OBJECTIVE: To compare different specimen extraction techniques in laparoscopic simple nephrectomy among female patients, focusing on perioperative outcomes, complications, and postoperative recovery. METHODS: A retrospective analysis was conducted on data from 45 female patients who underwent laparoscopic nephrectomy between September 2022 and July 2024. Patients were divided into three groups: laparoscopic transperitoneal nephrectomy with transvaginal extraction (LTN-TVS), Pfannenstiel extraction (LTN-PFN), and retroperitoneoscopic nephrectomy (RPN) with flank extraction. Demographic data, operative details, extraction times, postoperative outcomes, and sexual function scores were analyzed. RESULTS: The LTN-PFN group had the shortest operative (106.93 ± 20.89 min) and extraction times (18.00 ± 2.97 min) compared to LTN-TVS (127.80 ± 27.88 min, 30.13 ± 8.05 min) and RPN (130.8 ± 32.62 min, 18.93 ± 16.35 min) groups (P <
0.05). Initially longer extraction times were seen in the transvaginal group which decreased with experience. The LTN-TVS group had significantly lower pain scores at 24 and 48 h and reduced analgesic needs (P <
0.01) as compared to other groups. Scar assessment scores favored the transvaginal group. Incisional hernias occurred in 2 PFN and 1 RPN patient, but none in the TVS group. Hospital stay, pelvic floor, and sexual function scores showed no significant differences among the groups. CONCLUSION: The transvaginal extraction method offers a promising, minimally invasive alternative with superior postoperative outcomes and minimal complications, making it a preferred approach in female patients undergoing laparoscopic nephrectomy.