Colectomía total laparoscópica con extracción transvaginal

INTRODUCTION: Transvaginal extraction of the surgical specimen in laparoscopic colectomies has proven to be a safe alternative in selected female patients. By utilizing natural orifices, the minilaparotomy frequently used for specimen extraction is avoided. Consequently, recovery parameters such as postoperative pain and abdominal wall complications are improved, positively impacting aesthetic and functional outcomes. DESCRIPTION: We present the case of a 45-year-old female patient who, in the context of a family history of colorectal cancer, underwent a videocolonoscopy reporting multiple colonic polyps (>100). In the rectum, she presented with fewer than 20 polyps. With a diagnosis of familial adenomatous polyposis, a laparoscopic total colectomy with transvaginal specimen extraction was performed. The patient was placed in a modified Lloyd-Davies position. The abdominal cavity was accessed via the placement of 4 trocars: three 12-mm trocars in the right iliac fossa, right hypochondrium, and supraumbilical region, and one 5-mm trocar in the left iliac fossa. The procedure began with a medial-to-lateral approach to the right colon, sweeping down the retroperitoneal structures. The ileocolic vessels were identified, ligated, and transected with a harmonic scalpel. The middle colic artery was identified and ligated. The procedure continued with a lateral approach and mobilization of the right paracolic gutter. Subsequently, the transverse colon was approached by transecting the gastrocolic ligament and the transverse mesocolon, ensuring complete mobilization of the colon up to the splenic flexure. A medial approach to the left colon followed, with the transection of the inferior mesenteric artery. The left paracolic gutter was then mobilized. Transection at the level of the upper rectum was performed using a 60-mm laparoscopic linear stapler. The surgical specimen was then extracted transvaginally through a posterior colpotomy, protected by a wound retractor. A colorectal anastomosis was created using a 29-mm circular stapler. The integrity of the anastomosis was confirmed using an air leak test. The colpotomy was closed with absorbable suture material. The patient had a favorable recovery and was discharged 72 hours postoperatively. Final pathology reported more than 100 polyps ranging from 5 to 10 mm, consisting of tubular and tubulovillous adenomas with low-grade dysplasia. CONCLUSION: Laparoscopic colectomy with transvaginal specimen extraction is a viable alternative to the standard technique and is feasible to perform in selected female patients.