J Gastric Cancer.  2016 Mar;16(1):51-53. 10.5230/jgc.2016.16.1.51.

Laparoscopic Gastrectomy and Transvaginal Specimen Extraction in a Morbidly Obese Patient with Gastric Cancer

  • 1Liver Transplantation Institute, Inonu University, Malatya, Turkey. cuneytkayaalp@hotmail.com


Laparoscopic gastrectomy for cancer has some significant postoperative benefits over open surgery with similar oncologic outcomes. This procedure is more popular in the Far East countries where obesity is not a serious public health problem. In the Western countries, laparoscopic gastrectomy for cancer is not a common procedure, yet obesity is more common. Herein, we aimed to demonstrate the feasibility of laparoscopic gastrectomy for advanced gastric cancer in a morbidly obese patient. Additionally, we used natural orifice specimen extraction as an option to decrease wound-related complications, which are more prevalent in morbidly obese patients. In this case, we performed a fully laparoscopic subtotal gastrectomy with lymph node dissection and Roux-en-Y gastrojejunostomy with the specimen extracted through the vagina. To the best of our knowledge, this was the first report of a natural orifice surgery in a morbidly obese patient with gastric cancer.


Stomach neoplasms; Natural orifice endoscopic surgery; Laparoscopy; Obesity

MeSH Terms

Far East
Gastric Bypass
Lymph Node Excision
Natural Orifice Endoscopic Surgery
Public Health
Stomach Neoplasms*


  • Fig. 1 Transvaginal extraction of the stomach.

  • Fig. 2 of specimen including subtotal gastrectomy, omentectomy, and D2 lymph node dissection.


1. Sodergren MH, Markar S, Pucher PH, Badran IA, Jiao LR, Darzi A. Safety of transvaginal hybrid NOTES cholecystectomy: a systematic review and meta-analysis. Surg Endosc. 2015; 29:2077–2090.
2. Pavlidis TE, Pavlidis ET, Sakantamis AK. The role of laparoscopic surgery in gastric cancer. J Minim Access Surg. 2012; 8:35–38.
3. Glenn JA, Turaga KK, Gamblin TC, Hohmann SF, Johnston FM. Minimally invasive gastrectomy for cancer: current utilization in US academic medical centers. Surg Endosc. 2015; 29:3768–3775.
4. Sumer F, Kayaalp C, Ertugrul I, Yagci MA, Karagul S. Total laparoscopic subtotal gastrectomy with transvaginal specimen extraction is feasible in advanced gastric cancer. Int J Surg Case Rep. 2015; 16:56–58.
5. Kayaalp C, Yagci MA. Laparoscopic right colon resection with transvaginal extraction: a systematic review of 90 cases. Surg Laparosc Endosc Percutan Tech. 2015; 25:384–391.
6. Huang YL, Lin HG, Yang JW, Jiang FQ, Zhang T, Yang HM, et al. Laparoscopy-assisted versus open gastrectomy with D2 lymph node dissection for advanced gastric cancer: a meta-analysis. Int J Clin Exp Med. 2014; 7:1490–1499.
7. Qiu J, Pankaj P, Jiang H, Zeng Y, Wu H. Laparoscopy versus open distal gastrectomy for advanced gastric cancer: a systematic review and meta-analysis. Surg Laparosc Endosc Percutan Tech. 2013; 23:1–7.
8. Martínez-Ramos D, Miralles-Tena JM, Cuesta MA, Escrig-Sos J, Van der Peet D, Hoashi JS, et al. Laparoscopy versus open surgery for advanced and resectable gastric cancer: a meta-analysis. Rev Esp Enferm Dig. 2011; 103:133–141.
9. Asakuma M, Cahill RA, Lee SW, Nomura E, Tanigawa N. NOTES: the question for minimal resection and sentinel node in early gastric cancer. World J Gastrointest Surg. 2010; 2:203–206.
10. Nakajima K, Nishida T, Takahashi T, Souma Y, Hara J, Yamada T, et al. Partial gastrectomy using natural orifice translumenal endoscopic surgery (NOTES) for gastric submucosal tumors: early experience in humans. Surg Endosc. 2009; 23:2650–2655.
11. Auyang ED, Santos BF, Enter DH, Hungness ES, Soper NJ. Natural orifice translumenal endoscopic surgery (NOTES(®)): a technical review. Surg Endosc. 2011; 25:3135–3148.
12. Gunkova P, Gunka I, Zonca P, Dostalik J, Ihnat P. Laparoscopic sleeve gastrectomy for morbid obesity with natural orifice specimen extraction (NOSE). Bratisl Lek Listy. 2015; 116:422–425.
Full Text Links
  • JGC
export Copy
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr