Intracorporeal mesenteric division of the colon can make the specimen more suitable for natural orifice extraction.

Laparoscopic surgery combined with natural orifice specimen extraction (NOSE) avoids extra incisions to the abdominal wall and causes less pain and fewer wound complications, together with a shorter recovery and reduced time off from work. However, the size of the specimen is a limiting factor for NOSE. We describe a novel method for natural orifice colorectal specimen extraction that reduces the diameter of the specimen and provides an easier extraction through the vagina. A totally laparoscopic right hemicolectomy for a cecal adenocarcinoma 5 cm in diameter was performed on a 62-year-old woman. Ileocolic anastomosis was done intracorporeally. Before transvaginal extraction, the largest width of the specimen was measured as 12 cm. The bulky mesentery of the cecum that limited the NOSE was divided partially along the bowel with a LigaSure™ (Covidien, Boulder, CO) device. The largest width of the specimen was reduced to 9 cm, and the specimen was extracted without difficulty through the vagina in a bag. The stage of the tumor was pT3pN1. There was no recurrence with a 7-month follow-up. Transvaginal specimen extraction may fail because of the size of the specimen. Reduction of the width of the specimen by partial division of the mesocolon provides a high success rate for NOSE. This novel technique should be in the repertoire of laparoscopic colorectal surgeons.