Pouch of Douglas: A Noble Route for Surgical Specimen Retrieval in Laparoscopic Pelvic Mass Surgery

Abstract

Aim: To evaluate the feasibility and surgical outcome of surgical specimen retrieval through the pouch of Douglas by an innovative way of puncturing the same with a 10 mm trocar and cannula in 100 consecutive women undergoing laparoscopic gynecological procedures for a pelvic mass. Materials and methods: A prospective study over a period of 2 years from June 2012 to June 2014; 100 cases of pelvic mass (small-to-large) surgeries were done laparoscopically and specimens removed through pouch of Douglas by our own new method of puncturing the same with 10 mm trocar and cannula and putting the mass in endobag and removing with a grasper. Parameters studied were indications, operative time, blood loss, spillage, postoperative pain, long-term complications. Results: In 96% of cases, surgical specimens were retrieved successfully, with minimal spillage without any intraoperative or postoperative complication. Though the rest 4% were retrieved successfully, 2% had laceration but they were managed intraoperatively, 2% had postoperative abscess formation managed conservatively. Only 5% had pain in vagina at 24 hours on 10 cm visual analog scale (VAS); 95% cases had no complaint of dyspareunia on 3rd month follow-up and 5% were lost to follow-up. Conclusion: A pouch of Douglas approach for specimen removal by our new method after laparoscopic resection of pelvic masses offers the advantage of less postoperative pain, with minimal spillage, good cosmetic result, and patient satisfaction without prolonging the operative time. Clinical significance: Tissue retrieved through pouch of Douglas after puncturing with 10 mm trocar with cannula under vision is a safe, feasible, less time-consuming method in laparoscopic pelvic mass surgery. It avoids the enlargement of operative port site.