title: Laparoscopic Anterior Resection with Transvaginal Specimen Extraction (TVSE) for Colorectal Cancer and Concomitant Total Hysterectomy and Bilateral Salpingo-Oophrectomy (THBSO): A Technical Description.
abstract: BACKGROUND
  Natural orifice specimen extraction (NOSE) has evolved to circumvent the need for a specimen extraction site. Transvaginal specimen extraction (TVSE) for colorectal disease has been shown to be safe and feasible in selected cases.1,2 We describe our technique of TVSE in a case of laparoscopic ultra-low anterior resection (ULAR) with defunctioning ileostomy (DI) with a concomitant total hysterectomy and bilateral salpingo-oophrectomy (THBSO).
  
  
  RESULTS
  A 74-year-old Chinese female was diagnosed with a mid-rectal cancer following colonoscopic evaluation for a change in bowel habits. Preoperative magnetic resonance imaging (MRI) suggested T2N0 disease and the patient was recommended for upfront surgery following multidisciplinary discussion. Computed tomography (CT) scan confirmed a 4.3 × 3.4 cm right adnexal cystic lesion, without enhancing septations or soft tissue component. No metastatic disease was identified. The patient underwent a laparoscopic ULAR with DI and THBSO with TVSE; operative time was 469 min. The specimen showed a 2.5 cm mid-rectal tumour. Histology revealed a pT3N1a moderately differentiated adenocarcinoma of the mid rectum, with 1 of 20 lymph nodes involved by metastatic carcinoma. The quality of the total mesorectal excision (TME) was good, with no breach in the mesorectal fascia. The distal and radial margins were 1.5 and 3.0 cm, respectively. The patient recovered well postoperatively, with minimal wound site pain, and was discharged well on postoperative day 5.
  
  
  CONCLUSIONS
  TVSE is oncologically safe and feasible in certain malignant colorectal pathologies. It is an option to consider in selected cases that require a concomitant gynecological procedure.
authors: Division of Colorectal Surgery, Department of Surgery, National University Health System, Singapore, Singapore.|Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
authors: Chun-Han Nigel
authors: CN
authors: Tan
authors: Division of Colorectal Surgery, Department of Surgery, National University Health System, Singapore, Singapore.|Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
authors: Choon-Seng
authors: CS
authors: Chong
authors: Division of Benign Gynaecology and Minimally Invasive Surgery, Department of Obstetrics and Gynaecology, National University Health System, Singapore, Singapore.
authors: Yoke-Fai
authors: YF
authors: Fong
authors: Division of Reproductive Endocrinology and Infertility and Minimally Invasive Surgery, Department of Obstetrics and Gynaecology, National University Health System, Singapore, Singapore.
authors: Shakina
authors: S
authors: Rauff
authors: Division of Colorectal Surgery, Department of Surgery, National University Health System, Singapore, Singapore. ker_kan_tan@nuhs.edu.sg.|Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore. ker_kan_tan@nuhs.edu.sg.
authors: Ker-Kan
authors: KK
authors: Tan
mesh_terms: D000368:Aged; D015179:Colorectal Neoplasms / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000379:methods*; D010535:Laparoscopy / Q000379:methods*; D057605:Natural Orifice Endoscopic Surgery / Q000379:methods*; D061646:Operative Time; D000074868:Salpingo-oophorectomy / Q000379:methods*; D016896:Treatment Outcome; D014621:Vagina / Q000601:surgery*