Totally Laparoscopic Total Gastrectomy with Transvaginal Specimen Extraction in Gastric Cancer:

A Report of 4 Cases

Abstract

Although natural-orifice specimen extraction is increasingly performed, no report of total gastrectomy with transvaginal specimen extraction has yet been published. This is the first report to apply this procedure to treat gastric cancer. We applied this procedure to four postmenopausal female patients who previously underwent vaginal delivery. They underwent laparoscopic total gastrectomy and D1+ lymph node dissection for gastric cancer. After posterior colpotomy was performed, an Alexis bundle wound protector with a cap was placed to expand and protect the vaginal incision. The resected specimens were retrieved via the vaginal route. Reconstruction was performed using the intracorporeal Roux-en-Y method. Totally laparoscopic total gastrectomy with transvaginal specimen extraction was successfully accomplished in all patients. No patient developed complications associated with this procedure. We achieved good cosmetic outcomes and patients experienced little pain. Totally laparoscopic total gastrectomy with transvaginal specimen extraction may be safe and feasible in a selected group of patients with gastric cancer.