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Raju AS, Taghavi SMJ, Gilmore AJ. Single versus double stapled anastomosis in natural orifice specimen extraction (NOSE) laparoscopic anterior resection. ANZ J Surg 2025. [PMID: 39749843 DOI: 10.1111/ans.19387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 11/08/2024] [Accepted: 12/24/2024] [Indexed: 01/04/2025]
Abstract
BACKGROUND Laparoscopic anterior resection (LAR) with Natural Orifice Specimen Extraction (NOSE) has shown benefits such as reduced pain, fewer wound complications, and improved cosmesis. In colorectal anastomosis during NOSE, double staple anastomosis (DSA) and triple stapled technique (TSA) are common. However, a novel single stapled anastomosis (SSA) technique, utilising two laparoscopically placed purse strings and only four 5 mm ports, has emerged. This study aims to compare the complications between single and double stapled anastomoses in NOSE LAR. METHODS A retrospective analysis of NOSE LAR data from 2011 to 2022 included patients. All patients received mechanical bowel preparation, colonoscopic instillation of betadine or chlorhexidine, and antibiotics. DSA was performed conventionally, while the SSA technique involved an additional rectal laparoscopic purse string. Fisher's exact test assessed anastomotic leak rates and the need for intraoperative revisions. RESULTS Analysis of 179 patients revealed 40 with SSA and 139 with DSA. Patient age ranged from 20 to 88 years, with a BMI between 22 and 46 kg/m2. Diverticulitis and malignant polyps, the most common indications. Operation duration was similar between groups (238 min in SSA, 234 min in DSA; P = 0.69). Intraoperative laparoscopic anastomotic redo was significantly higher in the SSA group (six patients) than the DSA group (five patients; P = <0.05). No anastomotic leaks occurred in the SSA group, while six occurred in the DSA group (P = 0.34). There was no significant difference in Length of Stay (LOS), (5 days in SSA versus 6 days in DSA group, P = 0.29). CONCLUSIONS Single stapled anastomosis in NOSE LAR appears safe for benign conditions but is more likely to necessitate intraoperative redo compared to double stapled anastomosis.
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Affiliation(s)
- Abdus Salam Raju
- Department of Colorectal Surgery, Liverpool Hospital, Sydney, New South Wales, Australia
- School of Medicine, Western Sydney University, Sydney, New South Wales, Australia
| | - Seyed Mohammad Javad Taghavi
- Department of Colorectal Surgery, Liverpool Hospital, Sydney, New South Wales, Australia
- School of Medicine, Western Sydney University, Sydney, New South Wales, Australia
| | - Andrew James Gilmore
- Department of Colorectal Surgery, Liverpool Hospital, Sydney, New South Wales, Australia
- School of Medicine, Western Sydney University, Sydney, New South Wales, Australia
- Colorectal Surgery, Macquarie University Hospital, Sydney, New South Wales, Australia
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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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Affiliation(s)
- Eric M Haas
- Houston Methodist Hospital, Houston, TX, USA.
- HCA Gulf Coast Division, Houston, TX, USA.
- Houston Colon PLLC, Houston, TX, USA.
| | | | | | | | | | | | - Matthew Weaver
- HCA Gulf Coast Division, Houston, TX, USA
- Houston Colon PLLC, Houston, TX, USA
| | - Jean-Paul LeFave
- Houston Methodist Hospital, Houston, TX, USA
- Houston Colon PLLC, Houston, TX, USA
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He Q, Huang J, Niu L, Zhai C. A comparison of the efficacy and safety of natural orifice specimen extraction and conventional laparoscopic surgery in patients with sigmoid colon/high rectal cancer. J Surg Oncol 2023; 127:1160-1166. [PMID: 36913188 DOI: 10.1002/jso.27235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 02/02/2023] [Accepted: 02/28/2023] [Indexed: 03/14/2023]
Abstract
OBJECTIVE This study aimed to investigate the efficacy and safety of natural orifice specimen extraction surgery (NOSES) compared to conventional laparoscopic radical resection in the treatment of patients with sigmoid colon/high rectal cancer. METHODS The control group (n = 62) underwent traditional laparoscopic radical resection, and the observation group (n = 62) underwent transanal NOSES laparoscopic radical resection. The operation length; amount of bleeding; number of lymph node dissections and days of hospitalization after surgery; visual pain scores on the first and third days after surgery; first leaving bed, anal exhaust, eating a liquid diet, and effective sleep times; and the postoperative complications (abdominal or incision infection or anastomotic fistula) of the two groups of patients were compared and analyzed. RESULTS The effective sleep time of the observation group on the first day after the operation was 12.3 ± 2.9 h, which was longer than that of the control group (10.6 ± 3.2 h), and the difference was statistically significant (p < 0.001). The pain degree of the two groups on the third day after the operation was lower than that on the first day, and the pain score of the observation group was lower than that of the control group (2.0 ± 1.0 vs. 3.2 ± 1.2, p < 0.001). The postoperative hospital stay in the observation group was significantly shorter than that in the control group (9.7 ± 2.3 vs. 11.2 ± 2.6, p < 0.001). The incidence of postoperative complications in the observation group was significantly lower than that in the control group (3.2% vs. 12.9%, p = 0.048). In addition, it was found that the first leaving bed, anal exhaust and liquid diet times in the observation group were significantly shorter than those in the control group (p < 0.001). CONCLUSION Laparoscopic radical resection NOSES in patients with sigmoid colon cancer or high rectal cancer leads to lower postoperative pain and longer sleep time than in patients who undergo traditional laparoscopic radical surgery. The complication rate of this procedure is low, and the curative effect is safe and positive.
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Affiliation(s)
- Qiang He
- Department of Colorectal Surgery, The Shanxi Province People's Hospital, Taiyuan, China
| | - Jing Huang
- Department of Colorectal Surgery, The Shanxi Province People's Hospital, Taiyuan, China
| | - Liyun Niu
- Department of Colorectal Surgery, The Shanxi Province People's Hospital, Taiyuan, China
| | - Chunbao Zhai
- Department of Colorectal Surgery, The Shanxi Province People's Hospital, Taiyuan, China
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Zhao F, Zhao W, Xiao T, Wang Z, Huang F, Xing W, Liu Q. Evaluating short-term and survival outcomes of natural orifice specimen extraction surgery for colorectal cancer: A single-centre retrospective study. Front Surg 2023; 10:1078316. [PMID: 36911615 PMCID: PMC9995366 DOI: 10.3389/fsurg.2023.1078316] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 01/27/2023] [Indexed: 02/25/2023] Open
Abstract
Background Natural orifice specimen extraction surgery (NOSES) has been confirmed as an alternative approach without auxiliary incisions. The purpose of this study was to investigate the short-term and survival outcomes of NOSES versus conventional laparoscopic surgery (LAP) in treatment of sigmoid and high rectal cancer. Method The retrospective study was conducted at single centers between January 2017 to December 2021. Relevant data included clinical demographics, pathological features, operative parameters, postoperative complications and survival outcomes were collected and analyzed. All procedures were performed using either a NOSES or a conventional LAP approach. Propensity score matching (PSM) was conducted to balance clinical and pathological features between the two groups. Results After PSM, a total of 288 patients were eventually included in this study, 144 in each group. Patients in the NOSES group experienced faster recovery of gastrointestinal function (2.6 ± 0.8 vs. 3.6 ± 0.9 day, P = 0.037), less pain and less analgesia required (12.5% vs. 33.3%, P < 0.001). In addition, the incidence of surgical site infection in the LAP group was significantly higher than that in the NOSES group (12.5% vs. 4.2%, P = 0.011), especially incision-related complications (8.3% vs. 2.1%, P = 0.017). After a median follow-up of 32 (range, 3-75) months, the two groups had similar 3-year overall survival rates (88.4% vs. 88.6%; P = 0.850) and disease-free survival rates (82.9% vs. 77.2%; P = 0.494). Conclusion The transrectal NOSES procedure is a well-established strategy with advantages in reducing postoperative pain, faster recovery of gastrointestinal function, and less incision-related complications. In addition, the long-term survival is similar between NOSES and conventional laparoscopic surgery.
