Reference Citation Analysis: Find an Article, Find a Category, Find a Journal, Find a Scholar

For: Wolthuis AM, Penninckx F, D'Hoore A. Laparoscopic sigmoid resection with transrectal specimen extraction has a good short-term outcome. Surg Endosc 2010;25:2034-8. [PMID: 21136110 DOI: 10.1007/s00464-010-1472-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2010] [Accepted: 11/05/2010] [Indexed: 12/16/2022]

For:	Wolthuis AM, Penninckx F, D'Hoore A. Laparoscopic sigmoid resection with transrectal specimen extraction has a good short-term outcome. Surg Endosc 2010;25:2034-8. [PMID: 21136110 DOI: 10.1007/s00464-010-1472-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2010] [Accepted: 11/05/2010] [Indexed: 12/16/2022]

Number

Cited by Other Article(s)

Mui J, Sarofim M, Cheng E, Gilmore A. Laparoscopic natural orifice specimen extraction for diverticular disease: a systematic review. Surg Endosc 2025;39:3049-3056. [PMID: 40140081 PMCID: PMC12041039 DOI: 10.1007/s00464-025-11683-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2025] [Accepted: 03/14/2025] [Indexed: 03/28/2025]

Abstract

BACKGROUND

Diverticular disease is extremely common in the Western world, with a proportion of complications requiring colonic resection. Whilst laparoscopic surgery has its benefits, a large wound for specimen extraction predisposes to surgical site infection, prolonged pain and prolonged hospital admission. Natural orifice specimen extraction (NOSE) is an alternative technique that has not yet been widely adopted in diverticular disease surgery. The aim of this systematic review is to evaluate the evidence on the outcomes of NOSE in left sided resections for diverticular disease.

METHODS

A systematic review of PubMed, Ovid MEDLINE and EMBASE was performed to identify studies that reported outcomes for left sided resections with NOSE in diverticular disease. The studies reviewed were all human studies published in a peer-reviewed journal after 2010. The participants had to be over the age of 18 and the extraction site had to be transanal/transrectal. Articles that were not full text or not in English were excluded. These studies were assessed independently by two reviewers using a standardised pre-piloted form.

RESULTS

One hundred and eighty-seven articles were screened, with 9 articles meeting the inclusion criteria. The study sample size ranged from 8 to 157 participants, with a pooled total of 428 patients who had NOSE. Hospital length of stay varied from 4 to 6 days. Only 2 patients required conversion to transabdominal extraction. Pain scores were lower post-NOSE compared to traditional abdominal extraction in 2 out of 3 studies. The anastomotic leak rate varied from 0 to 18%. Six studies reported no surgical site infections and there was only 1 mortality.

CONCLUSION

NOSE is a safe and feasible option for patients requiring left sided resection for diverticular disease based on the current available data. The literature demonstrates low rates of surgical site infection, mortality and reduced hospital length of stay.

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Haas EM, Secchi Del Rio R, Reif de Paula T, Margain Trevino D, Presacco S, Hinojosa-Gonzalez DE, Weaver M, LeFave JP. The robotic NICE procedure outperforms conventional laparoscopic extracorporeal-assisted colorectal resection: results of a matched cohort analysis. Surg Endosc 2024;38:390-399. [PMID: 37803185 DOI: 10.1007/s00464-023-10452-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 09/06/2023] [Indexed: 10/08/2023]

Abstract

INTRODUCTION

We introduced the robotic NICE procedure for left-sided colorectal resection in 2018 in which the entire procedure is performed without loss of pneumoperitoneum and without an abdominal wall incision by performing natural orifice-assisted transrectal extraction of the specimen and intracorporeal anastomosis. We compare the results of the NICE procedure versus conventional laparoscopic resection, which was our standard approach prior to 2018.

METHODS

A matched pair case-control study compared patients following the NICE procedure versus those who underwent laparoscopic left-sided colorectal resection with conventional extracorporeal-assisted technique. Cases were performed at an Academic Medical Center and recorded in a prospective database to analyze perioperative outcomes.

RESULTS

From a total cohort of 352 patients, 83 were matched in each group. When comparing the NICE procedure vs. the Extracorporeal-Assisted laparoscopic group, there were no significant differences in age (58.5 vs. 59.3 years old), sex (47 vs. 42 Female), body mass index (27.4 vs. 27.5 kg/m2), ASA, diagnosis, or type of surgery. Operative time (198.8 vs. 197.7 min), blood loss (56.0 vs. 53.3 ml), intraoperative complications (0.0% vs. 0.0%), and conversion rates (0.0% vs. 0.0%) were similar in both groups. The NICE procedure was associated with significantly earlier return of bowel function (40.7 vs. 23.6 h), shorter length of stay (3.1 vs. 2.2 days), and lower total opioid use (94.6 vs. 70.5 morphine milligram equivalents). Overall, there were no differences in postoperative abscess formation, complications, readmission, or reoperation rates.

CONCLUSION

When compared to conventional laparoscopic resection, the NICE procedure is associated with short-term benefits including earlier recovery and less opioid use without increased operative time or increased risk of complications. Multicenter studies are recommended to validate benefits and limitations of this technique.

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Liu Z, Guan X, Zhang M, Hu X, Yang M, Bai J, Li J, Yu S, Ding K, He QS, Kang L, Ma D, Fu C, Hu J, Wei Y, Sun DH, Yu G, He S, Wang C, Gao Y, Wang GY, Yao H, Peng J, Zheng Y, Jiang B, Li T, Xiong Z, Sun X, Wang Z, Meng W, Chen WTL, Shen MY, Marks JH, Ternent CA, Shaw DD, Khan JS, Tsarkov PV, Tulina I, Efetov S, da Costa Pereira JM, Nogueira F, Escalante R, Leroy J, Saklani A, Dulskas A, Kayaalp C, Nishimura A, Uehara K, Lee WY, Kim SH, Lee SH, Wang X. International Guideline on Natural Orifice Specimen Extraction Surgery (NOSES) for Colorectal Cancer (2023 Version). NATURAL ORIFICE SPECIMEN EXTRACTION SURGERY 2023:953-961. [DOI: 10.1007/978-981-99-2750-0_75] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2025]

Xu SZ, Ding ZJ, Zhang SF, Yuan SB, Yan F, Wang ZF, Liu GY, Cai JC. Clinical outcomes of laparoscopic-assisted natural orifice specimen extraction colectomy using a Cai tube for left-sided colon cancer: a prospective randomized trial. Surg Endosc 2023;37:749-758. [PMID: 35906459 DOI: 10.1007/s00464-022-09435-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 07/03/2022] [Indexed: 01/18/2023]

Abstract

BACKGROUND

The role of laparoscopic-assisted natural orifice specimen extraction (LA-NOSE) colectomy in the treatment of left-sided colon cancer has not been well defined, and there remains confusion about how to conveniently exteriorize specimens through natural orifices. Therefore, we introduced a homemade invention, the Cai tube, to facilitate the extraction of specimens and compared the clinical outcomes of LA-NOSE with conventional laparoscopic (CL) colectomy for left-sided colon cancer.

METHODS

From March 2015 to August 2017, patients with left-sided colon cancer were randomly divided into LA-NOSE and CL groups. Specimens were extracted through the anus with the help of a Cai tube (Patent Number: ZL201410168748.2) in the LA-NOSE group. The primary outcome measure was postoperative pain. Secondary outcomes were the duration of operation, postoperative recovery, surgical morbidity, pathological quality of the specimen, and long-term outcomes, including 3-year overall survival, disease-free survival, local recurrence, and overall recurrence.

RESULTS

A total of 60 patients (30 per group) were recruited for this study. None of the patients required emergency conversion to conventional laparoscopic or open surgery during the operation. The postoperative maximum pain score was significantly lower in the LA-NOSE group (mean 2.5 vs. 5.1, P = 0.001), as was the additional analgesia requirement (mean 2/30 vs. 10/30, P = 0.021). Patients in the LA-NOSE group experienced a shorter first time to passage of flatus (mean 2.2 vs. 3.1 days, P = 0.026). All patients could control their defecation at 6 months after surgery. The comparison between the two groups showed no significant differences in the operative time, bleeding volume, postoperative hospital stay, surgical morbidity rates, number of lymph nodes harvested, or resection margin status. The mean follow-up was 48 months (range 7-59) and was similar in both groups. The results showed no differences in long-term outcomes between the two groups.

CONCLUSION

In the treatment of left-sided colon cancer, compared with conventional laparoscopic colectomy, LA-NOSE colectomy using the Cai tube exhibited lower postoperative pain, shorter recovery of gastrointestinal function, and similar long-term outcomes.

REGISTRATION NUMBER

ChiCTR-OOR-15007060 ( http://www.chictr.org.cn/ ).

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Affiliation(s)

Shu-Zhen Xu Department of Gastrointestinal Surgery, Zhongshan Hospital Xiamen University, No. 201-209, Hubin South Road, Xiamen, 361004, Fujian, China.,Institute of Gastrointestinal Oncology, Medical College of Xiamen University, No. 201-209, Hubin South Road, Xiamen, 361004, Fujian, China.,Xiamen Municipal Key Laboratory of Gastrointestinal Oncology, No. 201-209, Hubin South Road, Xiamen, 361004, Fujian, China
Zhi-Jie Ding Department of Gastrointestinal Surgery, Zhongshan Hospital Xiamen University, No. 201-209, Hubin South Road, Xiamen, 361004, Fujian, China.,Institute of Gastrointestinal Oncology, Medical College of Xiamen University, No. 201-209, Hubin South Road, Xiamen, 361004, Fujian, China.,Xiamen Municipal Key Laboratory of Gastrointestinal Oncology, No. 201-209, Hubin South Road, Xiamen, 361004, Fujian, China
Shi-Feng Zhang Department of Gastrointestinal Surgery, Zhongshan Hospital Xiamen University, No. 201-209, Hubin South Road, Xiamen, 361004, Fujian, China.,Institute of Gastrointestinal Oncology, Medical College of Xiamen University, No. 201-209, Hubin South Road, Xiamen, 361004, Fujian, China.,Xiamen Municipal Key Laboratory of Gastrointestinal Oncology, No. 201-209, Hubin South Road, Xiamen, 361004, Fujian, China
Si-Bo Yuan Department of Gastrointestinal Surgery, Zhongshan Hospital Xiamen University, No. 201-209, Hubin South Road, Xiamen, 361004, Fujian, China.,Institute of Gastrointestinal Oncology, Medical College of Xiamen University, No. 201-209, Hubin South Road, Xiamen, 361004, Fujian, China.,Xiamen Municipal Key Laboratory of Gastrointestinal Oncology, No. 201-209, Hubin South Road, Xiamen, 361004, Fujian, China
Feng Yan Department of Gastrointestinal Surgery, Zhongshan Hospital Xiamen University, No. 201-209, Hubin South Road, Xiamen, 361004, Fujian, China.,Institute of Gastrointestinal Oncology, Medical College of Xiamen University, No. 201-209, Hubin South Road, Xiamen, 361004, Fujian, China.,Xiamen Municipal Key Laboratory of Gastrointestinal Oncology, No. 201-209, Hubin South Road, Xiamen, 361004, Fujian, China
Zhen-Fa Wang Department of Gastrointestinal Surgery, Zhongshan Hospital Xiamen University, No. 201-209, Hubin South Road, Xiamen, 361004, Fujian, China.,Institute of Gastrointestinal Oncology, Medical College of Xiamen University, No. 201-209, Hubin South Road, Xiamen, 361004, Fujian, China.,Xiamen Municipal Key Laboratory of Gastrointestinal Oncology, No. 201-209, Hubin South Road, Xiamen, 361004, Fujian, China
Guo-Yan Liu Department of Gastrointestinal Surgery, Zhongshan Hospital Xiamen University, No. 201-209, Hubin South Road, Xiamen, 361004, Fujian, China.,Institute of Gastrointestinal Oncology, Medical College of Xiamen University, No. 201-209, Hubin South Road, Xiamen, 361004, Fujian, China.,Xiamen Municipal Key Laboratory of Gastrointestinal Oncology, No. 201-209, Hubin South Road, Xiamen, 361004, Fujian, China
Jian-Chun Cai Department of Gastrointestinal Surgery, Zhongshan Hospital Xiamen University, No. 201-209, Hubin South Road, Xiamen, 361004, Fujian, China. .,Institute of Gastrointestinal Oncology, Medical College of Xiamen University, No. 201-209, Hubin South Road, Xiamen, 361004, Fujian, China. .,Xiamen Municipal Key Laboratory of Gastrointestinal Oncology, No. 201-209, Hubin South Road, Xiamen, 361004, Fujian, China.

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Haas EM, de Paula TR, Luna-Saracho R, Smith MS, De Elguea-Lizarraga JIO, del Rio RS, Edgcomb M, LeFave JP. The success rate of robotic natural orifice intracorporeal anastomosis and transrectal extraction (NICE procedure) in a large cohort of consecutive unselected patients. Surg Endosc 2023;37:683-691. [PMID: 36418639 PMCID: PMC9839785 DOI: 10.1007/s00464-022-09717-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 10/11/2022] [Indexed: 11/25/2022]

Abstract

BACKGROUND

The Robotic NICE procedure is a total intracorporeal natural orifice approach in which specimen extraction and anastomosis is accomplished without an abdominal wall incision other than the port sites themselves. We aim to present the success rate of the NICE procedure in a large cohort of unselected consecutive patients presenting with colorectal disease using a stepwise and reproducible robotic approach.

METHODS

Consecutive patients who presented with benign or malignant disease requiring left-sided colorectal resection and anastomosis between May 2018 and June 2021 were evaluated. Data abstracted included demographic, clinical data, disease features, intervention data, and outcomes data. The main outcome was success rate of Intracorporeal anastomosis (ICA), transrectal extraction of specimen (TRSE), and conversion rate.

RESULTS

A total of 306 patients underwent NICE procedure. Diverticulitis was the main diagnosis (64%) followed by colorectal neoplasm (27%). Median operative time was 219 min, and the median estimated blood loss was 50 ml. ICA was achieved in all cases (100%). TRSE was successfully achieved in 95.4% of cases. In 14 patients (4.6%), an abdominal incision was required due to inability to extract a bulky specimen through the rectum. There overall postoperative complications rate was 12.4%. Eight patients (2.6%) experienced postoperative ileus. There were no superficial or deep surgical site infection (SSI). Eleven patients (3.6%) developed organ SSI space including 5 patients with intra-abdominal abscess and 4 patients with anastomotic leak. There was one mortality (0.3%) due to toxic megacolon from resistant Clostridium difficile. The 30-day reoperation rate was 2.9% (n = 9) including six patients presenting with organ space SSI and three patients with postoperative obstruction at the diverting loop ileostomy site.

CONCLUSION

The NICE procedure is associated with a very high success rate for both intracorporeal anastomosis and transrectal specimen extraction in a large cohort of unselected patients.

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Huang Y, Yi T, He H, Li Q, Long X, Hu G, Chen Q, Li Y, Chen R, Yi X. Laparoscopic specimen extraction in vitro: preliminary experience. BMC Surg 2021;21:305. [PMID: 34210315 PMCID: PMC8246676 DOI: 10.1186/s12893-021-01300-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2021] [Indexed: 11/10/2022] Open

Abstract

BACKGROUND

The last procedure performed by the surgeon in laparoscopic surgery is to extract the specimen through the smallest incision possible. This experiment aimed to explore the maximum diameter of specimens that can be extracted through auxiliary incisions of different lengths and shapes by in vitro physical experiments.

MATERIALS AND METHODS

We used the abdominal wall with the muscle layer, fixed on a square wooden frame, to simulate the human abdominal wall. Then, specimen extraction ports were made with circular, inverted Y-shaped and straight-line incisions of different sizes and lengths, and specimens of different sizes were made from tissues of different species. These specimens were extracted from different incisions with a force gauge. The tension value (N) was measured, and records were made of the length or diameter of the smallest auxiliary incision through which a given specimen could pass, as well as the largest specimen diameter that could pass through an incision of a given size. This experiment provides us with preliminary experience-based knowledge of how to choose the appropriate auxiliary incision for surgical specimen extraction according to the diameter of the specimen.

RESULTS

The maximum diameters of specimens that could be extracted with circular ostomy diameters of 2.4, 2.7 and 3.3 cm were 4.0, 4.5 and 6.0 cm, respectively. Specimens with diameters of 6.0, 8.0 and 10.0 cm could be extracted through inverted Y-shaped incisions with a length around the umbilicus of 1 cm and an extension length of 1.0, 3.0, and 4.0 cm, respectively. Moreover, these same specimens could be extracted through inverted Y-shaped incisions with a length around the umbilicus of 2 cm and extension lengths of 0.0, 1.0 and 2.0 cm. Tough tissue specimens (made from chicken gizzards) with diameters of 1.0, 2.0, 4.0 and 6.0 cm, respectively, could be removed through straight-line incisions measuring 1.0, 2.0, 3.0 and 4.0 cm in length.

CONCLUSION

Along with preoperative imaging, surgical planning and trocar position, the shape and length of auxiliary incisions can be used to improve the extraction of specimens via laparoscopic surgery.

