Two cases of laparoscopic right colectomy and laparoscopic subtotal colectomy with transvaginal extraction in two different approaches: A report of two cases

The surgical trend nowadays is in favor of minimally invasive procedures, particularly for complicated surgeries such as colectomies that require large incisions. Even laparoscopic colectomies still need mini-laparotomy for specimen extraction. Natural orifice specimen extraction (NOSE) has emerged as a way to avoid such incisions and decrease postoperative complications. We present two cases of middle-aged ladies that underwent laparoscopic colectomies with NOSE. The first patient presented for recurrent flare-ups of Crohn's refractory to medical treatment with a history of ileocecectomy ending up in anastomotic stenosis at the level of the terminal ileum. Laparoscopic right hemicolectomy was performed with transvaginal specimen extraction through a posterior colpotomy. The second patient underwent a laparoscopic subtotal colectomy for two stenotic lesions of the transverse and left colon. however, in this case, the specimen was extracted transvaginally through an anterior colpotomy. The postoperative hospital stay for both patients was uneventful and neither patient developed any complications related to the site of extraction. Laparoscopic colectomies with NOSE have a better outcome than traditional ones still requiring abdominal incisions. Following laparoscopic colectomies with transvaginal extraction can be accomplished when patient criteria and surgeon skills allow it. More studies are needed to evaluate the criteria making patients candidates for such procedures and to predict possible postoperative complications.