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Affiliation(s)
- Fuqiang Zhao
- 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, Beijing, China
| | - Wei Zhao
- 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, Beijing, China
| | - Tixian Xiao
- 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, Beijing, China
| | - Zhijie 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, Beijing, China
| | - Fei Huang
- 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, Beijing, China
| | - Wei Xing
- Department of General Surgery, Hebei Province Hospital of Chinese Medicine, Affiliated Hospital of Hebei University of Chinese Medicine, Shijiazhuang, China
| | - Qian 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, Beijing, 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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Affiliation(s)
- Eric M. Haas
- University of Houston College of Medicine, Chief Quality Colon and Rectal Surgery, HCA Healthcare Gulf Coast Division, 6560 Fannin Street, Houston, TX 77030 USA
- Houston Colon Foundation, Houston, TX USA
| | - Thais Reif de Paula
- University of Houston College of Medicine, Chief Quality Colon and Rectal Surgery, HCA Healthcare Gulf Coast Division, 6560 Fannin Street, Houston, TX 77030 USA
| | - Roberto Luna-Saracho
- University of Houston College of Medicine, Chief Quality Colon and Rectal Surgery, HCA Healthcare Gulf Coast Division, 6560 Fannin Street, Houston, TX 77030 USA
| | - Melissa S. Smith
- University of Houston College of Medicine, Chief Quality Colon and Rectal Surgery, HCA Healthcare Gulf Coast Division, 6560 Fannin Street, Houston, TX 77030 USA
- Houston Colon Foundation, Houston, TX USA
| | - Jose I. Ortiz De Elguea-Lizarraga
- University of Houston College of Medicine, Chief Quality Colon and Rectal Surgery, HCA Healthcare Gulf Coast Division, 6560 Fannin Street, Houston, TX 77030 USA
| | | | - Mark Edgcomb
- University of Houston College of Medicine, Chief Quality Colon and Rectal Surgery, HCA Healthcare Gulf Coast Division, 6560 Fannin Street, Houston, TX 77030 USA
- Houston Colon Foundation, Houston, TX USA
| | - Jean-Paul LeFave
- University of Houston College of Medicine, Chief Quality Colon and Rectal Surgery, HCA Healthcare Gulf Coast Division, 6560 Fannin Street, Houston, TX 77030 USA
- Houston Colon Foundation, Houston, TX USA
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Tillu N, Kulkarni J. Multi-quadrant Robotic-Assisted Surgery for Synchronous Tumours Involving the Genitourinary System - Our Experience. Indian J Surg Oncol 2022; 13:842-847. [PMID: 36687229 PMCID: PMC9845482 DOI: 10.1007/s13193-022-01584-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 07/07/2022] [Indexed: 02/07/2023] Open
Affiliation(s)
- Neeraja Tillu
- Asian Cancer Institute, 93, ACI Hospital, 95, August Kranti Rd, Kemps Corner, Cumballa Hill, Mumbai, Maharashtra 400036 India
| | - Jagdeesh Kulkarni
- Asian Cancer Institute, 93, ACI Hospital, 95, August Kranti Rd, Kemps Corner, Cumballa Hill, Mumbai, Maharashtra 400036 India
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Muhammad S, Gao Y, Guan X, QingChao T, Fei S, Wang G, Chen Y, Liu Z, Jiang Z, Kaur K, Tatiana K, Ul Ain Q, Wang X, He J. Laparoscopic natural orifice specimen extraction, a minimally invasive surgical technique for mid-rectal cancers: Retrospective single-center analysis and single-surgeon experience of selected patients. J Int Med Res 2022; 50:3000605221134472. [PMID: 36440806 PMCID: PMC9712411 DOI: 10.1177/03000605221134472] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 10/05/2022] [Indexed: 03/27/2024] Open
Abstract
OBJECTIVE To evaluate the feasibility, safety, and short-term outcomes of middle rectal resection followed by transanal specimen extraction. METHODS Forty-four patients with small mid-rectal tumors underwent laparoscopic rectal resection followed by transanal specimen extraction. RESULTS The procedure was successful in all patients without intraoperative conversion or additional access. The mean operation time was 182.7 minutes (range, 130-255 minutes), the mean blood loss was 26.5 mL (range, 5-120 mL), the mean postoperative exhaust time was 31.3 hours (range, 16-60 hours), and the mean length of hospital stay was 9.5 days (range, 8-19 days). One patient developed anastomotic leakage, which was treated by intravenous antibiotics and daily pelvic cavity flushes through the abdominal drainage tube. No infection-related complications or anal incontinence were observed. The mean tumor size was 2.1 cm (range, 1.6-3.2 cm), the mean number of harvested lymph nodes was 16.5 (range, 6-31), and the mean follow-up time was 8.5 months (range, 2-16 months). By the last follow-up, no signs of recurrence had been found in any patient. CONCLUSION The combination of standard laparoscopic proctectomy and transanal specimen extraction could become a well-established strategy for selected patients.
