Anatomical measurements to optimize instrumentation for transvaginal surgery

Kiyokazu Nakajima, Yoshihito Souma, Tsuyoshi Takahashi, Makoto Yamasaki, Yasuaki Miyazaki, Masaki Mori, Yuichiro Doki

Research output: Contribution to journalArticle

Abstract

Background: Use of rigid instruments via transvaginal (TV) route has been proposed as a practical alternative to natural orifice translumenal endoscopic surgery (NOTES) using flexible devices. However, its safety has not been fully evaluated for each abdominal organ with different positional relationship to the vagina. The aim of this study is to obtain baseline anatomical data necessary for safer use of rigid TV instruments, by three-dimensional (3-D) radiologic measurements. Patients and methods: A retrospective study was conducted on 51 consecutive female Japanese patients with aortic aneurysm who underwent whole-body multidetector computed tomography as preoperative evaluation. The gallbladder (GB), esophagogastric junction (EGJ), and spleen were located on 3-D images, and the following were obtained: (1) the distance from the vagina, (2) the transverse deviation from the midline, and (3) the sagittal deviation from the "vagina-promontory (V-P)" line. Results: The median distance from the vagina was 26.1 cm for GB, 30.6 cm for EGJ, and 31.1 cm for spleen. The transverse deviation from the midline was 17.7 for GB, 7.0 for EGJ, and 12.9 for spleen. The sagittal deviation from the V-P line was 7.6 degrees for GB, -7.0 for EGJ, and -10.3 for spleen. The percentage of "negative angle" cases, which means that the target is located "below" the V-P line, was only 9.8 % for GB versus 88 % for EGJ and spleen. Conclusions: The intra-abdominal length of TV instruments should be more than 35 cm in Japanese population. GB is widely deviated from the midline and therefore can be safely approached even with rigid/straight instruments. Access to more midline and distant targets may suffer from interference by the sacral promontory, and be potentially dangerous in terms of risk of compression injury by rigid and straight instruments.

Original languageEnglish
Pages (from-to)2052-2057
Number of pages6
JournalSurgical Endoscopy
Volume27
Issue number6
DOIs
Publication statusPublished - Jan 1 2013
Externally publishedYes

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Vagina
Esophagogastric Junction
Gallbladder
Spleen
Natural Orifice Endoscopic Surgery
Three-Dimensional Imaging
Multidetector Computed Tomography
Aortic Aneurysm
Retrospective Studies
Safety
Equipment and Supplies
Wounds and Injuries
Population

All Science Journal Classification (ASJC) codes

  • Surgery

Cite this

Nakajima, K., Souma, Y., Takahashi, T., Yamasaki, M., Miyazaki, Y., Mori, M., & Doki, Y. (2013). Anatomical measurements to optimize instrumentation for transvaginal surgery. Surgical Endoscopy, 27(6), 2052-2057. https://doi.org/10.1007/s00464-012-2709-2

Anatomical measurements to optimize instrumentation for transvaginal surgery. / Nakajima, Kiyokazu; Souma, Yoshihito; Takahashi, Tsuyoshi; Yamasaki, Makoto; Miyazaki, Yasuaki; Mori, Masaki; Doki, Yuichiro.

In: Surgical Endoscopy, Vol. 27, No. 6, 01.01.2013, p. 2052-2057.

Research output: Contribution to journalArticle

Nakajima, K, Souma, Y, Takahashi, T, Yamasaki, M, Miyazaki, Y, Mori, M & Doki, Y 2013, 'Anatomical measurements to optimize instrumentation for transvaginal surgery', Surgical Endoscopy, vol. 27, no. 6, pp. 2052-2057. https://doi.org/10.1007/s00464-012-2709-2
Nakajima K, Souma Y, Takahashi T, Yamasaki M, Miyazaki Y, Mori M et al. Anatomical measurements to optimize instrumentation for transvaginal surgery. Surgical Endoscopy. 2013 Jan 1;27(6):2052-2057. https://doi.org/10.1007/s00464-012-2709-2
Nakajima, Kiyokazu ; Souma, Yoshihito ; Takahashi, Tsuyoshi ; Yamasaki, Makoto ; Miyazaki, Yasuaki ; Mori, Masaki ; Doki, Yuichiro. / Anatomical measurements to optimize instrumentation for transvaginal surgery. In: Surgical Endoscopy. 2013 ; Vol. 27, No. 6. pp. 2052-2057.
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