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Bu J, Li N, He S, Deng HY, Wen J, Yuan HJ, Zhang CM, Hu M, Wu XT. Effect of laparoscopic surgery for colorectal cancer with N. O. S. E. on recovery and prognosis of patients. MINIM INVASIV THER 2020;31:230-237. [PMID: 32940092 DOI: 10.1080/13645706.2020.1799410] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]

Bendifallah S, Puchar A, Vesale E, Moawad G, Daraï E, Roman H. Surgical Outcomes after Colorectal Surgery for Endometriosis: A Systematic Review and Meta-analysis. J Minim Invasive Gynecol 2020;28:453-466. [PMID: 32841755 DOI: 10.1016/j.jmig.2020.08.015] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 08/13/2020] [Accepted: 08/19/2020] [Indexed: 02/06/2023]

Abstract

OBJECTIVE

To assess the impact of type of surgery for colorectal endometriosis-rectal shaving or discoid resection or segmental colorectal resection-on complications and surgical outcomes.

DATA SOURCES

We performed a systematic review of all English- and French-language full-text articles addressing the surgical management of colorectal endometriosis, and compared the postoperative complications according to surgical technique by meta-analysis. The PubMed, Clinical Trials.gov, Cochrane Library, and Web of Science databases were searched for relevant studies published before March 27, 2020. The search strategy used the following Medical Subject Headings terms: ("bowel endometriosis" or "colorectal endometriosis") AND ("surgery for endometriosis" or "conservative management" or "radical management" or "colorectal resection" or "shaving" or "full thickness resection" or "disc excision") AND ("treatment", "outcomes", "long term results" and "complications").

METHODS OF STUDY SELECTION

Two authors conducted the literature search and independently screened abstracts for inclusion, with resolution of any difference by 3 other authors. Studies were included if data on surgical management (shaving, disc excision, and/or segmental resection) were provided and if postoperative outcomes were detailed with at least the number of complications. The risk of bias was assessed according to the Cochrane recommendations.

TABULATION, INTEGRATION, AND RESULTS

Of the 168 full-text articles assessed for eligibility, 60 were included in the qualitative synthesis. Seventeen of these were included in the meta-analysis on rectovaginal fistula, 10 on anastomotic leakage, 5 on anastomotic stenosis, and 9 on voiding dysfunction <30 days. The mean complication rate according to shaving, disc excision, and segmental resection were 2.2%, 9.7%, and 9.9%, respectively. Rectal shaving was less associated with rectovaginal fistula than disc excision (odds ratio [OR] = 0.19; 95% confidence interval [CI], 0.10-0.36; p <.001; I² = 33%) and segmental colorectal resection (OR = 0.26; 95% CI, 0.15-0.44; p <.001; I² = 0%). No difference was found in the occurrence of rectovaginal fistula between disc excision and segmental colorectal resection (OR = 1.07; 95% CI, 0.70-1.63; p = .76; I² = 0%). Rectal shaving was less associated with leakage than disc excision (OR = 0.22; 95% CI, 0.06-0.73; p = .01; I² = 86%). No difference was found in the occurrence of leakage between rectal shaving and segmental colorectal resection (OR = 0.32; 95% CI, 0.10-1.01; p = .05; I² = 71%) or between disc excision and segmental colorectal resection (OR = 0.32; 95% CI, 0.30-1.58; p = .38; I² = 0%). Disc excision was less associated with anastomotic stenosis than segmental resection (OR = 0.15; 95% CI, 0.05-0.48; p = .001; I² = 59%). Disc excision was associated with more voiding dysfunction <30 days than rectal shaving (OR = 12.9; 95% CI, 1.40-119.34; p = .02; I² = 0%). No difference was found in the occurrence of voiding dysfunction <30 days between segmental resection and rectal shaving (OR = 3.05; 95% CI, 0.55-16.87; p = .20; I² = 0%) or between segmental colorectal and discoid resections (OR = 0.99; 95% CI, 0.54-1.85; p = .99; I² = 71%).

CONCLUSION

Colorectal surgery for endometriosis exposes patients to a risk of severe complications such as rectovaginal fistula, anastomotic leakage, anastomotic stenosis, and voiding dysfunction. Rectal shaving seems to be less associated with postoperative complications than disc excision and segmental colorectal resection. However, this technique is not suitable for all patients with large bowel infiltration. Compared with segmental colorectal resection, disc excision has several advantages, including shorter operating time, shorter hospital stay, and lower risk of postoperative bowel stenosis.

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Zhu Z, Wang KJ, Orangio GR, Han JY, Lu B, Zhou ZQ, Gao W, Fu CG. Clinical efficacy and quality of life after transrectal natural orifice specimen extraction for the treatment of middle and upper rectal cancer. J Gastrointest Oncol 2020;11:260-268. [PMID: 32399267 DOI: 10.21037/jgo.2020.03.05] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open

Xu L, Chen H, Hu H, Hu K, Zhang Q, Jin Y, Fu Q, Jiang Y, Qian L, Wu L, Huang X, Xia Y. Natural orifice specimen extraction with a modified reverse puncture device technique for total laparoscopic colorectal resection: feasibility and efficacy. Scand J Gastroenterol 2020;55:376-382. [PMID: 32180478 DOI: 10.1080/00365521.2020.1736618] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]

Guan X, Liu Z, Longo A, Cai JC, Tzu-Liang Chen W, Chen LC, Chun HK, Manuel da Costa Pereira J, Efetov S, Escalante R, He QS, Hu JH, Kayaalp C, Kim SH, Khan JS, Kuo LJ, Nishimura A, Nogueira F, Okuda J, Saklani A, Shafik AA, Shen MY, Son JT, Song JM, Sun DH, Uehara K, Wang GY, Wei Y, Xiong ZG, Yao HL, Yu G, Yu SJ, Zhou HT, Lee SH, Tsarkov PV, Fu CG, Wang XS. International consensus on natural orifice specimen extraction surgery (NOSES) for colorectal cancer. Gastroenterol Rep (Oxf) 2019;7:24-31. [PMID: 30792863 PMCID: PMC6375350 DOI: 10.1093/gastro/goy055] [Citation(s) in RCA: 110] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Accepted: 12/26/2018] [Indexed: 12/19/2022] Open

Affiliation(s)

Xu Guan Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Bejing, China
Zheng Liu Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Bejing, China
Antonio Longo Department of Coloproctology and Pelvic Diseases, Humanitas Gavazzeni, Bergamo, Italy
Jian-Chun Cai Department of Gastrointestinal Surgery, Zhongshan Hospital of Xiamen University, Xiamen, China
William Tzu-Liang Chen Department of Surgery, China Medical University Hospital, Taichung, Taiwan, China
Lu-Chuan Chen Department of Abdominal Surgery, Fujian Medical University Cancer Hospital, Fuzhou, China
Ho-Kyung Chun Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea
Joaquim Manuel da Costa Pereira Department of Surgery, Hospital de Braga, Braga, Portugal
Sergey Efetov Colorectal Surgery Department, Sechenov First Moscow State Medical University, Moscow, Russia
Ricardo Escalante Universidad Central de Venezuela, Centro Medico Loira, Caracas, Venezuela
Qing-Si He Department of General Surgery, Shandong University Qilu Hospital, Jinan, China
Jun-Hong Hu Department of General Surgery, Huaihe Hospital of Henan University, Kaifeng, China
Cuneyt Kayaalp Department of Gastrointestinal Surgery, Inonu University, Malatya, Turkey
Seon-Hahn Kim Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, South Korea
Jim S Khan Department of Colorectal Surgery, Portsmouth Hospitals NHS Trust, Queen Alexandra Hospital, Portsmouth, UK
Li-Jen Kuo Division of Colorectal Surgery, Taipei Medical University Hospital, Taipei, Taiwan, China
Atsushi Nishimura Department of Surgery, Nagaka Chuo General Hospital, Nagaoka City, Japan
Fernanda Nogueira Department of Surgery, Hospital de Braga, Braga, Portugal
Junji Okuda Innovation Unit / Colorectal Cancer, Osaka Medical College Hospital Cancer Center, Osaka, Japan
Avanish Saklani Department of GI Surgical Oncology, Tata Memorial Hospital, Mumbai, India
Ali A Shafik Department of Colorectal Surgery, Cairo University, Cairo, Egypt
Ming-Yin Shen Department of Surgery, China Medical University Hospital, Taichung, Taiwan, China
Jung-Tack Son Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea
Jun-Min Song Department of Anorectal Surgery, First Affiliated Hospital, Zhengzhou University, Zhengzhou, China
Dong-Hui Sun Department of Gastric and Colorectal Surgery, Jilin University First Hospital, Changchun, China
Keisuke Uehara Division of Surgical Oncology, Nagoya University Graduate School of Medicine, Nagoya, Japan
Gui-Yu Wang Department of Colorectal Cancer Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
Ye Wei Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
Zhi-Guo Xiong Department of Gastrointestinal Surgery, Hubei Provincial Cancer Hospital, Wuhan, China
Hong-Liang Yao Department of General Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
Gang Yu Department of Surgery, People's Hospital of Linzi District, Affiliated to Binzhou Medical College, Zibo, China
Shao-Jun Yu Department of Surgical Oncology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
Hai-Tao Zhou Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Bejing, China
Suk-Hwan Lee Department of Surgery, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, South Korea
Petr V Tsarkov Clinic of Colorectal and Minimally Invasive Surgery, Sechenov First Moscow State Medical University, Moscow, Russia
Chuan-Gang Fu Department of Gastrointestinal Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
Xi-Shan Wang Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Bejing, China
The International Alliance of NOSES

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Su H, Li B, Ren W, Bao M, Wang P, Liu Q, Wang X, Zhou Z, Zhou H. Successful treatment of recurrent rectal implantation metastasis of ovarian cancer by natural orifice specimen extraction surgery: a case report. Onco Targets Ther 2018;11:5925-5931. [PMID: 30271177 PMCID: PMC6149866 DOI: 10.2147/ott.s166535] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open

Izquierdo KM, Unal E, Marks JH. Natural orifice specimen extraction in colorectal surgery: patient selection and perspectives. Clin Exp Gastroenterol 2018;11:265-279. [PMID: 30087574 PMCID: PMC6063249 DOI: 10.2147/ceg.s135331] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open

Abstract

Over the past 30 years, colorectal surgery has evolved to include minimally invasive surgical techniques. Minimally invasive surgery is associated with reduced postoperative pain, reduced wound complications, earlier return of bowel function, and possibly shorter length of hospital stay. These benefits have been attributed to a reduction in operative trauma compared to open surgery. The need to extract the specimen in colorectal operations through a “mini-laparotomy” can negate many of the advantages of minimally invasive surgery. Natural orifice specimen extraction (NOSE) is the opening of a hollow viscus that already communicates with the outside world, such as the vagina or distal gastrointestinal tract, in order to remove a specimen. The premise of this technique is to reduce the trauma required to remove the specimen with the expectation that this may improve outcomes. Reduction in postoperative analgesic use, quicker return of bowel function, and shorter length of hospital stay have been observed in colorectal operations with NOSE compared to conventional specimen extraction. While the feasibility of NOSE has been demonstrated in colorectal surgery, failures of this technique have also been described. Selection of patients who can successfully undergo NOSE needs further investigation. This review aims to guide surgeons in appropriately selecting patients for NOSE in colorectal surgery. Patient and specimen characteristics are reviewed in order to define patient populations in which NOSE is likely to be successful. Randomized trials comparing NOSE to conventional specimen extraction in colorectal surgery tend to enroll patients with favorable characteristics (body mass index <30, American Society of Anesthesiologists class ≤3, specimen diameter <6.5 cm) and demonstrate improved outcomes. Adopters of NOSE should restrict using this technique to the populations in which feasibility has been defined in the literature. Wider application to other populations, particularly patients with body mass index >30 and those with significant comorbidities, requires further study.

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Zattoni D, Popeskou GS, Christoforidis D. Left colon resection with transrectal specimen extraction: current status. Tech Coloproctol 2018;22:411-423. [PMID: 29948523 DOI: 10.1007/s10151-018-1806-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 05/25/2018] [Indexed: 12/16/2022]

Totally Laparoscopic Resection for Low Sigmoid and Rectal Cancer Using Natural Orifice Specimen Extraction Techniques. Surg Laparosc Endosc Percutan Tech 2018;27:e74-e79. [PMID: 28731950 DOI: 10.1097/sle.0000000000000438] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]

Cheong C, Kim NK. Minimally Invasive Surgery for Rectal Cancer: Current Status and Future Perspectives. Indian J Surg Oncol 2017;8:591-599. [PMID: 29203993 PMCID: PMC5705499 DOI: 10.1007/s13193-017-0624-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Accepted: 01/31/2017] [Indexed: 02/07/2023] Open

Natural Orifice Specimen Extraction With Single Stapling Colorectal Anastomosis for Laparoscopic Anterior Resection: Feasibility, Outcomes, and Technical Considerations. Dis Colon Rectum 2017;60:43-50. [PMID: 27926556 DOI: 10.1097/dcr.0000000000000739] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]

Abstract

BACKGROUND

Double and triple stapling techniques to close the rectal stump in laparoscopic anterior resection are fraught with technical drawbacks that could possibly be avoided with the use of the single stapling technique. However, little is known of its safety in laparoscopic surgery or outcomes when combined with natural orifice specimen extraction.

OBJECTIVE

This study aims to analyze the feasibility and the operative and immediate postoperative outcomes of single-stapled anastomosis and natural orifice specimen extraction with conventional techniques. It intends to evaluate technical variations related to colon, mesentery, and pelvic anatomy characteristics.

DESIGN AND PATIENTS

A consecutive series of 188 patients underwent elective surgery for benign or malignant lesions between 10 and 40 cm from the anal verge, 5 cm or less in diameter on radiological examination, stage T1 to T3, Nx, M0, with 2 different methods of rectal stump closure (pursestring vs linear-stapled closure) associated with single or double stapling and per anus vs conventional specimen extraction.

SETTING

This study was conducted at China Medical University Hospital, Taiwan, a tertiary referral center, between January 2012 and April 2015.

MAIN OUTCOME MEASURES

The main outcomes measured are feasibility and operative and immediate postoperative outcomes.

RESULTS

Single-stapled resection with natural orifice specimen extraction was feasible in 94% patients with an 11% perioperative morbidity rate. The patients required statistically significantly less analgesia, had earlier return of bowel movements, and shorter hospital stay, whereas there was no statistically significant difference in the overall readmission rate and overall morbidity, including anastomotic leakage.

LIMITATIONS

This was a single-center, retrospective case-matched study.

CONCLUSION

Anatomic variations (short colon and short mesentery) can be managed adequately with intracorporeal anvil head fixation. The single stapling technique is feasible and as safe as conventional double stapling techniques, although it is technically more demanding. The transanal endoscopic operation platform can be useful when the rectal stump is long.

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Zhang H, Cong JC, Ling YZ, Cui MM, Zhang FY, Feng Y, Chen CS. Laparoscopic Low Anterior Resection of the Rectum with Transanal Prolapsing Specimen Extraction: Early Experience with 23 Patients. J Laparoendosc Adv Surg Tech A 2016;26:379-85. [PMID: 26863098 DOI: 10.1089/lap.2015.0141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open

Wolthuis AM, Meuleman C, Tomassetti C, D'Hooghe T, Fieuws S, de Buck van Overstraeten A, D'Hoore A. How do patients score cosmesis after laparoscopic natural orifice specimen extraction colectomy? Colorectal Dis 2015;17:536-41. [PMID: 25546712 DOI: 10.1111/codi.12885] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Accepted: 11/23/2014] [Indexed: 12/31/2022]

Wolthuis AM, De Buck Van Overstraeten A, D'Hoore A. Laparoscopic NOSE colectomy with a camera sleeve: a technique in evolution. Colorectal Dis 2015;17:O123-5. [PMID: 25706915 DOI: 10.1111/codi.12929] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Accepted: 01/27/2015] [Indexed: 02/08/2023]

Atallah S, Martin-Perez B, Keller D, Burke J, Hunter L. Natural-orifice transluminal endoscopic surgery. Br J Surg 2015;102:e73-92. [PMID: 25627137 DOI: 10.1002/bjs.9710] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 10/20/2014] [Indexed: 02/06/2023]

Wolthuis AM, Fieuws S, Van Den Bosch A, de Buck van Overstraeten A, D'Hoore A. Randomized clinical trial of laparoscopic colectomy with or without natural-orifice specimen extraction. Br J Surg 2015;102:630-7. [DOI: 10.1002/bjs.9757] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 10/13/2014] [Accepted: 11/26/2014] [Indexed: 11/08/2022]

Abstract Abstract Background Although conventional laparoscopic colectomy is a validated technique, laparoscopic natural-orifice specimen extraction (NOSE) colectomy might improve outcome. This randomized clinical trial compared analgesia requirements, postoperative pain, anorectal function, inflammatory response and cosmesis in laparoscopic NOSE colectomy and conventional laparoscopic colectomy. Methods Patients were randomly assigned to undergo laparoscopic NOSE colectomy or conventional laparoscopic colectomy for left-sided colonic disease. The primary endpoint was analgesia requirement. Secondary endpoints were operative outcome, inflammatory response, anorectal function and cosmesis. Results Forty patients were enrolled in the study, 20 in each group (15 with diverticulitis and 5 with colorectal cancer in each group). A significant difference was observed in morphine analogue requirements (1 of 20 patients in the NOSE group versus 10 of 20 in the conventional group; P = 0·003). Patient-controlled epidural analgesia was lower in the NOSE group (mean 116 ml versus 221 ml in the conventional group; P < 0·001), as was paracetamol use (mean 11·0 versus 17·0 g respectively; P < 0·001). Postoperative pain scores were lower in the NOSE group: mean maximum visual analogue score of 3·5 versus 2·1 (P < 0·001). One week after hospital discharge, pain scores remained higher in the conventional group: 15 of 20 patients in the conventional group reported pain, compared with one of 20 in the NOSE group (P < 0·001). Inflammatory responses were greater in patients undergoing NOSE colectomy: higher peak C-reactive protein and interleukin 6 levels were observed on postoperative day 2 (P < 0·001) and day 1 (P = 0·002) respectively. Postoperative anorectal function, complications and hospital stay were similar in the two groups. Conclusion Laparoscopic NOSE colectomy was associated with less pain and lower analgesia requirements than the conventional laparoscopic extraction. Registration number: NCT01033838 (http://www.clinicaltrials.gov). Collapse

Kim SJ, Choi BJ, Lee SC. A novel single-port laparoscopic operation for colorectal cancer with transanal specimen extraction: a comparative study. BMC Surg 2015;15:10. [PMID: 25633605 PMCID: PMC4328051 DOI: 10.1186/1471-2482-15-10] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Accepted: 11/28/2014] [Indexed: 01/05/2023] Open

Wolthuis AM, Overstraeten ADBV, D’Hoore A. Laparoscopic natural orifice specimen extraction-colectomy: A systematic review. World J Gastroenterol 2014;20:12981-12992. [PMID: 25278692 PMCID: PMC4177477 DOI: 10.3748/wjg.v20.i36.12981] [Citation(s) in RCA: 83] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2013] [Revised: 03/28/2014] [Accepted: 04/29/2014] [Indexed: 02/06/2023] Open

Standardized laparoscopic NOSE-colectomy is feasible with low morbidity. Surg Endosc 2014;29:1167-73. [DOI: 10.1007/s00464-014-3784-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Accepted: 07/28/2014] [Indexed: 01/14/2023]

Sajid MS, Bhatti MI, Sains P, Baig MK. Specimen retrieval approaches in patients undergoing laparoscopic colorectal resections: a literature-based review of published studies. Gastroenterol Rep (Oxf) 2014;2:251-61. [PMID: 25146342 PMCID: PMC4219147 DOI: 10.1093/gastro/gou053] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open

Kim SJ, Choi BJ, Lee SC. Overview of single-port laparoscopic surgery for colorectal cancers: past, present, and the future. World J Gastroenterol 2014;20:997-1004. [PMID: 24574772 PMCID: PMC3921551 DOI: 10.3748/wjg.v20.i4.997] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2013] [Revised: 11/01/2013] [Accepted: 12/05/2013] [Indexed: 02/07/2023] Open

Leung ALH, Cheung HYS, Li MKW. Advances in laparoscopic colorectal surgery: a review on NOTES and transanal extraction of specimen. Asian J Endosc Surg 2014;7:11-6. [PMID: 24165166 DOI: 10.1111/ases.12070] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2013] [Accepted: 09/09/2013] [Indexed: 12/14/2022]

Atallah S. Transanal minimally invasive surgery for total mesorectal excision. MINIM INVASIV THER 2013;23:10-6. [PMID: 23992386 DOI: 10.3109/13645706.2013.833118] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]

Barry B, Leroy J, Mutter D, Marescaux J, Wu HS. Minimal-invasive chirurgische Behandlung der Sigmadivertikulitis. COLOPROCTOLOGY 2013;35:101-107. [DOI: 10.1007/s00053-012-0334-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]

Christoforidis D, Clerc D, Demartines N. Transrectal specimen extraction after laparoscopic left colectomy: a case-matched study. Colorectal Dis 2013;15:347-53. [PMID: 23030665 DOI: 10.1111/codi.12006] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]

Wolthuis AM, Van Geluwe B, Fieuws S, Penninckx F, D'Hoore A. Laparoscopic sigmoid resection with transrectal specimen extraction: a systematic review. Colorectal Dis 2012;14:1183-8. [PMID: 22022977 DOI: 10.1111/j.1463-1318.2011.02869.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]

Barry BD, Leroy J, Mutter D, Wu HS, Marescaux J. Minimally invasive surgical treatment of sigmoid diverticulitis. Langenbecks Arch Surg 2012;397:1035-1041. [PMID: 22644602 DOI: 10.1007/s00423-012-0965-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2012] [Accepted: 05/20/2012] [Indexed: 12/17/2022]

Wolthuis AM, Cini C, Penninckx F, D'Hoore A. Transanal single port access to facilitate distal rectal mobilization in laparoscopic rectal sleeve resection with hand-sewn coloanal anastomosis. Tech Coloproctol 2011;16:161-5. [PMID: 22170250 DOI: 10.1007/s10151-011-0795-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2011] [Accepted: 11/22/2011] [Indexed: 12/14/2022]

Makris KI, Rieder E, Kastenmeier AS, Swanström LL. Video. Transanal specimen retrieval using the transanal endoscopic microsurgery (TEM) system in minimally invasive colon resection. Surg Endosc 2011;26:1161-2. [PMID: 22052426 DOI: 10.1007/s00464-011-2021-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2011] [Accepted: 10/16/2011] [Indexed: 12/15/2022]

Abstract

BACKGROUND

During laparoscopic colectomy, the specimen is retrieved through substantial incisions, which increase postoperative pain, wound infections, and incisional hernias. In the era of natural orifice transluminal endoscopic surgery (NOTES), incisionless transrectal approaches for colon resections have been investigated with promising results [4-6]. Transanal retrieval of the colonic specimen in laparoscopic colectomy has been described but not widely adopted, although it seems to be an appealing step towards NOTES colectomy. We have used the TEM rectoscope (Richard Wolf Medical Instruments Corporation, Vernon Hills, IL, USA) as a retrieval conduit, which facilitates transanal extraction of the specimen, and protects the rectal edge and anal sphincter during laparoscopic left colectomy.