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Affiliation(s)
- Shan Muhammad
- Department of Thoracic Surgery, National Cancer Center/National
Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical
Sciences and Peking Union Medical College, Beijing 100021, China
- Laboratory of Translational Medicine, National Cancer
Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese
Academy of Medical Sciences and Peking Union Medical College, Beijing 100021,
China
- Department of Colorectal Surgery, National Cancer
Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese
Academy of Medical Sciences & Peking Union Medical College, Beijing 100021,
China
- Department of Colorectal Surgery, the Second Affiliated Hospital
of Harbin Medical University, Harbin 150086, China
| | - YiBo Gao
- Department of Thoracic Surgery, National Cancer Center/National
Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical
Sciences and Peking Union Medical College, Beijing 100021, China
- Laboratory of Translational Medicine, National Cancer
Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese
Academy of Medical Sciences and Peking Union Medical College, Beijing 100021,
China
| | - Xu Guan
- Department of Colorectal Surgery, National Cancer
Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese
Academy of Medical Sciences & Peking Union Medical College, Beijing 100021,
China
| | - Tang QingChao
- Department of Colorectal Surgery, the Second Affiliated Hospital
of Harbin Medical University, Harbin 150086, China
| | - Shao Fei
- Department of Thoracic Surgery, National Cancer Center/National
Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical
Sciences and Peking Union Medical College, Beijing 100021, China
- Laboratory of Translational Medicine, National Cancer
Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese
Academy of Medical Sciences and Peking Union Medical College, Beijing 100021,
China
| | - Guiyu Wang
- Department of Colorectal Surgery, the Second Affiliated Hospital
of Harbin Medical University, Harbin 150086, China
| | - Yinggang Chen
- Department of Colorectal Surgery, the Second Affiliated Hospital
of Harbin Medical University, Harbin 150086, China
| | - Zheng Liu
- Department of Colorectal Surgery, National Cancer
Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese
Academy of Medical Sciences & Peking Union Medical College, Beijing 100021,
China
| | - Zheng Jiang
- Department of Colorectal Surgery, National Cancer
Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese
Academy of Medical Sciences & Peking Union Medical College, Beijing 100021,
China
| | - Kavanjit Kaur
- Department of Colorectal Surgery, the Second Affiliated Hospital
of Harbin Medical University, Harbin 150086, China
| | | | - Qurat Ul Ain
- Department of Colorectal Surgery, the Second Affiliated Hospital
of Harbin Medical University, Harbin 150086, China
| | - Xishan Wang
- Department of Colorectal Surgery, National Cancer
Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese
Academy of Medical Sciences & Peking Union Medical College, Beijing 100021,
China
- Department of Colorectal Surgery, the Second Affiliated Hospital
of Harbin Medical University, Harbin 150086, China
| | - Jie He
- Department of Thoracic Surgery, National Cancer Center/National
Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical
Sciences and Peking Union Medical College, Beijing 100021, China
- Laboratory of Translational Medicine, National Cancer
Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese
Academy of Medical Sciences and Peking Union Medical College, Beijing 100021,
China
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Hahn SJ, Sylla P. Technological Advances in the Surgical Treatment of Colorectal Cancer. Surg Oncol Clin N Am 2022; 31:183-218. [DOI: 10.1016/j.soc.2022.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Jong BK, Cheng CC, Hsu YJ, Chern YJ, Tsai WS, Hung HY, Liao CK, Yeh CY, Hsieh PS, You JF. Transrectal natural orifice specimen extraction in left hemicolectomy for tumours around the splenic flexure: Old wine in new bottles. Colorectal Dis 2022; 24:128-132. [PMID: 34601777 DOI: 10.1111/codi.15930] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 09/17/2021] [Accepted: 09/27/2021] [Indexed: 02/08/2023]
Abstract
AIM Laparoscopic anterior resection with natural orifice specimen extraction (NOSE) has favourable short-term outcomes. However, NOSE is rarely adopted for left hemicolectomy procedures. This study aimed to review the feasibility, safety and short-term outcomes of transrectal NOSE in patients undergoing laparoscopic left hemicolectomy. METHOD All consecutive patients who underwent laparoscopic left hemicolectomy surgery with transrectal NOSE in a single institution between January 2018 and December 2020 were reviewed. Transrectal NOSE was performed with an enterotomy at the upper rectum. The specimen was brought out via a transanal endoscopic microsurgery scope inserted through the anus. A supplementary video demonstrates this technique. Surgical outcomes, including complications, postoperative short-term recovery and the level of pain intensity, are presented. RESULTS Twenty patients were reviewed. There were no immediate postoperative complications and no wound infections in these patients. The average time to tolerate a soft diet was 3.6 days, and the average postoperative hospital stay was 4.5 days. The average score on the numerical rating scale of postoperative pain was 3.0 on postoperative day 1. The median follow-up time was 23.5 months. CONCLUSION Laparoscopic left hemicolectomy with transrectal NOSE is a safe and feasible procedure that leads to early postoperative recovery and a short hospital stay.
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Affiliation(s)
- Bor-Kang Jong
- Colorectal Section, Department of Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan.,School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ching-Chung Cheng
- Colorectal Section, Department of Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan.,School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yu-Jen Hsu
- Colorectal Section, Department of Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan.,School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yih-Jong Chern
- Colorectal Section, Department of Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan.,School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Wen-Sy Tsai
- Colorectal Section, Department of Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan.,School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Hsin-Yuan Hung
- School of Medicine, Chang Gung University, Taoyuan, Taiwan.,New Taipei City Municipal Tucheng Hospital, New Taipei City, Taiwan
| | - Chun-Kai Liao
- Colorectal Section, Department of Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan.,School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chien-Yu Yeh
- Colorectal Section, Department of Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan.,School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Pao-Shiu Hsieh
- Colorectal Section, Department of Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan.,School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Jeng-Fu You
- Colorectal Section, Department of Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan.,School of Medicine, Chang Gung University, Taoyuan, Taiwan
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Huang B, Liu MC, Gao W, Tang J, Zhu Z, Chen L, Han JY, Zhou ZQ, Fu CG. Nomogram for predicting the feasibility of natural orifice specimen extraction after laparoscopic rectal resection. J Gastroenterol Hepatol 2021; 36:1803-1811. [PMID: 33150976 DOI: 10.1111/jgh.15333] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 10/21/2020] [Accepted: 11/03/2020] [Indexed: 01/18/2023]
Abstract
BACKGROUND AND AIM The goal of this study was to develop a preoperative nomogram for predicting the feasibility of trans-anal natural orifice specimen extraction (NOSE) for rectal cancer. METHODS The analysis included 201 patients who underwent trans-anal NOSE and 457 patients who failed to undergo trans-anal NOSE in Shanghai East Hospital. The data collected included age, gender, body mass index, presence of tumor obstruction, distance from anal verge; maximum tumor diameter and anteroposterior thickness of mesorectum (AP) measured by magnetic resonance imaging; interspinous diameter, intertuberous diameter (IT), anteroposterior diameter of the inlet (API), anteroposterior diameter of the midplane, anteroposterior diameter of the outlet (APO), sacral length and pelvic depth (PD) measured by computed tomography. RESULTS The multivariate analysis suggested that a lower body mass index (P < 0.001), no tumor obstruction (P = 0.005), a shorter distance from anal verge (P < 0.001), a smaller tumor size (P < 0.001), a thinner AP (P < 0.001), a wider and shallower bony pelvis (API/PD, P < 0.001), and a wider and shorter pelvic outlet (IT/APO, P < 0.001) were significantly associated with an increased probability of trans-anal NOSE. Successful NOSE patients had a decreased time to liquid intake (P < 0.001), a shorter postoperative hospital stay (P < 0.001), and fewer wound infections (P = 0.045). No significant difference in the rate of mortality or recurrence was observed. The nomogram model presented an area under the receiver operating characteristic curve of 0.81 (95% CI, 0.78 to 0.85) and good calibration. CONCLUSION We developed a nomogram model that has some predicative value for the feasibility of laparoscopic rectal resection with trans-anal NOSE, utilizing clinical and radiologic parameters, available in most institutions.
