Objective To investigate the clinical value of total laparoscopic right hemicolectomy with natural orifice specimen extraction（NOSE）using transvaginal specimen extraction in elderly female patients with right colon cancer in the mode of enhanced recovery after surgery（ERAS）. Methods A retrospective analysis was con⁃ ducted using the clinical data of 68 female patients aged more than 70 years with right colon cancer who were admit⁃ ted to our hospital from September 2017 to September 2020. There were 30 patients in the NOSES group who under⁃ went total laparoscopic right hemicolectomy with transvaginal specimen extraction and 38 patients in the TLC group who underwent traditional laparoscopic right hemicolectomy. The intraoperative condition，postoperative recovery， white blood cell count and serum albumin level were compared between the two groups. The enrolled patients were followed up till March 2022. Results The NOSES group had a longer operation time；lower white blood cell count on the first day after surgery；lower pain scores on the first and third days after surgery；higher serum albumin lev⁃ els on the first，third and fifth days after surgery；shorter first anal exhaust time after surgery and shorter average postoperative length of hospital stay than the TLC group，with the differences being statistically significant（all P < 0.05）. However，intraoperative bleeding，postoperative complication rate，postoperative 3⁃year distant metastasis rate and overall survival rate showed no significant differences between the two groups（all P > 0.05）. Conclusion Total laparoscopic right hemicolectomy with transvaginal specimen extraction is a safe therapeutic choice for elderly female patients and can reduce postoperative pain，postoperative gastrointestinal function recovery time and length of hospital stay. It has immense significance in the clinical practice of enhanced recovery after surgery.