Laparoscopic Specimen Extraction in Vitro and in Vivo

Objectives: To explore the maximum diameter of specimens that can be extracted with different adjuvant incision length and shape by in vitro physical experiments. Materials: and Methods: The abdominal wall with the muscle layer of pigs was fixed on a square wooden frame to simulate the abdominal wall of humans. Then, circular, inverted Y-shaped and straight-line incisions with different sizes and lengths were made for specimen extraction. Specimens of different sizes and textures were then extracted by a force device. The specimen with the largest diameter could be extracted using the smallest incision. The results were analysed by recording the maximum pull force (N). Results: : The maximum diameters of specimens that can be extracted with circular ostomy diameters of 2.4, 2.7 and 3.3 cm are 4.0, 4.5 and 6.0 cm, respectively. Specimens with diameters of 6.0, 8.0 and 10.0 cm could be extracted with inverted Y-shaped incisions with the length around umbilicus of 1 cm and extension length of 1.0, 3.0, 4.0 cm, respectively. Moreover, these same specimens could be extracted with inverted Y-shaped incisions with the length around umbilicus of 2 cm and extension length of 0.0, 1.0 and 2.0 cm, respectively. In straight-line incisions, tough tissue specimens (made from chicken gizzard) with diameters of 1.0, 2.0, 4.0 and 6.0 cm could be removed from incisions with diameters of 1.0, 2.0, 3.0 and 4.0 cm, respectively. Conclusion: Along with preoperative imaging, surgical planning and trocar position, the shape and length of adjuvant incisions can be used to improve the extraction of specimens via laparoscopy.