title: Transvaginal specimen extraction after combined laparoscopic splenectomy and hysterectomy: Introduction to NOSE (Natural Orifice Specimen Extraction) in a community hospital.
abstract: BACKGROUND
  Developments in the field of minimally invasive surgery have led to interest in NOTES (natural orifice transluminal endoscopic surgery). Even as technologies continue to evolve and develop, interest in some of the advantages of specimen retrieval transvaginally has been roused and we describe a case of combined laparoscopic splenectomy and hysterectomy with transvaginal retrieval of both specimens.
  
  
  METHODS
  Patient underwent laparoscopic splenectomy and robot-assisted hysterectomy with transvaginal delivery of specimens. Total operative time was 245min with no complications. Closure of the colpotomy was achieved laparoscopically. Post-operative course was unremarkable. Patient has done well clinically at 18 months follow-up except for an episode of post-coital spotting, which resolved spontaneously.
  
  
  CONCLUSIONS
  We explored the technical feasibility of concurrent laparoscopic splenectomy and hysterectomy along with transvaginal retrieval of both solid organs without morcellation. We wanted to illustrate the fact that transvaginal organ extraction may be performed safely in a community or district hospital with standard instruments without incurring additional cost, morbidity or increased operating time.
  
  
  CONCLUSIONS
  Transvaginal specimen retrieval was technically easy to accomplish. Our patient has not experienced any infectious complications or sexual dysfunction to date. For surgeons exploring an alternative to transabdominal specimen retrieval, transvaginal NOSE is an attractive proposition with several advantages. When combined with a gynecological procedure that involves a colpotomy, this may present a unique opportunity to explore the utility of NOSE.
authors.affiliation: 18250N 32nd Street, Unit 1034, Phoenix, AZ 85032, United States. Electronic address: vijayboyz@gmail.com.
authors.forename: Mohan
authors.initials: M
authors.lastname: Ramalingam
authors.forename: Jon
authors.initials: J
authors.lastname: King
authors.forename: Lisa
authors.initials: L
authors.lastname: Jaacks
keywords: Hysterectomy; Natural orifice surgery; Splenectomy; Transvaginal specimen extraction