An innovative technique for colorectal specimen retrieval: a new era of "natural orifice specimen extraction" (N.O.S.E).
OBJECTIVE
The common incisions for transabdominal specimen retrieval after laparoscopic colorectal surgery are lower quadrant, midline, or transverse suprapubic incision. This study was designed to evaluate a novel method of specimen extraction after totally laparoscopic proctocolectomies.


METHODS
We retrospectively studied seven women patients from 2004 to 2007. The indication for surgery was familial polyposis coexisting with adenocarcinoma of the upper rectum. A totally laparoscopic proctocolectomy with ileal pouch-anal anastomosis was successfully performed for all cases. The entire specimen was extracted via a transvaginal route.


RESULTS
The mean age of the patients was 49.5 years, and mean body mass index was 25.3 kg/m(2). The mean operating time was 222.5 minutes, and average blood loss was 172 ml. The average hospital stay was 25.5 days. Postoperative complications included ileus (n = 1), pouchitis (n = 1), and deep vein thrombosis (n = 1). The vaginal wound had healed completely by the first follow-up. There was no mortality.


CONCLUSIONS
Our technique of transvaginal retrieval effectively prevents wound-related complications by completely eliminating minilaparotomies for specimen retrieval. It could be called "Natural Orifice Specimen Extraction," or N.O.S.E. We stress the need for innovations in specimen extraction, for which importance is not given by surgeons.
Palanivelu
Chinnusamy
C
GEM Hospital and Postgraduate Institute, 45-A, Pankaja Mill Road, Ramnathapuram, Coimbatore, 641045, India. drcp@gemhospital.net
Rangarajan
Muthukumaran
M
Jategaonkar
Priyadarshan Anand
PA
Anand
Natesan Vijay
NV
D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery*; D011125:Adenomatous Polyposis Coli / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D015992:Body Mass Index; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007194:India / Q000453:epidemiology; D007431:Intraoperative Complications / Q000453:epidemiology / Q000517:prevention & control; D010535:Laparoscopy; D007902:Length of Stay; D008875:Middle Aged; D009378:Neoplasms, Multiple Primary; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control; D016737:Proctocolectomy, Restorative / Q000379:methods*; D011446:Prospective Studies; D012004:Rectal Neoplasms / Q000473:pathology / Q000601:surgery*; D012307:Risk Factors; D016896:Treatment Outcome; D014621:Vagina / Q000601:surgery*; D014945:Wound Healing