Step 7 Entrapment and Removal of Specimen

Entrapment of the specimen within a bag for specimen removal is a technically challenging procedure. While bags without a delivery system such as the Lap Sacc can be used, the relatively small space of the retroperitoneum combined with the limited port sites results in the entrapment procedure escalating an order of magnitude in difficulty compared to bags with a delivery system. The Endocatch I and Endocatch II bagsd, with their butterfly net type delivery hoop, aid in entrapment as the metal delivery ring holds open the plastic bag, allowing the specimen to be flipped into the open bag (Fig. 8).

In some instances, particularly when the specimen is very large, entrapment is facilitated by creating an intentional anterior peritoneotomy. The specimen is then negotiated into the larger space of the peritoneal cavity, resulting in easier entrapment.

After entrapment, the specimen is removed intact. The choice of the location for the specimen extraction incision is influenced by the size of the specimen, size of the patient, prior surgical history, and sex of the patient. Options include (i) enlargement of the primary camera port, (ii) a small posterior dorsolumbotomy incision, (iii) a Pfannenstiel incision, or, in a female, (iv) a vaginal extraction (7).

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