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Affiliation(s)
- Ben Huang
- Department of Colorectal Surgery, Shanghai East Hospital, Tongji University, Shanghai, China.,Department of General Surgery, Shanghai East Hospital, Tongji University, Shanghai, China
| | - Meng-Cheng Liu
- Department of Colorectal Surgery, Shanghai East Hospital, Tongji University, Shanghai, China.,Department of General Surgery, Shanghai East Hospital, Tongji University, Shanghai, China
| | - Wei Gao
- Department of Colorectal Surgery, Shanghai East Hospital, Tongji University, Shanghai, China.,Department of General Surgery, Shanghai East Hospital, Tongji University, Shanghai, China
| | - Jie Tang
- Department of Colorectal Surgery, Shanghai East Hospital, Tongji University, Shanghai, China.,Department of General Surgery, Shanghai East Hospital, Tongji University, Shanghai, China
| | - Zhe Zhu
- Department of Colorectal Surgery, Shanghai East Hospital, Tongji University, Shanghai, China.,Department of General Surgery, Shanghai East Hospital, Tongji University, Shanghai, China
| | - Lin Chen
- Department of Colorectal Surgery, Shanghai East Hospital, Tongji University, Shanghai, China.,Department of General Surgery, Shanghai East Hospital, Tongji University, Shanghai, China
| | - Jun-Yi Han
- Department of Colorectal Surgery, Shanghai East Hospital, Tongji University, Shanghai, China.,Department of General Surgery, Shanghai East Hospital, Tongji University, Shanghai, China
| | - Zhu-Qing Zhou
- Department of Colorectal Surgery, Shanghai East Hospital, Tongji University, Shanghai, China.,Department of General Surgery, Shanghai East Hospital, Tongji University, Shanghai, China
| | - Chuan-Gang Fu
- Department of Colorectal Surgery, Shanghai East Hospital, Tongji University, Shanghai, China.,Department of General Surgery, Shanghai East Hospital, Tongji University, Shanghai, China
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11
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Ahmad NZ, Swayamjoti R, Flashman K, Naqvi SAH, Khan J. A Case Series of Laparoscopic Colorectal Resections with Natural Orifice Specimen Extraction and Systematic Literature Review. Surg J (N Y) 2021; 7:e203-e208. [PMID: 34395873 PMCID: PMC8354358 DOI: 10.1055/s-0041-1733833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 04/06/2021] [Indexed: 11/05/2022] Open
Abstract
Background Minimal access surgery is associated with improved cosmetic and other short-term outcomes. Conventionally, an abdominal incision is made for specimen extraction. We assessed the feasibility of specimen extraction through one of the natural orifices and analyzed its impact on short-term outcomes. Methods A prospectively collected data were reviewed on consecutive patients who underwent natural orifice specimen extraction (NOSE) after laparoscopic colorectal surgery. The results were compared with a matched group who had transabdominal extraction (TAE) of the specimens. A systematic literature review was performed to compare our results. Results The combined median operating time for right and left colectomies was significantly higher in the NOSE group as compared with TAE group (260 vs. 150). There was no mortality in either group and no conversions to TAE in the NOSE group. No local metastasis or major iatrogenic injuries were reported at the time of retrieval. The results were comparable to those of a meta-analysis of randomized controlled trials. Conclusion The results of NOSE are comparable to those of TAEs. The absence of a minilaparotomy for specimen extraction may lead to a speedy recovery and better cosmesis.
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Affiliation(s)
- Nasir Zaheer Ahmad
- Department of General Surgery, University Hospital Limerick, Limerick, Ireland
| | - Ray Swayamjoti
- Department of Colorectal Surgery, Queen Alexandra Hospital, Portsmouth, United Kingdom
| | - Karen Flashman
- Department of Colorectal Surgery, Queen Alexandra Hospital, Portsmouth, United Kingdom
| | | | - Jim Khan
- Department of Colorectal Surgery, Queen Alexandra Hospital, Portsmouth, United Kingdom
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12
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Completely intracorporeal anastomosis in robotic left colonic and rectal surgery: technique and 30-day outcomes. Updates Surg 2021; 73:2137-2143. [PMID: 33993462 DOI: 10.1007/s13304-021-01061-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 04/19/2021] [Indexed: 10/21/2022]
Abstract
As robotic surgery continues to disseminate into the field of colon and rectal surgery, there is a growing interest in the utilization of intracorporeal anastomosis to potentially improve surgical outcomes. The purpoe of this study was to compare feasibility, safety, and short-term outcomes of robotic sigmoid and low anterior resections performed with completely intracorporeal anastomosis (CICA) technique to the traditional extracorporeal assisted anastomosis (ECAA) technique. Consecutive series of patients who underwent elective robotic sigmoid or low anterior resections for benign or malignant disease utilizes either CICA or ECAA between August 2017 and November 2019. Surgical complications were assessed until 30 postoperative days and compared between the two groups. A total of 160 patients were identified; 73 (45.6%) in the CICA group and 87 (54.4%) in the ECAA group. Most of the procedures were performed for malignancy (76%). Estimated blood loss was lower in the CICA group (80.7 mL vs. 110.2 mL; p = 0.048), while operative times were longer (5.9 ± SD hours vs. 4.9 ± SD hours; p = < 0.001). Overall conversion rate was 1.9%, with no conversions in the CICA group. Overall complications occurred in 54 patients (33.8%) with 13 (8.3%) representing major complications. There were no significant differences in 30 day outcomes between the two groups. This study demonstrates the feasibility and safety of robotic sigmoid and low anterior resections with CICA. Outcomes for robotic sigmoid and low anterior resections are encouraging regardless of anastomotic technique (CICA vs ECAA).
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13
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Wang J, Hong J, Wang Q, Luo F, Guo F. A Novel Method of Natural Orifice Specimen Extraction Surgery (NOSES) during Laparoscopic Anterior Resection for Rectal Cancer. Gastroenterol Res Pract 2021; 2021:6610737. [PMID: 33574839 PMCID: PMC7857920 DOI: 10.1155/2021/6610737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 12/28/2020] [Accepted: 01/12/2021] [Indexed: 11/17/2022] Open
Abstract
We propose a modification to the reconstruction method of natural orifice specimen extraction surgery (NOSES) during laparoscopic anterior resection (LAR) for rectal cancer (RC) and evaluated its feasibility and short-term safety by comparing surgical and postoperative outcomes with those of conventional LAR. Twenty patients with RC underwent "double-purse" NOSES-LAR from October 2017 to June 2018. Data of clinicopathological characteristics, surgical and postoperative outcomes, and follow-up findings in NOSES-LAR cases were collected and retrospectively compared with those of conventional LAR to clarify the clinical benefits. The median postoperative hospital stay was lower in the double-purse NOSES group than the conventional group (6.6 vs. 7.1 days, respectively). In the conventional group, anastomotic leakage and incision site infection occurred in one patient each. In contrast, there were no complications in the double-purse group. There were no significant differences in blood loss, surgical duration, and time of the first flatus between the two groups. Additionally, "double-purse" NOSES-LAR was more economical than the conventional LAR. "Double-purse" NOSES-LAR is a safe, feasible, and minimally invasive promising procedure for LAR of RC with faster recovery, while requiring less surgical skills and lower clinical costs.
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Affiliation(s)
- Jun Wang
- Department of General Surgery, Huashan Hospital, Fudan University, Shanghai 200090, China
| | - Jun Hong
- Department of General Surgery, Huashan Hospital, Fudan University, Shanghai 200090, China
| | - Qianwei Wang
- Department of General Surgery, Huashan Hospital, Fudan University, Shanghai 200090, China
| | - Fen Luo
- Department of General Surgery, Huashan Hospital, Fudan University, Shanghai 200090, China
| | - Fenghua Guo
- Department of General Surgery, Huashan Hospital, Fudan University, Shanghai 200090, China
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14
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Liang H, Zhu Z, Zhang C, Zhang H, Zhang C. A safe and feasible technique: laparoscopic manual binding technique for intracorporeal anastomosis in totally laparoscopic anterior resection of high-mid rectal cancer. Surg Endosc 2021; 35:1927-1930. [PMID: 33492507 DOI: 10.1007/s00464-021-08294-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 01/05/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Totally laparoscopic anterior resection (TLAC) is difficult even for experienced surgeons because of difficulties in fixating the anvil of circular stapling device with laparoscopy. We herein report a novel technique of laparoscopic manual binding technique (MBT) to conduct intracorporeal anastomosis by the double-stapling technique (DST) for high-mid rectal cancer. METHODS Since April 2019, MBT for intracorporeal anastomosis in TLAC were performed for 12 patients. After the total mesorectal excision, the anvil of a circular stapling device is put in the abdominal cavity through the anus and inserted into the proximal colonic stump. At the pre-anastomotic site, the intestinal wall of colon is fully fixated on the central rod of the anvil with surgical suture No. 0 by manual binding with laparoscopic instruments as laparoscopic grasping forceps, in addition, double binding if necessary. Then, the end of the colon and rectum is anastomosised by the double-stapling technique (DST). RESULTS A total of 12 patients completed the operation successfully. Only one patient experienced fever (T < 38.5 °C) after operation. No patients experienced surgical complications greater than Clavien-Dindo grade I. CONCLUSIONS We introduced the usefulness of the MBT to improve TLAC. MBT for intracorporeal anastomosis in TLAC for high-mid rectal cancer is safe and feasible.
