title: Natural orifice specimen extraction in laparoscopic colorectal surgery: transanal and transvaginal approaches.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: The Texas Endosurgery Institute, 4242 E Southcross Blvd., Suite 1, San Antonio, TX 78222, USA. texasendosurgery@texasendosurgery.com
authors.forename: M E
authors.initials: ME
authors.lastname: Franklin
authors.forename: S
authors.initials: S
authors.lastname: Liang
authors.forename: K
authors.initials: K
authors.lastname: Russek
mesh_terms: D000368:Aged; D001003:Anal Canal; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D003107:Colorectal Surgery / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D057605:Natural Orifice Endoscopic Surgery / Q000379:methods*; D018579:Patient Selection; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D016896:Treatment Outcome; D014621:Vagina