Background

Seamless specimen retrieval is key to a successful laparoscopic vertical sleeve gastrectomy. Multiple methods have been described including hand-over-hand technique, laparoscopic extraction bag, wound protector, and snare ligature. Bag tearing, specimen avulsion, and multiple fascial spreads lead to surgeon frustration and increased operative time. The best method has yet to be determined. Objectives:Compare specimen extraction techniques in laparoscopic vertical sleeve gastrectomy Setting:Community hospital

Methods

Three different techniques were compared: snare plus bag, wound protector, and no accessory use. Sleeve gastrectomy was performed in standard fashion with slight variations for each extraction technique. Snare and bag technique used 15mm port with 32Fr bougie. 12mm port and 40Fr bougie was used for wound protector and no accessory techniques. Each method was also compared for time and cost of resources.

Results

On average, the shortest time for specimen extraction did not use any accessories (58sec), followed by wound protector (1min 33sec), and snare plus bag (1min 45sec). Wound protector cost $60. Snare ($26.80) and bag ($74.30) cost $101.10 total. Techniques that used 12mm port required fascial spreading prior to extraction, whereas the 15mm port did not.

Conclusions

Each retrieval method has its benefits, some at a small additional cost and marginal increase in operative time. These factors can help surgeons determine the best technique for a seamless operation. Further investigation is needed to determine differences in postoperative pain and port site hernia risk when extracting from a 15mm port versus 12mm port with fascial spreading.