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Affiliation(s)
- Hong Liang
- Department of Gastrointestinal Surgery, Henan Provincial People's Hospital, Zhengzhou, Henan, People's Republic of China.,Department of Gastrointestinal Surgery, People's Hospital of Zhengzhou University, Zhengzhou, People's Republic of China.,Henan University Clinical Medical College, Zhengzhou, Henan, People's Republic of China
| | - Zhonglin Zhu
- Department of Gastrointestinal Surgery, Henan Provincial People's Hospital, Zhengzhou, Henan, People's Republic of China.,Department of Gastrointestinal Surgery, People's Hospital of Zhengzhou University, Zhengzhou, People's Republic of China.,Henan University Clinical Medical College, Zhengzhou, Henan, People's Republic of China
| | - Chao Zhang
- Department of Gastrointestinal Surgery, Henan Provincial People's Hospital, Zhengzhou, Henan, People's Republic of China. .,Department of Gastrointestinal Surgery, People's Hospital of Zhengzhou University, Zhengzhou, People's Republic of China. .,Henan University Clinical Medical College, Zhengzhou, Henan, People's Republic of China.
| | - Hui Zhang
- Department of Gastrointestinal Surgery, Henan Provincial People's Hospital, Zhengzhou, Henan, People's Republic of China.,Department of Gastrointestinal Surgery, People's Hospital of Zhengzhou University, Zhengzhou, People's Republic of China.,Henan University Clinical Medical College, Zhengzhou, Henan, People's Republic of China
| | - Chunbo Zhang
- Department of Gastrointestinal Surgery, Henan Provincial People's Hospital, Zhengzhou, Henan, People's Republic of China.,Henan University Clinical Medical College, Zhengzhou, Henan, People's Republic of China
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15
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Masubuchi S, Okuda J, Yamamoto M, Inoue Y, Tanaka K, Uchiyama K. Natural orifice specimen extraction in laparoscopic colorectal cancer surgery: A case series study. Int J Surg Case Rep 2021; 78:204-209. [PMID: 33360631 PMCID: PMC7773675 DOI: 10.1016/j.ijscr.2020.12.059] [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] [Received: 12/07/2020] [Revised: 12/17/2020] [Accepted: 12/17/2020] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION In recent years, natural orifice specimen extraction (NOSE) has been attracting attention as a further minimally invasive operation for colorectal cancer, and not only improvement of appearance, but also reduction of pain and wound-related complications due to abdominal wall destruction has been reported. However, NOSE is technically complicated and difficult, and it has not yet been widely used. The aim of this study was to confirm the feasibility, safety, and short-term outcomes of total laparoscopic colon cancer surgery with NOSE. CASE PRESENTATION From May 2018 to October 2019, eight patients with stage 0 or I colon cancer underwent NOSE surgery in our hospital. Transanal specimen extraction was performed in six cases, and transvaginal specimen extraction was performed in two cases. All operations were successfully accomplished without conversion to open surgery. The anastomosis method was double stapling technique in three cases and overlap method in five cases. The median operative time was 224 min. The median blood loss was 10 mL. The median time to first flatus was 1 day, and the median time to first stool was 2 days. The median postoperative observation period was 18 months, but there was no recurrence. There were no postoperative complications in these cases. CONCLUSION Total laparoscopic colon cancer surgery with NOSE appears to be feasible, safe, and show promising efficacy for selected patients.
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Affiliation(s)
- Shinsuke Masubuchi
- Department of General and Gastroenterological Surgery, Osaka Medical College, Takatsuki 569-8686, Japan; Department of Gastroenterological Surgery, Hirakata City Hospital, Hirakata 573-1013, Japan.
| | - Junji Okuda
- Cancer Center, Osaka Medical College, Takatsuki 569-8686, Japan.
| | - Masashi Yamamoto
- Department of General and Gastroenterological Surgery, Osaka Medical College, Takatsuki 569-8686, Japan.
| | - Yoshihiro Inoue
- Department of General and Gastroenterological Surgery, Osaka Medical College, Takatsuki 569-8686, Japan.
| | - Keitaro Tanaka
- Department of General and Gastroenterological Surgery, Osaka Medical College, Takatsuki 569-8686, Japan.
| | - Kazuhisa Uchiyama
- Department of General and Gastroenterological Surgery, Osaka Medical College, Takatsuki 569-8686, Japan.
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16
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Long-term Oncologic Outcomes of Laparoscopic Anterior Resections for Cancer with Natural Orifice Versus Conventional Specimen Extraction: A Case-Control Study. Dis Colon Rectum 2020; 63:1071-1079. [PMID: 32692072 DOI: 10.1097/dcr.0000000000001622] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Although the short-term advantages of natural orifice specimen extraction are widely recognized, controversy exists concerning oncologic safety after laparoscopic surgery for colorectal cancer. OBJECTIVE This study aimed to investigate the impact of natural orifice specimen extraction on local recurrence and long-term survival of patients undergoing colorectal cancer surgery. DESIGN This is a propensity score-matched comparative study. SETTING This study presents a single-center experience. PATIENTS We retrospectively analyzed the records of patients who underwent curative laparoscopic anterior resection for American Joint Committee on Cancer stage I to III sigmoid or upper rectal cancer in 2011 to 2014, based on prospectively collected data. INTERVENTIONS Oncologic outcomes were compared between patients undergoing natural orifice or conventional specimen extraction by minilaparotomy. Patients were matched 1:1 according to propensity scores calculated by logistic regression analysis with the following covariates: American Joint Committee on Cancer stage, tumor diameter, age, sex, BMI, and T stage. Cox proportional hazards regression analysis was performed to determine the impact on oncologic outcome. MAIN OUTCOME MEASURES The primary outcomes measured were local recurrence and disease-free survival rates at 5 years. RESULTS Of 392 eligible patients, 188 were matched (94 undergoing natural orifice specimen extraction and 94 undergoing conventional extraction by minilaparotomy). Median follow-up was 50.3 months. The cumulative local recurrence risk at 5 years was 2.3% and 3.5% (p = 0.632), whereas 5-year disease-free survival for all tumor stages combined was 87.3% and 82.0% (p = 0.383) in laparoscopic anterior resection with natural orifice specimen extraction and conventional extraction groups. T3 and T4 stages were the only variables independently associated with disease-free survival. LIMITATIONS This study was limited because it focused on a single center, was a retrospective analysis, contained no long-term anorectal function testing, and had a small sample size. CONCLUSION Long-term oncologic outcomes of patients undergoing laparoscopic anterior resection with natural orifice specimen extraction for sigmoid and upper rectal cancer do not differ from those undergoing conventional extraction. Thus, natural orifice specimen extraction could be a viable alternative to reduce abdominal wall insult in laparoscopic colorectal operations for malignancy in selected patients. See Video Abstract at http://links.lww.com/DCR/B241. RESULTADOS ONCOLÓGICOS A LARGO PLAZO DE RESECCIONES ANTERIORES LAPAROSCÓPICAS PARA CÁNCER A TRAVÉS DE ORIFICIO NATURAL FRENTE A EXTRACCIÓN CONVENCIONAL DEL ESPÉCIMEN: UN ESTUDIO DE CASOS Y CONTROLES: Si bien las ventajas a corto plazo de la extracción de especímenes