TECHNIQUE

After standard laparoscopic dissection and vascular control, the colon is divided distally, whereas the proximal colonic end is ligated to prevent fecal spillage. The TEM rectoscope is advanced through the rectal stump. The proximal colon is grasped and withdrawn through the rectoscope. The colon is stapled off proximally, and the specimen is removed transanally. An anvil is introduced into the pelvis through the rectoscope and inserted in the descending colon through a colotomy, which is subsequently sealed with an endo-loop. The rectoscope is withdrawn, and the rectal stump edge is stapled off. A circular stapler is introduced in the rectum, and end-to-end anastomosis is performed.

DISCUSSION

The extraction incisions in laparoscopic colectomy increase invasiveness and compromise the "purity" of the laparoscopic approach. Retrieval of the specimen through natural orifices constitutes a stepping stone in the transition to future incisionless NOTES colectomy. These techniques have not been widely adopted because of technical difficulties and concerns regarding trauma. In our experience, transanal retrieval of the colonic specimen is hampered by friction between the specimen and the rectum, which requires countertraction to the edges of the open rectal stump. These manipulations are time consuming and increase the risk of injury, even when retrieval bags are used. The TEM rectoscope allows gentle dilation of the anus, provides stability during extraction, and protects the edges of the rectum, therefore decreasing the risk of rectal or anal canal injuries. It maintains pneumoperitoneum and eases retrieval of the specimen through the large-caliber metal conduit. Alternative options in the form of a rigid conduit would be the use of the transanal endoscopic operation device (Karl Storz, Tuttlingen, Germany), the plastic McCartney tube (Tyco Healthcare, Norwalk, CT, USA) used for transvaginal operations, or an anecdotally reported, "homemade" rectoscope from a customized polyvinyl chloride tube. Potential limitations of this technique include the increased cost of acquiring and using the TEM rectoscope, although this should not be significant if this reusable system is already available for transanal procedures. The 4 cm diameter of the TEM rectoscope can also be a limiting factor in the case of large, bulky, incompressible specimens or large colonic tumors. We have also avoided using this technique in patients with preexisting anal sphincter dysfunction and fecal incontinence, as well as in the presence of severe perianal disease (i.e., fistulae or fissures). Naturally, the open lumen in the peritoneal cavity raises concerns regarding bacterial contamination and potential tumor cell seeding in cases of cancer. Preliminary evidence on these issues comes from TEM and NOTES research without obvious signs of increased risk currently. We do not perform preoperative bowel preparation for our colectomies, but we do perform rectal enema with Betadine solution at the beginning of the procedure.

CONCLUSIONS

Use of the TEM system facilitates transanal removal of the specimen and protects the anorectum during laparoscopic colectomy.

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Diana M, Wall J, Costantino F, D'agostino J, Leroy J, Marescaux J. Transanal extraction of the specimen during laparoscopic colectomy. Colorectal Dis 2011;13 Suppl 7:23-27. [PMID: 22098513 DOI: 10.1111/j.1463-1318.2011.02774.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]

D'Hoore A, Wolthuis AM. Laparoscopic low anterior resection and transanal pull-through for low rectal cancer: a Natural Orifice Specimen Extraction (NOSE) technique. Colorectal Dis 2011;13 Suppl 7:28-31. [PMID: 22098514 DOI: 10.1111/j.1463-1318.2011.02773.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]

Minimally invasive surgery for colorectal cancer: past, present, and future. Int J Surg Oncol 2011;2011:490917. [PMID: 22312511 PMCID: PMC3263673 DOI: 10.1155/2011/490917] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2011] [Accepted: 06/20/2011] [Indexed: 12/12/2022] Open

Rieder E, Spaun GO, Khajanchee YS, Martinec DV, Arnold BN, Smith Sehdev AE, Swanstrom LL, Whiteford MH. A natural orifice transrectal approach for oncologic resection of the rectosigmoid: an experimental study and comparison with conventional laparoscopy. Surg Endosc 2011;25:3357-63. [PMID: 21556994 DOI: 10.1007/s00464-011-1726-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2011] [Accepted: 04/02/2011] [Indexed: 12/21/2022]

Abstract

BACKGROUND

A transrectal (TR) approach for natural orifice translumenal endoscopic surgery (NOTES) makes sense for colorectal surgery because the colotomy can be incorporated into subsequent anastomosis. Because cancer is a primary indication for left-sided colon resection, oncologic standards will have to be met by a NOTES procedure. This study aimed to assess whether pure TR rectosigmoidectomy can be performed with strict adherence to oncologic principles compared with a conventional laparoscopically assisted approach (LAP).

METHODS

Human male cadavers were allocated to either TR (n = 4) or LAP (n = 2). A simulated sigmoid lesion was created at 25 cm. Transrectal retrograde mobilization of the rectosigmoid was performed using conventional transanal endoscopic microsurgery (TEM) instrumentation. After ligation of the superior hemorrhoidal artery and further mobilization, the specimen was delivered transanally and divided extracorporeally. Using a circular stapler, NOTES colorectal anastomosis was performed. Lymph node yield, adequate resection margins, and operative time were compared with LAP.

RESULTS

Transrectal retrograde rectosigmoid dissection was achieved in all attempts (4/4) and showed numbers of lymph nodes (median, 5; range, 3-6) similar to the LAP group (median, 4.5; range, 2-7). One pure TR approach failed to resect the lesion. Three TR procedures required additional mobilization via an abdominal approach to provide adequate margins. The mean length of TR specimens was 16 ± 4 cm compared with 31 ± 9 cm achieved by LAP (p < 0.01). The TR operative time was significantly longer (247 ± 15 vs 110 ± 14 min).

CONCLUSION

Lymph node yield during TR rectosigmoidectomy was similar to that achieved by the LAP approach. However, conventional TEM instrumentation alone did not permit adequate colon mobilization. This indicates a need for flexible instrumentation or other technical solutions to perform true NOTES colectomies.

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