prevention & control; D004238:Diverticulitis / Q000473:pathology / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D057605:Natural Orifice Endoscopic Surgery / Q000379:methods*; D020858:Tissue and Organ Harvesting / Q000379:methods*; D016896:Treatment Outcome; D014472:Umbilicus / Q000601:surgery