por orificio natural son ampliamente reconocidas, existe controversia con respecto a la seguridad oncológica después de la cirugía laparoscópica para el cáncer colorrectal.Investigar el impacto de la extracción de especímenes por orificio natural en la recurrencia local y la supervivencia a largo plazo de pacientes sometidos a cirugía de cáncer colorrectal.Estudio comparativo con emparejamiento por puntuación de propensión.Experiencia en un centro único.Analizamos retrospectivamente los registros de pacientes que se sometieron a resección anterior laparoscópica curativa para cáncer sigmoideo o rectal superior AJCC en estadio I-III en 2011-2014, con base en datos recolectados prospectivamente.Los resultados oncológicos se compararon entre pacientes sometidos a extracción por orificio natural o convencional mediante minilaparotomía de especímenes. Los pacientes fueron emparejados 1:1 de acuerdo con los puntajes de propensión calculados por análisis de regresión logística con las siguientes covariables: estadio AJCC, diámetro del tumor, edad, sexo, índice de masa corporal y estadio T. Se realizó un análisis de regresión de riesgos proporcionales de Cox para determinar el impacto en el resultado oncológico.Recurrencia local y tasas de supervivencia libre de enfermedad a los 5 años.De 392 pacientes elegibles, 188 fueron emparejados (94 sometidos a extracción de espécimen por orificio natural y 94 a extracción convencional por minilaparotomía). La mediana de seguimiento fue de 50.3 meses. El riesgo cumulativo de recurrencia local a 5 años fue de 2.3% y 3.5% (p = 0.632), mientras que la supervivencia libre de enfermedad a 5 años para todas las etapas tumorales combinadas fue de 87.3% y 82.0% (p = 0.383) en los grupos de resección anterior laparoscópica con extracción de espécimen por orificio natural y extracción convencional, respectivamente. Las etapas T3 y T4 fueron las únicas variables asociadas independientemente con la supervivencia libre de enfermedad.Centro único, análisis retrospectivo, ausencia de pruebas de función anorrectal a largo plazo y tamaño de muestra pequeño.Los resultados oncológicos a largo plazo de los pacientes sometidos a resección anterior laparoscópica con extracción de espécimen por orificio natural para cáncer sigmoideo y rectal superior no difieren de los de aquellos sometidos a extracción convencional. Por lo tanto, la extracción de especímenes por orificio natural podría ser una alternativa viable para reducir el insulto a la pared abdominal en operaciones colorrectales laparoscópicas por malignidad en pacientes selectos. Consulte Video Resumen en http://links.lww.com/DCR/B241.
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17
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Zhou ZQ, Wang K, Du T, Gao W, Zhu Z, Jiang Q, Ji F, Fu CG. Transrectal Natural Orifice Specimen Extraction (NOSE) With Oncological Safety: A Prospective and Randomized Trial. J Surg Res 2020; 254:16-22. [PMID: 32402832 DOI: 10.1016/j.jss.2020.03.064] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 03/16/2020] [Accepted: 03/30/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND In the present paper, we introduce our experience with the novel method during laparoscopic anterior resection of upper rectal or sigmoid colon cancer by transrectal natural orifice specimen extraction (NOSE). METHODS A prospective randomized controlled trial was performed from June 2016 to May 2019. Patients with upper rectal or sigmoid colon cancer were randomized in a 1:1 ratio to the NOSE group and the non-NOSE group. Preoperative and postoperative clinical variables were analyzed and compared between groups. Postoperative pain was analyzed utilizing a visual analog scale. Postoperative overall survival was analyzed using a Kaplan-Meier curve. RESULTS A total of 276 patients were enrolled, of whom 254 were randomly divided into the NOSE group (n = 122) and the conventional laparoscopic group (n = 119). NOSE failed in 22 cases, which were converted to transabdominal specimen extraction. Intention-to-treat analysis was performed, and these 22 cases were included in the NOSE group. The incidence of postoperative complications was significantly lower in the NOSE group (11/122, 9%) than in the non-NOSE group (25/119, 21%). The NOSE group had a longer operation time, less blood loss, and a lower postoperative visual analog scale score than the non-NOSE group. The time for intestinal function recovery (ventilation) and the length of hospital stay were significantly longer in the non-NOSE group. The Kaplan-Meier survival curve showed no statistically significant difference in the disease-free survival rate between the NOSE group and the non-NOSE group. CONCLUSIONS The novel NOSE method is safe and feasible to use in patients having colorectal cancer. Compared with traditional laparoscopic surgery, the postoperative complication rates of NOSE surgery were lower with an improved short-term clinical recovery.
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Affiliation(s)
- Zhu-Qing Zhou
- Department of General Surgery and Colorectal Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Kaijing Wang
- Department of General Surgery and Colorectal Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Tao Du
- Department of General Surgery and Colorectal Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Wei Gao
- Department of General Surgery and Colorectal Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Zhe Zhu
- Department of General Surgery and Colorectal Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Qixin Jiang
- Department of General Surgery and Colorectal Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Fang Ji
- Department of General Surgery and Colorectal Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Chuan-Gang Fu
- Department of General Surgery and Colorectal Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China.
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18
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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
Abstract
Background Laparoscopic anterior resection with natural orifice specimen extraction (NOSE) avoids extra abdominal extraction incision during colorectal surgery. Some surgeons realized the benefits of NOSE on clinical efficacy. We compared the clinical efficacy of laparoscopic NOSE, laparoscopic non-NOSE and open surgery (OS) for short-term recovery and quality of life (QoL). Methods A single randomized controlled trial of NOSE for middle and upper rectal cancer between April 2014 and February 2018. Preoperative and postoperative clinical variables were analyzed and compared between the groups. Preoperative and 6 months postoperative QoL was assessed with the SF-36 QoL questionnaire. Results A total of 378 patients were enrolled, 334 patients randomly divided into NOSE group (n=104), non-NOSE group (n=119), OS group (n=111). The NOSE group was superior to the other two groups on the QoL after surgery. The NOSE group had the lowest postoperative VAS score between three groups. The postoperative time for bowel function recovery and the length of hospital stay was statistically significantly different among the three groups, with the NOSE group having the shortest time. The incidence of postoperative complications was lower in the NOSE group (12/104, 11.5%) than in the non-NOSE group (20/119, 16.8%), the difference was statistically significant. The Kaplan-Meier (K-M) survival curve showed no statistically significant difference in the disease-free survival (DFS) rate between the three groups. Conclusions Comparing NOSE to non-NOSE and OS, the NOSE had significantly better functional recovery and better QoL. The NOSE group had a significant lower surgical complication rate than the non-NOSE group.
