• Colectomy
• Laparoscopy
• Minimally invasive surgical procedures
• Natural orifice endoscopic surgery
• Natural orifice specimen extraction
• Transrectal specimen extraction

Over the last 20 years, laparoscopic colorectal surgery has shown equal efficacy for benign and malignant colorectal diseases when compared to open surgery. However, a laparoscopic approach reduces postoperative morbidity and shortens hospital stay. In the quest to optimize outcomes after laparoscopic colorectal surgery, reduction of access trauma could be a way to improve recovery. To date, one method to reduce access trauma is natural orifice specimen extraction (NOSE). NOSE aims to reduce access trauma in laparoscopic colorectal surgery. The specimen is delivered via a natural orifice and the anastomosis is created intracorporeally. Different methods are used to extract the specimen and to create a bowel anastomosis. Currently, specimens are delivered transcolonically, transrectally, transanally, or transvaginally. Each of these NOSE-procedures raises specific issues with regard to operative technique and application. The presumed benefits of NOSE-procedures are less pain, lower analgesia requirements, faster recovery, shorter hospital stay, better cosmetic results, and lower incisional hernia rates. Avoidance of extraction site laparotomy is the most important characteristic of NOSE. Concerns associated with the NOSE-technique include bacterial contamination of the peritoneal cavity, inflammatory response, and postoperative outcomes, including postoperative pain and the functional and oncologic outcomes. These issues need to be studied in prospective randomized controlled trials. The aim of this systematic review is to describe the role of NOSE in minimally invasive colorectal surgery.

• Laparoscopy
• Colorectal surgery
• Natural orifice specimen extraction
• Natural orifice specimen extraction-colectomy
• Transcolonic
• Transrectal
• Transanal
• Transvaginal
• Transanal minimally invasive surgery
• Gastrointestinal endoscopy

• Colectomy/adverse effects
• Colectomy/methods
• Humans
• Laparoscopy/adverse effects
• Laparoscopy/methods
• Natural Orifice Endoscopic Surgery/adverse effects
• Natural Orifice Endoscopic Surgery/methods
• Operative Time
• Postoperative Complications/etiology
• Risk Factors
• Time Factors
• Treatment Outcome

• Barbed suture
• Laparoscopic ileocecal resection
• Natural orifice transluminal endoscopic surgery
• Transanus

Although laparoscopic colectomy is commonly performed around the world, an operative wound formed during the surgery is large but not sufficient enough to convert for the majority of open surgery. Thus, a certain sized skin incision is required to remove the resected colon. Here we report the case of a pure laparoscopic ileocecal resection which involves transanal specimen extraction. We present a case characterized by a laterally spreading type of tumor of the cecum. We performed a pure laparoscopic ileocecal resection and the resected specimen was removed transanally using colonoscopy. Intracorporeal functional anastomosis was then performed using a flexible linear stapling device under supporting barbed suture traction. The patient was discharged without complications on postoperative day 4. Laparoscopic colectomy performed with minimal incision could essentially increase the usage of this surgical technique. Although our method is restricted to flat or small lesions, we think it is a feasible and realistic solution for minimization of operative invasion because it involves specimen extraction through a natural orifice.

• Laparoscopic ileocecal resection
• Natural orifice transluminal endoscopic surgery
• Transanus
• Barbed suture

• Anal Canal
• Colectomy/methods
• Colonic Diseases/surgery
• Humans
• Laparoscopy/methods
• Natural Orifice Endoscopic Surgery/methods