Laparoscopic surgery for colonic disease has experienced an increased utilization by surgeons owing to decreased morbidity, less pain, earlier ambulation, earlier bowel function, fewer complications, decreased narcotic use, and improved cosmesis compared with open colon surgery. Current techniques require an abdominal incision, albeit smaller than an open laparotomy incision, which increases pain and complication rates such as infection, hernia development, and a less pleasing cosmetic result. The ability to perform a totally intracorporeal anastomosis will be an initial step to allow surgeons to perform natural orifice colon surgery in the future. One benefit of the intracorporeal anastomosis technique is that the only incision needed is for trocar placement. By combining the 2 techniques of totally intracorporeal anastomosis and transvaginal extraction of the specimen, surgeons will have the option to perform a totally laparoscopic colectomy on female patients. This case study describes a patient with a transvaginal route of specimen extraction after an oncologic laparoscopic right colon resection with intracorporeal anastomosis. It is the intent to further advance the technical options in the field of natural orifice surgery with the description of this technique. After completing a totally laparoscopic right colectomy with intracorporeal anastomosis and transvaginal extraction, an excellent postoperative recovery was demonstrated and has shown future potential for natural orifice surgery.

abnormal vaginal bleeding requiring intervention had no statistical difference between VP and WVP patients group (p=0.3074) as other complications as well (table 1). Median of related days of vaginal bleeding after the procedure were 7.4 days (SD 8.75) in VP group and 7.34days (SD 8.52) in WVP group, with no statistical difference (p=0.912). Conclusions Insert a vaginal pack or not, after LEEP, do not affect the number of postoperative gynecologic intervention due to vaginal bleeding or the amount of postoperative bleeding days. Previous pregnancies, hormonal status, cytology or LEEP specimen characteristics did not affect the disclosure. We also could not find any risk factor associated to abnormal bleeding. Based on that, the use of vaginal pack can be omitted with no further complications.

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