title: Transvaginal specimen extraction in colorectal surgery: current state of the art.
abstract: OBJECTIVE
  
  
  
  BACKGROUND
  The expected benefit of transvaginal specimen extraction is reduced incision-related morbidity.
  
  
  OBJECTIVE
  A systematic review of transvaginal specimen extraction in colorectal surgery was carried out to assess this expectation.
  
  
  METHODS
  
  
  
  METHODS
  The following keywords, in various combinations, were searched: NOSE (natural orifices specimen extraction), colorectal, colon surgery, transvaginal, right hemicolectomy, left hemicolectomy, low anterior resection, sigmoidectomy, ileocaecal resection, proctocolectomy, colon cancer, sigmoid diverticulitis and inflammatory bowel diseases.
  
  
  METHODS
  SELECTION CRITERIA included large bowel resection with transvaginal specimen extraction, laparoscopic approach, human studies and English language. Exclusion criteria were experimental studies and laparotomic approach or local excision. All articles published up to February 2011 were included.
  
  
  RESULTS
  Twenty-three articles (including a total of 130 patients) fulfilled the search criteria. The primary diagnosis was colorectal cancer in 51% (67) of patients, endometriosis in 46% (60) of patients and other conditions in the remaining patients. A concurrent gynaecological procedure was performed in 17% (22) of patients. One case of conversion to laparotomy was reported. In two patients, transvaginal extraction failed. In left- and right-sided resections, the rate of severe complications was 3.7% and 2%, respectively. Two significant complications, one of pelvic seroma and one of rectovaginal fistula, were likely to have been related to transvaginal extraction. The degree of follow up was specified in only one study. Harvested nodes and negative margins were adequate and reported in 70% of oncological cases.
  
  
  CONCLUSIONS
  Vaginal extraction of a colorectal surgery specimen shows potential benefit, particularly when associated with a gynaecological procedure. Data from prospective randomized trials are needed to support the routine use of this technique.
authors.affiliation: IRCAD/EITS, University Hospital of Strasbourg, Strasbourg, France.
authors.forename: M
authors.initials: M
authors.lastname: Diana
authors.forename: S
authors.initials: S
authors.lastname: Perretta
authors.forename: J
authors.initials: J
authors.lastname: Wall
authors.forename: F A
authors.initials: FA
authors.lastname: Costantino
authors.forename: J
authors.initials: J
authors.lastname: Leroy
authors.forename: N
authors.initials: N
authors.lastname: Demartines
authors.forename: J
authors.initials: J
authors.lastname: Marescaux
mesh_terms: D003082:Colectomy / Q000379:methods*; D003108:Colonic Diseases / Q000601:surgery*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D057605:Natural Orifice Endoscopic Surgery; D014621:Vagina