Introduction Transvaginal NOSES technique offers reduced postoperative pain and analgesia use, reduced length of hospital stays, faster return of bowel function, less chance of herniation, reduced skin surgical site infections and improved cosmesis. This case video demonstrates a laparoscopic radical hysterectomy bilateral salpingo-oophorectomy, pelvic lymphadenectomy, radical vaginectomy, ultra-low anterior resection using the Transvaginal NOSES technique for retrieval of the en bloc specimen in a 57-year-old with a 4 cm high grade vaginal sarcoma in the post vaginal wall.

Description Adhesiolysis performed then splenic flexure mobilization. Inferior mesenteric vein and artery are ligated and divided. Dissection is started medially then laterally to mobilize colon adequately. Mesorectal resection performed, pelvic spaces are opened bilaterally, ureters identified before dividing uterine arteries. Pelvic lymphadenectomy performed. Bladder dissected before performing anterior colpotomy to visualize the tumor and stitch placed a centimeter below tumor. Posterior colpotomy is performed and recto vaginal space is developed. Once total mesorectal resection complete, rectum is divided using an ENDO GIA Stapler. The specimen is retrieved through the vagina, resected and the anvil is placed in preparation for anastomosis. The vagina is then sutured. Rectal anastomosis is performed with EEA stapler. Abdomen inspected, drain inserted and a covering loop ileostomy is formed. Patient made a good post-operative recovery.

Conclusion/Implications Transvaginal NOSES technique is safe and feasible to perform and offers additional benefits over traditional abdominal specimen retrieval.