title: A case of splenic metastasis of ovarian cancer treated with complete laparoscopic splenectomy and transvaginal specimen extraction.
abstract: A 61-year-old woman was diagnosed with right inguinal lymph node and splenic metastasis of ovarian serous cystadenocarcinoma. We performed right inguinal lymph node dissection and total laparoscopic splenectomy in the supine position followed by transvaginal specimen extraction (TVSE). First, using three ports, we extracted the right inguinal lymph node. We repaired the posterior wall of the inguinal canal using a mesh plug. We added two ports and displaced the spleen from the retroperitoneum and lifted it using a snake retractor, disconnecting the hilum using an automatic suturing device. Next, the posterior wall of the vagina was intraperitoneally incised. And an Alexis® laparoscopic system was inserted into the vagina. The cap maintained aeroperitoneum, a collection bag was inserted in the abdominal cavity via the vagina, and the spleen was collected. When the spleen was removed from the body, partial fragmentation of the organ was required in the bag. Organ fragmentation was performed only within the bag, and we made sure not to tear the bag. The vaginal wound was laparoscopically sutured. The patient had no operative complications and was able to actively ambulate at the first day after surgery due to a slight postoperative pain. Total laparoscopic splenectomy with TVSE in the supine position may be a safe and feasible method for selected female patients. This technique enables minimally invasive surgery for female patients with splenic disease.
authors.affiliation: Maebashi Red Cross Hospital, 3-21-36 Asahi-chou, Maebashi, Gunma, 371-8511, Japan.|Department of Thoracic and Visceral Organ Surgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, 371-0014, Japan.
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Takase
authors.affiliation: Maebashi Red Cross Hospital, 3-21-36 Asahi-chou, Maebashi, Gunma, 371-8511, Japan. n-tomizawa@maebashi.jrc.or.jp.|Department of Thoracic and Visceral Organ Surgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, 371-0014, Japan. n-tomizawa@maebashi.jrc.or.jp.
authors.forename: Naoki
authors.initials: N
authors.lastname: Tomizawa
authors.affiliation: Maebashi Red Cross Hospital, 3-21-36 Asahi-chou, Maebashi, Gunma, 371-8511, Japan.|Department of Thoracic and Visceral Organ Surgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, 371-0014, Japan.
authors.forename: Yasuaki
authors.initials: Y
authors.lastname: Enokida
authors.affiliation: Maebashi Red Cross Hospital, 3-21-36 Asahi-chou, Maebashi, Gunma, 371-8511, Japan.
authors.forename: Takuya
authors.initials: T
authors.lastname: Shiraishi
authors.affiliation: Maebashi Red Cross Hospital, 3-21-36 Asahi-chou, Maebashi, Gunma, 371-8511, Japan.|Department of Thoracic and Visceral Organ Surgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, 371-0014, Japan.
authors.forename: Ryuji
authors.initials: R
authors.lastname: Katoh
authors.affiliation: Maebashi Red Cross Hospital, 3-21-36 Asahi-chou, Maebashi, Gunma, 371-8511, Japan.|Department of Thoracic and Visceral Organ Surgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, 371-0014, Japan.
authors.forename: Yujin
authors.initials: Y
authors.lastname: Suto
authors.affiliation: Maebashi Red Cross Hospital, 3-21-36 Asahi-chou, Maebashi, Gunma, 371-8511, Japan.|Department of Thoracic and Visceral Organ Surgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, 371-0014, Japan.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Sato
authors.affiliation: Maebashi Red Cross Hospital, 3-21-36 Asahi-chou, Maebashi, Gunma, 371-8511, Japan.|Department of Thoracic and Visceral Organ Surgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, 371-0014, Japan.
authors.forename: Ken
authors.initials: K
authors.lastname: Muroya
authors.affiliation: Maebashi Red Cross Hospital, 3-21-36 Asahi-chou, Maebashi, Gunma, 371-8511, Japan.|Department of Thoracic and Visceral Organ Surgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, 371-0014, Japan.
authors.forename: Ryo
authors.initials: R
authors.lastname: Kurosaki
authors.affiliation: Maebashi Red Cross Hospital, 3-21-36 Asahi-chou, Maebashi, Gunma, 371-8511, Japan.|Department of Thoracic and Visceral Organ Surgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, 371-0014, Japan.
authors.forename: Katsumi
authors.initials: K
authors.lastname: Kobayashi
authors.affiliation: Maebashi Red Cross Hospital, 3-21-36 Asahi-chou, Maebashi, Gunma, 371-8511, Japan.|Department of Thoracic and Visceral Organ Surgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, 371-0014, Japan.
authors.forename: Kazuhisa
authors.initials: K
authors.lastname: Arakawa
authors.affiliation: Maebashi Red Cross Hospital, 3-21-36 Asahi-chou, Maebashi, Gunma, 371-8511, Japan.|Department of Thoracic and Visceral Organ Surgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, 371-0014, Japan.
authors.forename: Tatsumasa
authors.initials: T
authors.lastname: Ando
authors.affiliation: Department of Thoracic and Visceral Organ Surgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, 371-0014, Japan.
authors.forename: Izumi
authors.initials: I
authors.lastname: Takesyohi
keywords: Laparoscopic surgery; Natural orifice specimen extraction; Splenectomy; Transvaginal specimen extraction