1. Transvaginal Extraction: Feasible
Howard Ross, MD, FACS, FASCRS
Chief, Colon and Rectal Surgery
Riverview Medical Center
Clinical Associate Professor of Surgery UMDNJ

2. Disclosures Consultant and Course Director:
Applied Medical
Covidien
Woke at 4 am to watch royal wedding

3. Natural Orifice Surgery

4. 50% of Population Have a Vagina

5. Transvaginal Extraction

6. Transvaginal Extraction

7. Published Results Studies Small Selected patients As of February 2011:
23 articles
130 patients
Complications Related to Transvaginal Extraction
Rectovaginal fistula
Pelvic Seroma
Diana M, Perretta S, Wall J, Costantino FA, Leroy J, Demartines N, Marescaux
J. Colorectal Dis Jun;13(6):e

8. Laparoscopic restorative proctocolectomy 7 patients 2004-2007
An Innovative Technique for Colorectal Specimen Retrieval: A New Era of “Natural Orifice Specimen Extraction” (N.O.S.E)
Laparoscopic restorative proctocolectomy
7 patients
Familial adenomatous polyposis with cancer
Posterior vaginal vault was opened with an ultracision shears, endobag placed in the vagina
All vaginal wounds healed
No vaginal metastasis
1 DVT, 1 anastamotic leak
Palanivelu C, Rangarajan M, Jategaonkar PA, Anand NV.
Dis Colon Rectum Jul;51(7): Epub 2008 May 15.

9. 88 yr old woman, 4 cm cecal cancer
Transvaginal Extraction of the Specimen After Total Laparoscopic Right Hemicolectomy With Intracorporeal Anastomosis
First US report
88 yr old woman, 4 cm cecal cancer
3-cm transvaginal posterior colpotomy
No complications
Franklin ME Jr, Kelley H, Kelley M, Brestan L, Portillo G, Torres J
Surg Laparosc Endosc PercutanTech Jun;18(3):294-8.

10. Case Reports Lead Author Country Op Type Disease n Complication Year
Dozois
USA
JPouch Vag hys
FAP 1
None
2008
Garcia Florez
Spain
LAR RSO
(Alexis ring)
Colon Ca
2010
McKenzie (Pigazzi)
R Colectomy
2 Cancer
2 polyp 4
(sbo unrelated)
Park
S Korea
R colectomy 14
2 aborted extractions d/t colpotomy issues

11. Laparoscopic Right Colectomy
Case Controlled Study
Laparoscopic Right Colectomy
vs.
Laparoscopic R Colectomy with natural orifice specimen extraction (NOSE)
34 Patients Each Group
NOSE patients less pain POD 1 and POD 3 (0.01)
Visual analogue and blinded observer
Improved Cosmesis
No morbidity difference
J. S. Park, G.-S. Choi, H. J. Kim, S. Y. Park and S. H. Jun
British Journal of Surgery 2011; 98: 710–715

12. Trans-Vaginal Extraction

13. For Discussion Patient Selection Process to begin Who should try?
IRB, Ethics
Who should try?