title: [Reducing invasiveness of laparoscopic surgery using natural orifices and abdominal wall defects for extraction of the specimen].
abstract: BACKGROUND
  Due to significant technical evolution complex surgeries can be performed laparoscopically nowadays. However, laparotomy is needed frequently for the extraction of the specimen, which decreases the advantages of laparoscopy.
  
  
  OBJECTIVE
  The aim of the authors was to analyse and present their experience on the use of natural orifices and abdominal wall defects for extraction of the surgical specimen.
  
  
  METHODS
  From 2009 the authors used natural orifices (stomach, vagina, rectum) when viscerotomy was an obligate part of laparoscopic surgery and, in a special gastrointestinal laparoscopic operation, the gate of the inguinal hernia for specimen extraction.
  
  
  RESULTS
  In 3 patients benign lesions of the stomach were extracted using gastroscope. In 6 patients with bowel endometriosis, in whom the wall of the vagina was completely infiltrated, the resected bowel was extracted transvaginally, and in 5 patients transrectal extraction of the specimen was performed. In 2 patients the inguinal hernia was used for the surgical specimen extraction after laparoscopic sigmoid resection, and in one patient a single-port was inserted into the gate of the hernia during laparoscopic cholecystectomy. Complications occurred only after transvaginal specimen extraction (rectovaginal fistula in 2 patients).
  
  
  CONCLUSIONS
  Use of natural orifices and abdominal wall defects for surgical specimen extraction further decreases the invasiveness of laparoscopic surgery, if indications made appropriately.
authors.affiliation: Semmelweis Egyetem, Általános Orvostudományi Kar I. Sebészeti Klinika Budapest Üllői út 78. 1082.
authors.forename: Péter
authors.initials: P
authors.lastname: Lukovich
authors.affiliation: Semmelweis Egyetem, Általános Orvostudományi Kar I. Nőgyógyászati Klinika Budapest.
authors.forename: Attila
authors.initials: A
authors.lastname: Bokor
mesh_terms: D000328:Adult; D013505:Digestive System Surgical Procedures / Q000295:instrumentation / Q000379:methods*; D004715:Endometriosis / Q000601:surgery*; D005260:Female; D020699:Gastroscopes / Q000706:statistics & numerical data; D006552:Hernia, Inguinal; D006801:Humans; D007410:Intestinal Diseases / Q000601:surgery*; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D057605:Natural Orifice Endoscopic Surgery / Q000295:instrumentation / Q000379:methods*; D012007:Rectum; D013048:Specimen Handling / Q000379:methods*; D014621:Vagina
keywords: natural orifice specimen extraction; természetes szájadékokon keresztüli specimeneltávolítás (NOSE); transgastric; transgastricus; transhernial specimen extraction; transhernialis specimeneltávolítás; transrectal; transrectalis; transvaginal; transvaginalis