Comparison of transanal and transvaginal specimen extraction in laparoscopic colorectal surgery

This study aimed to compare the outcomes of transanal and transvaginal NOSES in patients undergoing laparoscopic colorectal surgery.

This study included 45 patients who were scheduled for NOSES after undergoing laparoscopic colorectal resection in our clinic between January 2019 and March 2020. To ensure homogeneity between the groups, the data of 22 female patients were analyzed in this study. Patients were divided into two groups according to the specimen extraction technique used. Demographic data, preoperative and postoperative findings, as well as the pathology and sizes of the specimens were examined in both the groups.

The demographic characteristics and preoperative and early postoperative outcomes were similar in both the groups. The size of the lesion was larger in the transvaginal group than that in the transanal group [4.58 ± 1.28 and 2.71 ± 1.55, respectively (P = 0.039)]. Two complications associated with extraction were observed (%9.09). A patient who underwent transanal extraction developed transient anal incontinence, which spontaneously resolved, and a patient who underwent transvaginal extraction developed anastomotic leakage and rectovaginal fistula associated with anastomotic leakage; a colonic stent was inserted for the management of this condition following which the patient recovered.

Only the lesion size was statistically significantly different between the transanal and transvaginal routes. Further, avoiding secondary organ injury is essential; therefore, the transanal route is primarily preferred. However, if the diameter of the lesion is large and the patient is female, the transvaginal route can be a useful alternative.

Natural orifice specimen extraction surgery, Laparoscopic colorectal surgery, Minimally invasive surgery.