title: Specimen retrieval approaches in patients undergoing laparoscopic colorectal resections: a literature-based review of published studies.
abstract: OBJECTIVE
  To review the published studies reporting various specimen retrieval incisions being used by colorectal surgeons in patients undergoing laparoscopic colorectal resections (LCR).
  
  
  METHODS
  Standard medical electronic databases were searched to find relevant articles and a summary conclusion was generated.
  
  
  RESULTS
  There were 43 studies reporting various approaches used for the purpose of specimen retrieval in 2388 patients undergoing LCR. The most common approaches were periumbilical midline incision (1260 reported case in the literature), transverse incision (583 reported cases in the literature) in the right- or left iliac fossa, depending on the side of colonic resection, and Pfannensteil incision (293 reported cases in the literature). Periumbilical midline incision was associated with the higher risk of developing incisional hernia (odds ratio 53.72; 95% confidence interval 7.48-386.04; Z = 3.96; P = 0.0001). In terms of surgical site infection (SSI), there was no difference between the three common approaches to specimen retrieval. Transanal and transvaginal approaches were associated with higher risk of SSI.
  
  
  CONCLUSIONS
  Midline, transverse and Pfannensteil incisions were the most commonly used approaches for specimen retrieval following LCR. Midline incision was associated with higher risk of incisional hernia. Risk of SSI was similar in all three common approaches. The transanal and transvaginal approaches pose a higher risk of SSI. These conclusions are based on the combined outcome of published case series, case reports and comparative studies. Randomized, controlled trials with longer follow-up are required before recommending the routine use of any approach for specimen retrieval in patients undergoing LCR.
authors.affiliation: Department of General & Laparoscopic Colorectal Surgery, Worthing Hospital, Worthing, UK and Department of General Surgery, Queen Elizabeth Hospital, Kings Lynn NHS Foundation Trust, Kings Lynn, UK surgeon1wrh@hotmail.com.
authors.forename: Muhammad S
authors.initials: MS
authors.lastname: Sajid
authors.affiliation: Department of General & Laparoscopic Colorectal Surgery, Worthing Hospital, Worthing, UK and Department of General Surgery, Queen Elizabeth Hospital, Kings Lynn NHS Foundation Trust, Kings Lynn, UK.
authors.forename: Muhammad I
authors.initials: MI
authors.lastname: Bhatti
authors.affiliation: Department of General & Laparoscopic Colorectal Surgery, Worthing Hospital, Worthing, UK and Department of General Surgery, Queen Elizabeth Hospital, Kings Lynn NHS Foundation Trust, Kings Lynn, UK.
authors.forename: Parv
authors.initials: P
authors.lastname: Sains
authors.affiliation: Department of General & Laparoscopic Colorectal Surgery, Worthing Hospital, Worthing, UK and Department of General Surgery, Queen Elizabeth Hospital, Kings Lynn NHS Foundation Trust, Kings Lynn, UK.
authors.forename: Mirza K
authors.initials: MK
authors.lastname: Baig
keywords: anal retrieval; colorectal cancer; laparoscopic colorectal surgery; transverse incision; umbilical incision; vaginal retrieval