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Affiliation(s)
- Zhe Zhu
- Department of Colorectal Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200120, China
| | - Kai-Jing Wang
- Department of Colorectal Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200120, China
| | - Guy R Orangio
- Department of Surgery, Louisiana State University, New Orleans, LA, USA
| | - Jun-Yi Han
- Department of Colorectal Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200120, China
| | - Bing Lu
- Department of Colorectal Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200120, China
| | - Zhu-Qing Zhou
- Department of Colorectal Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200120, China
| | - Wei Gao
- Department of Colorectal Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200120, China
| | - Chuan-Gang Fu
- Department of Colorectal Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200120, China
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19
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The Comparison of Laparoscopic Colorectal Resection with Natural Orifice Specimen Extraction versus Mini-Laparotomy Specimen Extraction for Colorectal Tumours: A Systematic Review and Meta-Analysis of Short-Term Outcomes. JOURNAL OF ONCOLOGY 2020; 2020:6204264. [PMID: 32454825 PMCID: PMC7218971 DOI: 10.1155/2020/6204264] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Accepted: 12/28/2019] [Indexed: 01/10/2023]
Abstract
Aim The aims of this study were to compare the short-term outcomes of natural orifice specimen extraction surgery (NOSES) and conventional laparoscopic surgery (CLAPS) for colorectal tumours and to evaluate the safety and feasibility of NOSES in colorectal resection. Methods A literature review was performed on the PubMed, Cochrane Library, and Embase databases up to March 2019. Papers conforming to the inclusion criteria were used for further analysis. The short-term outcomes included intraoperative outcomes and postoperative recovery results. The weighted mean difference (WMD) was calculated for continuous outcomes and odds ratio (OR) for dichotomous results. Study quality was evaluated using the Newcastle-Ottawa Quality Assessment Scale (NOS) or the 6-item Jadad scale. Results Eight studies comprising 686 patients met the inclusion criteria. Compared with CLAPS, NOSES had more advantages in terms of postoperative complications, postoperative pain, recovery of gastrointestinal function, duration of hospital stay, and cosmetic results. The lymph nodes harvested and intraoperative blood loss in NOSES were comparable with CLAPS; however, a prolonged operative time was observed in NOSES. Conclusions NOSES was shown to be a safe and viable alternative to CLAPS in colorectal oncology in terms of short-term results. Further long-term and randomized trials are required.
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20
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Liu Z, Efetov S, Guan X, Zhou H, Tulina I, Wang G, Tsarkov P, Wang X. A Multicenter Study Evaluating Natural Orifice Specimen Extraction Surgery for Rectal Cancer. J Surg Res 2019; 243:236-241. [PMID: 31229790 DOI: 10.1016/j.jss.2019.05.034] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Revised: 04/23/2019] [Accepted: 05/23/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Low anterior resections are increasingly performed laparoscopically for rectal cancer. Recently, natural orifice specimen extraction surgery (NOSES) has been reported as an alternative approach without additional incisions or extensions. In this study, we aimed to evaluate the safety and feasibility of NOSES by comparing the short-term outcomes with those of conventional laparoscopic resection (CLR) in a multicenter retrospective study from China and Russia. METHODS The retrospective multicenter study was conducted at three centers between January 2015 and December 2017. Relevant collected data included patient demographics, operative parameters, and postoperative complications. All procedures were performed using either a NOSES or a CLR approach. RESULTS The data of a total of 768 consecutive patients with rectal cancer were retrospectively analyzed, including 412 CLR and 356 NOSES cases. The two groups were comparable for all demographics and characteristics except for the median tumor size (P = 0.038). No difference was found in the operative time and number of retrieved lymph nodes. Intraoperative complications and positive resection margins were nil in both groups. No difference was found in the time to first flatus (P = 0.150), time to first defecation (P = 0.084), length of postoperative hospital stay (P = 0.152), anastomotic leakage (P = 0.377), and intra-abdominal abscess (P = NA). The CLR group but not the NOSES group had incisional hernia or wound infection events, although the difference between groups was not significant (P = 0.253). CONCLUSIONS The NOSES procedure is a well-established strategy and may be considered as an alternative procedure to CLR for rectal cancer. However, the long-term benefits of this approach require further evaluation.
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Affiliation(s)
- 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, Beijing, China
| | - Sergey Efetov
- Clinic of Colorectal and Minimally Invasive Surgery, Sechenov First Moscow State Medical University, Moscow, Russia
| | - 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, Beijing, China
| | - Haitao 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, Beijing, China
| | - Inna Tulina
- Clinic of Colorectal and Minimally Invasive Surgery, Sechenov First Moscow State Medical University, Moscow, Russia
| | - Guiyu Wang
- Department of Colorectal Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, China.
| | - Petr Tsarkov
- Clinic of Colorectal and Minimally Invasive Surgery, Sechenov First Moscow State Medical University, Moscow, Russia.
| | - Xishan 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, Beijing, China.
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Liu RJ, Zhang CD, Fan YC, Pei JP, Zhang C, Dai DQ. Safety and Oncological Outcomes of Laparoscopic NOSE Surgery Compared With Conventional Laparoscopic Surgery for Colorectal Diseases: A Meta-Analysis. Front Oncol 2019; 9:597. [PMID: 31334119 PMCID: PMC6617713 DOI: 10.3389/fonc.2019.00597] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 06/17/2019] [Indexed: 12/15/2022] Open
Abstract
Objective: To evaluate the safety and oncological outcomes of laparoscopic colorectal surgery using natural orifice specimen extraction (NOSE) compared with conventional laparoscopic (CL) colorectal surgery in patients with colorectal diseases. Methods: We conducted a systematic search of PubMed, EMBASE, and Cochrane databases for randomized controlled trials (RCTs), prospective non-randomized trials and retrospective trials up to September 1, 2018, and used 5-year disease-free survival (DFS), lymph node harvest, surgical site infection (SSI), anastomotic leakage, and intra-abdominal abscess as the main endpoints. Subgroup analyses were conducted according to the different study types [RCT and NRCT (non-randomized controlled trial)]. A sensitivity analysis was carried out to evaluate the reliability of the outcomes. RevMan5.3 software was used for statistical analysis. Results: Fourteen studies were included (two RCTs, seven retrospective trials and five prospective non-randomized trials) involving a total of 1,435 patients. Compared with CL surgery, the NOSE technique resulted in a shorter hospital stay, shorter time to first flatus, less post-operative pain, and fewer SSIs and total perioperative complications. Anastomotic leakage, blood loss, and intra-abdominal abscess did not differ between the two groups, while operation time was longer in the NOSE group. Oncological outcomes such as proximal margin [weighted mean difference [WMD] = 0.47; 95% confidence interval [CI] −0.49 to 1.42; P = 0.34], distal margin (WMD= −0.11; 95% CI −0.66 to 0.45; P = 0.70), lymph node harvest (WMD = −0.97; 95% CI −1.97 to 0.03; P = 0.06) and 5-year DFS (hazard ratio = 0.84; 95% CI 0.54–1.31; P = 0.45) were not different between the NOSE and CL surgery groups. Conclusions: Compared with CL surgery, NOSE may be a safe procedure, and can achieve similar oncological outcomes. Large multicenter RCTs are needed to provide high-level, evidence-based results in NOSE-treated patients and to determine the risk of local recurrence.
