title: Total laparoscopic subtotal gastrectomy with transvaginal specimen extraction is feasible in advanced gastric cancer.
abstract: OBJECTIVE
  Natural orifice specimen extraction (NOSE) is an ever-evolving advanced laparoscopic technique. NOSE minimizes surgical injury, involving a low risk of wound complications, fewer incisional hernias, faster recovery and less postoperative pain. Laparoscopic gastrectomy combined with NOSE is a procedure that can potentiate the advantages of both minimal invasive techniques. We aim to demonstrate the feasibility of laparoscopic subtotal gastrectomy with transvaginal specimen extraction in advanced gastric cancer.
  
  
  METHODS
  A 72-year-old woman with a 2cm adenocarcinoma in gastric antrum was treated by laparoscopic subtotal gastrectomy and lymph node dissection. A totally laparoscopic Roux-en-Y gastrojejunostomy was constructed. Specimen was extracted through the posterior fornix of vagina without difficulty. Histopathology confirmed pT3pN0 tumor. After a 10-month follow-up the patient was asymptomatic and getting adjuvant chemoradiotherapy.
  
  
  CONCLUSIONS
  Transvaginal specimen extraction after laparoscopic gastric resection for advanced gastric cancer is a feasible procedure. It is offered to selected patients and of course only to female patients. Natural orifice surgery may provide faster recovery and decrease the wound related complications which may cause a delay on postoperative adjuvant chemo-radio therapies. We have presented, as far as we know, the first human case of a transvaginal extraction of an advanced gastric cancer after laparoscopic gastrectomy.
authors.affiliation: Inonu University, Department of Surgery, Malatya, Turkey.
authors.forename: Fatih
authors.initials: F
authors.lastname: Sumer
authors.affiliation: Inonu University, Department of Surgery, Malatya, Turkey. Electronic address: cuneytkayaalp@hotmail.com.
authors.forename: Cuneyt
authors.initials: C
authors.lastname: Kayaalp
authors.affiliation: Inonu University, Department of Surgery, Malatya, Turkey.
authors.forename: Ismail
authors.initials: I
authors.lastname: Ertugrul
authors.affiliation: Inonu University, Department of Surgery, Malatya, Turkey.
authors.forename: Mehmet Ali
authors.initials: MA
authors.lastname: Yagci
authors.affiliation: Inonu University, Department of Surgery, Malatya, Turkey.
authors.forename: Servet
authors.initials: S
authors.lastname: Karagul
keywords: Gastric cancer; Laparoscopic gastrectomy; Natural orifice surgery; Natural orifice transluminal endoscopic surgery; Transvaginal