ABSTRACT
For slightly larger specimens such as postmenopausal ovaries without malignant features, decompressed adnexal cysts, or the appendix, the 10-12 mm umbilical sleeve is often adequate for tissue removal. Grasping forceps may be placed through an operative laparoscope and the specimen extracted under direct vision by drawing the scope along with the grasped specimen up through the sleeve. This method is well suited to the appendix, as it minimizes the likelihood of wound contamination. Alternatively, the instrument with the specimen may simply be removed together with the sleeve in a manner similar to that described above using a 5 mm sleeve, but this technique is not recommended for removal of the appendix, contaminated, or malignant tissue. If the surgeon is not using an operative (10 mm) laparoscope, a 5 mm laparoscope may be introduced through one of the lateral ports and the tissue recovered with a grasping forceps under direct vision using either
of the above techniques. It is important to grasp and hold onto the specimen while changing to a 5 mm laparoscope in order to avoid losing it within the upper abdomen.
