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However, the technique is associated with risk of injury to the anorectum and potential intra-abdominal contamination. Since Franklin et?al. reported a series of patients who underwent laparoscopic sigmoid colon resection with transanal specimen removal in 1993 [23], there have been a number of case series reporting laparoscopic colectomy with NOSE [13-22]. However, only a few of these studies compared the outcomes of NOSE and conventional laparoscopic colectomy [22, 24]. A recent systematic review of the current literature was not able to show the superiority of left-sided laparoscopic colectomy with transrectal specimen extraction over conventional laparoscopic resection [25]. The concept of NOSE even extends to single-site sigmoidectomy [26], laparoscopic [http://www.selleckchem.com/products/Gemcitabine-Hydrochloride(Gemzar).html Gemcitabine purchase] total mesorectal excision [27], and robotic colorectal resection [28]. NOSE is usually applied for left-sided colorectal pathologies. Tables?3 and 4 show recent case series or comparative studies using transanal specimen extraction for left-sided colorectal pathologies. (Those studies for mid- or low rectal pathologies, which required total mesorectal excision, are not discussed here) Median 20 (20�C50) Diverticular disease Small tumor ([https://en.wikipedia.org/wiki/Succimer Succimer] 86.5 (5?120 ) Mean?��?SD 122?min ��?36.5 Colorectal cancer Diverticular disease Transanal( 277 patients ) Transvaginal (26 patients with right hemicolectomy) Mean?��?SD (transanal) 164.7?��?47.5 Mean?��?SD (transvaginal) 159.0 ��?27.1 Mean?��?SD (transanal) 87.5?��?46.7 Mean?��?SD (transvaginal) 83.3?��?14.4 Median maximum 2 (range, 2�C3) Median 7 (range, 4�C18) Median 11 (range, 8�C14) Median 6 (range, 4�C6) Median 7 (range, 5�C14) Mean?��?SD 6.1 �� 2.4 Mean 0.85 (range, 0.65�C1.07) Median 5 (range, 5�C7) Median 6 (range 5�C7) Median 11 (range, 6�C15) Mean?��?SD 2.81 �� 2.60 Mean?��?SD 7.17 ��?4.9 3 (1.1%) anastomotic leakage for transanal extraction 2 injuries to sigmoid and rectum for transvaginal extraction Mean?��?SD (transanal) 6.9?��?2.8 Mean?��?SD (transvaginal) 5.5?��?2.5 To avoid tumor seedling and injury to the anorectum, there are various kinds of techniques and devices that can be employed in transanal specimen retrieval, including a transanal endoscopic microsurgery rectoscope [29], a transanal endoscopic device [13, 17], an Alexis wound retractor (Applied [http://www.selleckchem.com/products/cb-839.html CB-839] Medical, Rancho Santa Margarita, USA) [15], a plastic McCartney tube (Tyco Healthcare, Norwalk, USA) [16], and a specimen retrieval pouch (Endo Catch II; Covidien, Norwalk, USA) [19, 20]. Additionally, the bowel can be turned inside out [21]. Some surgeons do not use any device to protect the rectum [14, 18, 22]. The transanal endoscopic device is advantageous because it allows the passage of the anvil into the peritoneal cavity under direct vision and simultaneous carbon dioxide insufflation to maintain pneumoperitoneum, thus maintaining a good laparoscopic view.