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Natural orifice specimen extraction in laparoscopic colorectal surgery: transanal and transvaginal approaches

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This study was designed to evaluate the outcomes of patients who underwent various laparoscopic colorectal procedures with natural orifice specimen extraction (NOSE) at our institute over a 20-year period. Specifically, the study aimed to investigate whether transanal and transvaginal approaches are safe and effective alternatives for extracting the specimen during laparoscopic colorectal surgeries.


We analyzed a prospectively designed database of a consecutive series of patients who underwent various laparoscopic colorectal surgeries for different rectal pathologies between April 1991 and May 2011 at the Texas Endosurgery Institute. The selection criteria for the NOSE approach were based on disease entities, site and size of tumors, and distance of colorectal lesions from the anal verge.


A total of 303 patients underwent laparoscopic colorectal procedures with the NOSE approach for specimen extraction, including 277 transanal and 26 transvaginal extractions. The operative time for procedures with transanal specimen extraction was 164.7 ± 47.5 min, the estimated blood loss was 87.5 ± 46.7 ml, and the rate of postoperative complications was 3.6 %. For laparoscopic right hemicolectomy with transvaginal specimen extraction, the operative time was 159 ± 27.1 min and the estimated blood loss was 83.5 ± 14.4 ml. Intraoperatively, transvaginal extraction was associated with 2 complications (7.7 %); however, this procedure was not associated with any postoperative complications. The length of hospital stay was 6.9 ± 2.8 and 5.5 ± 2.5 days for patients who underwent transanal extraction and transvaginal extraction, respectively.


Both transanal and transvaginal specimen extractions in laparoscopic colorectal surgeries are safe and effective approaches with comparable postoperative complication rates. In comparison with transanal specimen extraction, transvaginal extraction is more complicated due to the anatomy of the pouch of Douglas. The transvaginal approach thus needs more effective extraction devices for preventing injury to adjacent organs, especially the sigmoid colon and rectum.

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  1. Franklin ME Jr, Ramos R, Rosenthal D, Schuessler W (1993) Laparoscopic colonic procedures. World J Surg 17:51–56

    Article  PubMed  Google Scholar 

  2. Bernstein MA, Dawson JW, Reissman P, Weiss EG, Nogueras JJ, Wexner SD (1996) Is complete laparoscopic colectomy superior to laparoscopic assisted colectomy? Am Surg 62:507–511

    PubMed  CAS  Google Scholar 

  3. Hazebroek EJ, Color Study Group (2002) COLOR: a randomized clinical trial comparing laparoscopic and open resection for colon cancer. Surg Endosc 16:949–953

    Article  PubMed  CAS  Google Scholar 

  4. Lacy AM, García-Valdecasas JC, Delgado S, Castells A, Taurá P, Piqué JM, Visa J (2002) Laparoscopy-assisted colectomy versus open colectomy for treatment of non-metastatic colon cancer: a randomised trial. Lancet 359:2224–2229

    Article  PubMed  Google Scholar 

  5. Senagore AJ, Delaney CP, Madboulay K, Brady KM, Fazio VW (2003) Laparoscopic colectomy in obese and nonobese patients. J Gastrointest Surg 7:558–561

    Article  PubMed  Google Scholar 

  6. Kaiser AM, Kang JC, Chan LS, Vukasin P, Beart RW Jr (2004) Laparoscopic-assisted vs. open colectomy for colon cancer: a prospective randomized trial. J Laparoendosc Adv Surg Tech A 14:329–334

    PubMed  Google Scholar 

  7. Clinical Outcomes of Surgical Therapy Study Group (2004) A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med 350:2050–2059

    Article  Google Scholar 

  8. Senagore AJ, Delaney CP, Brady KM, Fazio VW (2004) Standardized approach to laparoscopic right colectomy: outcomes in 70 consecutive cases. J Am Coll Surg 199:675–679

    Article  PubMed  Google Scholar 

  9. Raftopoulos I, Courcoulas AP, Blumberg D (2006) Should completely intracorporeal anastomosis be considered in obese patients who undergo laparoscopic colectomy for benign or malignant disease of the colon? Surgery 40:675–682

    Article  Google Scholar 

  10. Reza MM, Blasco JA, Andradas E, Cantero R, Mayol J (2006) Systematic review of laparoscopic versus open surgery for colorectal cancer. Br J Surg 93:921–928

    Article  PubMed  CAS  Google Scholar 

  11. Senagore AJ, Delaney CP (2006) A critical analysis of laparoscopic colectomy at a single institution: lessons learned after 1000 cases. Am J Surg 191:377–380

    Article  PubMed  Google Scholar 

  12. Bonjer HJ, Hop WC, Nelson H et al (2007) Laparoscopically assisted vs open colectomy for colon cancer: a meta-analysis. Arch Surg 142:298–303

