All specimens were easily removed transvaginally in partial resection cases. However, during the procedure for the first case, specimens could not be removed transvaginally to the pelvic cavity during left lateral lobectomy, due to the large volume of the liver. Therefore, laparoscopic scissors were used for intra-abdominal reduction of specimens to half the original size. For the second and subsequent cases, specimens were removed transvaginally. The average specimen size for partial liver resections was 6.2×5.0 cm. The average size for 1 of the 2 specimens retrieved during left lateral lobectomies was 14.6×10.6 cm (Fig. 8). No hemorrhage, bile leakage, or other organ injury was noted in necropsy studies.
In our series, transected specimens could be easily removed from the vagina in all partial liver resection cases. In contrast, it was not possible to remove the entire left lateral lobe through the porcine vagina. Of course, there are anatomic differences between the porcine and human pelvic cavity and vagina. Truong et al39 reported that they were able to remove a 14-cm left lateral liver section through the vagina. However, intracorporeal downsizing with scrupulous attention to avoid exposure of malignancies may be necessary to retrieve large specimens through a natural orifice. In addition, future studies should evaluate vaginal trauma after specimen removal.
The authors are grateful thank for the collaboration of the staff at UCSD and Toho University.
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