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• Specimen retrieval is a challenging step of laparoscopic subtotal hysterectomy (LSH). • Unsuspected malignancy could be spread intrabdominally at the time of morcellation. • Morcellation inside a purpose-built bag (contained) preserves oncological safety. • Specimen extraction through the posterior vaginal fornix is a reliable procedure. • Transvaginal contained uterus morcellation and extraction is feasible and safe in LSH. Laparoscopic subtotal hysterectomy (LSH) is a possible treatment for patients with benign uterine disease. Once the hysterectomy has been completed, morcellation and extraction of the corpus uteri is a crucial step of the procedure. We here present a case series to evaluate the feasibility of the in-bag transvaginal specimen retrieval following LSH. We report a case series of consecutive patients who underwent LSH followed by in-bag transvaginal specimen retrieval. LSH was accomplished in a standard fashion. Once the uterus was detached from the cervix, a 2 cm posterior colpotomy was performed laparoscopically with a monopolar hook under direct view to insert a specimen retrieval bag into the abdomen. The corpus uteri was placed into the bag and transvaginal contained manual morcellation was performed. The colpotomy was then sutured transvaginally. Baseline patients' characteristics and surgical data were collected. Postoperative complications, same-hospital readmissions, and reoperations were registered if occurred within 30 days from surgery. Patients' median age and BMI were 45,5 and 22,7, respectively. Median operative time was 71.5 min (range 34–143) and uterus weight ranged from 60 g to 470 g (median 210 g). The estimated blood loss was 100 mL (median) and no blood transfusion was required. No conversions to open surgery, nor intraoperative complications occurred. Median hospital stay was 2 days (1–3) and no postoperative complications within 30 days from surgery were recorded. LSH followed by in-bag transvaginal specimen extraction is a promising technique and might be considered a reliable and safe option to further reduce the invasiveness of the procedure. [ABSTRACT FROM AUTHOR]

Introduction: Port site hernias continue to be a major problem in laparoscopic surgery. The causes of this type of hernia are numerous. The main ones are operative wound infection, obesity, male gender, diabetes, BPH, etc. However, in addition to these factors it seems that in the etiology of post laparoscopic port - site hernias are at least two other factors that have an impact on these complications. Aim of the article is to assess the role of different factors in the occurrence of port site incisional hernias according to our experience. Material and Methods: the 187 patients who were operated on at the General Surgery Department of the Clinical Hospital of Tetovo between January, 2017 and June, 2019 on whom the surgical intervention was performed through laparoscopic techniques were included in this study. The reason for the surgical interventions has been various surgical pathologies of the abdomen such as cholecystolithiasis, acute appendicitis, cysts of the liver, ovaries and kidneys, etc. Postoperative complications in these patients, especially port site hernia will be in the focus of our study. Results: Out of the total of 187 patients included in this study the occurrence of incisional hernia was recorded in six of them. In five patients the hernia was localized at the site of insertion of the supra-umbilical trocar, while in the other, the trocar was inserted below the xiphoid process. From our records it happened that in all these patients, with postoperative hernia, the insertion of the cannula was done with the cutting trocar. At the same time in all six patients with post laparoscopic hernia the surgical intervention performed was cholecystectomy or appendectomy. Thus, the removal of the gallbladder and appendix, without the use of an Endo-bag, was performed at the site of the hernia presentation. In all these patients the entrance porta infection in which the hernia has occurred, was registered in the early post operative period. Conclusion: Of the many factors that increase the risk of incisional hernias, at the site of cannula insertion during laparoscopic interventions, it seems that the type of trocar and the place from which the extruded organ is removed, if it is done without the use of an Endo-bag, are very important.