    Article  PubMed  Google Scholar 

  13. Bergamaschi R, Schochet E, Haughn C, Burke M, Reed JF 3rd, Arnaud JP (2008) Standardized laparoscopic intracorporeal right colectomy for cancer: short-term outcome in 111 unselected patients. Dis Colon Rectum 51:1350–1355

    Article  PubMed  Google Scholar 

  14. Franklin ME Jr, Kelley H, Kelley M, Brestan L, Portillo G, Torres J (2008) Transvaginal extraction of the specimen after total laparoscopic right hemicolectomy with intracorporeal anastomosis. Surg Laparosc Endosc Percutan Tech 18:294–298

    Article  PubMed  Google Scholar 

  15. Laurent C, Leblanc F, Bretagnol F, Capdepont M, Rullier E (2008) Long-term wound advantages of the laparoscopic approach in rectal cancer. Br J Surg 95:903–908

    Article  PubMed  CAS  Google Scholar 

  16. Singh R, Omiccioli A, Hegge S, McKinley C (2008) Does the extraction-site location in laparoscopic colorectal surgery have an impact on incisional hernia rates? Surg Endosc 22:2596–2600

    Article  PubMed  Google Scholar 

  17. Akamatsu H, Omori T, Oyama T, Tori M, Ueshima S, Nakahara M, Abe T, Nishida T (2009) Totally laparoscopic sigmoid colectomy: a simple and safe technique for intracorporeal anastomosis. Surg Endosc 23:2605–2609

    Article  PubMed  Google Scholar 

  18. Hellan M, Anderson C, Pigazzi A (2009) Extracorporeal versus intracorporeal anastomosis for laparoscopic right hemicolectomy. JSLS 13:312–317

    PubMed  Google Scholar 

  19. Hussain A, Mahmood H, Singhal T, Balakrishnan S, Nicholls J, El-Hasani S (2009) Long-term study of port-site incisional hernia after laparoscopic procedures. JSLS 13:346–349

    PubMed  Google Scholar 

  20. Knol J, D’Hondt M, Dozois EJ, Vanden Boer J, Malisse P (2009) Laparoscopic-assisted sigmoidectomy with transanal specimen extraction: a bridge to NOTES? Tech Coloproctol 13:65–68

    Article  PubMed  CAS  Google Scholar 

  21. Laurent C, Leblanc F, Wütrich P, Scheffler M, Rullier E (2009) Laparoscopic versus open surgery for rectal cancer: long-term oncologic results. Ann Surg 250:54–61

    Article  PubMed  Google Scholar 

  22. Ooi BS, Quah HM, Fu CW, Eu KW (2009) Laparoscopic high anterior resection with natural orifice specimen extraction (NOSE) for early rectal cancer. Tech Coloproctol 13:61–64

    Google Scholar 

  23. Grams J, Tong W, Greenstein AJ, Salky B (2010) Comparison of intracorporeal versus extracorporeal anastomosis in laparoscopic-assisted hemicolectomy. Surg Endosc 24:1886–1891

    Article  PubMed  Google Scholar 

  24. Winslow ER, Fleshman JW, Birnbaum EH, Brunt LM (2002) Wound complications of laparoscopic vs open colectomy. Surg Endosc 16:1420–1425

    Article  PubMed  CAS  Google Scholar 

  25. Brennan TJ, Zahn PK, Pogatzki-Zahn EM (2005) Mechanism of incisional pain. Anesthesiol Clin N Am 23:1–20

    Article  CAS  Google Scholar 

  26. Leroy J, Costantino F, Cahill RA, D’Agostino J, Morales A, Mutter D, Marescaux J (2011) Laparoscopic resection with transanal specimen extraction for sigmoid diverticulitis. Br J Surg 98:1327–1334

    Article  PubMed  CAS  Google Scholar 

  27. Nishimura A, Kawahara M, Suda K, Makino S, Kawachi Y, Nikkuni K (2011) Totally laparoscopic sigmoid colectomy with transanal specimen extraction. Surg Endosc 25:3459–3463

    Article  PubMed  Google Scholar 

  28. Saad S, Hosogi H (2011) Laparoscopic left colectomy combined with natural orifice access: operative technique and initial results. Surg Endosc 25:2742–2747

    Article  PubMed  Google Scholar 

  29. Franklin ME Jr, Trevino JM (2007) Laparoscopic right, left, low anterior, abdominoperineal and total colon resection. In: Fischer JE, Bland KI (eds) Mastery of surgery. Lippincott Williams & Wilkins, Philadelphia, pp 1490–1509

    Google Scholar 

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Correspondence to M. E. Franklin Jr..

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Franklin, M.E., Liang, S. & Russek, K. Natural orifice specimen extraction in laparoscopic colorectal surgery: transanal and transvaginal approaches. Tech Coloproctol 17 (Suppl 1), 63–67 (2013).

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