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Natural orifice specimen extraction avoids a muscle-split incision for specimen retrieval. The results of a pilot study with a novel technique arepresented.All consecutive patients undergoing laparoscopic rectosigmoid resection with transanal specimen extraction were included. A specimen retrieval pouch was used to facilitate specimen extraction. All perioperative data, postoperative morbidity and short-term outcome were gathered in aprospective database.Twenty-one patients were treated by this new technique. Median age was 41 years (IQR: 34-66), median BMI was 23 kg/m2 (IQR: 22-26) and 90% of the patients were female. Thirteen (62%) patients underwent a resection for endometriosis, 5 (24%) for diverticular disease and 3 (14%) for neoplasia. Median operating time was 105 min (IQR: 90-110) and median intraoperative blood loss was 10 ml (IQR: 0-20). The median length of the extracted specimen was 20 cm (IQR: 13-25). There was one case of anastomotic leakage (5%). The median hospital stay was 6 (IQR: 5-7) days. All patients did well at a median follow-up of 3.6 months and none reported anal dysfunction.Totally laparoscopic rectosigmoid resection is feasible and has a good short term outcome.