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Affiliation(s)
- Rui-Ji Liu
- Department of Gastrointestinal Surgery, The Fourth Affiliated Hospital of China Medical University, Shenyang, China
| | - Chun-Dong Zhang
- Department of Gastrointestinal Surgery, The Fourth Affiliated Hospital of China Medical University, Shenyang, China.,Department of Gastrointestinal Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Yu-Chen Fan
- Department of Gastrointestinal Surgery, The Fourth Affiliated Hospital of China Medical University, Shenyang, China
| | - Jun-Peng Pei
- Department of Gastrointestinal Surgery, The Fourth Affiliated Hospital of China Medical University, Shenyang, China
| | - Cheng Zhang
- Department of Gastrointestinal Surgery, The Fourth Affiliated Hospital of China Medical University, Shenyang, China
| | - Dong-Qiu Dai
- Department of Gastrointestinal Surgery, The Fourth Affiliated Hospital of China Medical University, Shenyang, China.,Cancer Center, The Fourth Affiliated Hospital of China Medical University, Shenyang, China
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22
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Zhou S, Wang X, Zhao C, Pei W, Zhou H, Liu Q, Liang J, Zhou Z, Wang X. Comparison of short-term and survival outcomes for transanal natural orifice specimen extraction with conventional mini-laparotomy after laparoscopic anterior resection for colorectal cancer. Cancer Manag Res 2019; 11:5939-5948. [PMID: 31303795 PMCID: PMC6611704 DOI: 10.2147/cmar.s209194] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 06/04/2019] [Indexed: 02/06/2023] Open
Abstract
Background Transanal natural orifice specimen extraction (NOSE) in colorectal surgery has been introduced as a less invasive surgery. However, its long-term survival effects remain controversial. The aim of this study was to compare the short-term and long-term survival outcomes of transanal NOSE with those of the conventional laparoscopic approach with mini-laparotomy (LAP) for anastomosis construction and specimen extraction in sigmoid colon cancer or rectal cancer. Methods From January 2007 to January 2018, a retrospective study was conducted at the China National Cancer Center. In total, 52 consecutive patients who underwent laparoscopic anterior resection with NOSE were matched with an additional 52 patients who underwent conventional LAP for colorectal cancer. Results Patients in the NOSE group experienced shorter time to passage of flatus (2.8±0.8 vs 3.2±0.9 days; p=0.042), less pain (4.2±1.4 vs 5.4±1.7; p=0.003) and less analgesia required (7.7% vs 25.0%; p=0.032). After a median follow-up of 68.5 (range, 8–83) months, the two groups had similar 5-year overall survival rates (92.3% vs 94.2%; p=0.985) and disease-free survival rates (84.6% vs 86.5%; p=0.802). Conclusion Transanal NOSE for total laparoscopic anterior resection is safe and feasible with more advantages, including lower pain, lower tissue trauma and faster recovery of intestinal function. Moreover, with proper protection of the surgical route, transanal NOSE has the same long-term outcomes as conventional laparoscopic surgery.
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Affiliation(s)
- Sicheng 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, Beijing 100021, People's Republic of China
| | - Xuewei 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, Beijing 100021, People's Republic of China
| | - Chuanduo Zhao
- 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, Beijing 100021, People's Republic of China
| | - Wei Pei
- 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, Beijing 100021, People's Republic of China
| | - Haitao 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, Beijing 100021, People's Republic of China
| | - Qian 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, Beijing 100021, People's Republic of China
| | - Jianwei Liang
- 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, Beijing 100021, People's Republic of China
| | - Zhixiang 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, Beijing 100021, People's Republic of China
| | - Xishan 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, Beijing 100021, People's Republic of China
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Chen C, Chen H, Yang M, Wu X, Yuan X, Zhu C, Han Y, Yin L. Laparoscopy-Assisted Natural Orifice Specimen Extraction to Treat Tumors of the Sigmoid Colon and Rectum: The Short- and Long-Term Outcomes of a Retrospective Study. J Laparoendosc Adv Surg Tech A 2019; 29:801-808. [PMID: 30925119 DOI: 10.1089/lap.2018.0601] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background: Few studies have assessed the short- and long-term outcomes of laparoscopically assisted natural orifice specimen extraction (NOSE) in patients with sigmoid colon and rectal tumors. We investigated the short- and long-term outcomes of patients undergoing laparoscopic-assisted NOSE for tumors of the sigmoid colon and rectum. Methods: Ninety-eight patients with sigmoid colon and rectal tumors undergoing laparoscopic-assisted NOSE were included. The tumor was classified according to its distance from the anal verge: Group 1 (15-30 cm), Group 2 (5-15 cm), and Group 3 (≤5 cm). In Group 1 patients, a laparoscopic surgical specimen collection bag was used as a special transrectal device. In Group 2 patients, transanal endoscopic microsurgery device and specimen collection bag were used. In Group 3 patients, a Lone-Star retractor was used. The demographic characteristics and intra- and postoperative outcomes were measured. Results: In Group 1, 1 patient had respiratory disease and 1 had enterocolitis as short-term postoperative complications. One patient showed intestinal obstruction as a long-term postoperative complication. In Group 2, 2 patients had an ileus, 1 had an anastomotic leak, 2 had urinary retention, and 1 had respiratory disease as short-term complications. Only one patient had a long-term complication: anastomotic stenosis. In Group 3, short-term complications were present in 3 patients: 1 had hemorrhage, 1 had urinary retention, and 1 had respiratory disease. Long-term complications included one case of anastomotic stenosis and one of intestinal obstruction. Conclusions: NOSE is safe and cosmetically and theoretically superior to conventional laparoscopy when different devices are used according to the tumor's location.
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Affiliation(s)
- Chunqiu Chen
- 1 Center for Difficult and Complicated Abdominal Surgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Hong Chen
- 1 Center for Difficult and Complicated Abdominal Surgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Muqing Yang
- 1 Center for Difficult and Complicated Abdominal Surgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xiaocai Wu
- 1 Center for Difficult and Complicated Abdominal Surgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xiaoqi Yuan
- 1 Center for Difficult and Complicated Abdominal Surgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Chunyan Zhu
- 1 Center for Difficult and Complicated Abdominal Surgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yi Han
- 2 Department of General Surgery, Ruijin Hospital, Jiaotong University School of Medicine, Shanghai, China
| | - Lu Yin
- 1 Center for Difficult and Complicated Abdominal Surgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
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Imagami T, Takayama S. Needlescopic herniorrhaphy using one umbilical 5-mm trocar and two lateral 3-mm trocars: A case series. Int J Surg Case Rep 2018; 51:200-203. [PMID: 30189403 PMCID: PMC6126411 DOI: 10.1016/j.ijscr.2018.08.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 08/23/2018] [Accepted: 08/23/2018] [Indexed: 11/01/2022] Open
Abstract
INTRODUCTION Laparoscopic surgery has become a standard treatment for inguinal hernia, with it recently being characterized by the use of smaller instruments. However, reports on needlescopic transabdominal preperitoneal repair using one umbilical 5-mm and two lateral 3-mm trocars are extremely rare. METHODS Seven patients with unilateral inguinal hernia underwent this surgical procedure. A 5-mm trocar was inserted from the umbilical and two 3-mm trocars were inserted from the lateral. After dissection of the preperitoneal layer, a mesh was fixed using a tucker inserted from the umbilical 5-mm trocar while viewing through the 3-mm optics from the lateral trocar. RESULTS All procedures were completed without intraoperative complications and conversion to the conventional method. The surgical results of our needlescopic TAPP repair have been shown to not be inferior to those of the conventional method. CONCLUSION Our needlescopic herniorrhaphy using one umbilical 5-mm trocar and two lateral 3-mm trocars is minimally invasive hernia repair.
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Affiliation(s)
- Toru Imagami
- Department of Surgery, Nagoya Tokushukai General Hospital, Kasugai, Japan.
| | - Satoru Takayama
- Department of Surgery, Nagoya Tokushukai General Hospital, Kasugai, Japan
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25
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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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Affiliation(s)
- Kevin M Izquierdo
- Division of Colorectal Surgery, Lankenau Medical Center, Wynnewood, PA, USA,
| | - Ece Unal
- Division of Colorectal Surgery, Lankenau Medical Center, Wynnewood, PA, USA,
| | - John H Marks
- Division of Colorectal Surgery, Lankenau Medical Center, Wynnewood, PA, USA,
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26
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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]
Abstract
BACKGROUND Full laparoscopic left colectomy with transrectal specimen extraction is proposed as an improvement of the minimally invasive surgical technique. This paper reviews in detail the current status of left-sided colectomy and upper rectum resection with transrectal specimen extraction. METHODS A systematic review was performed of all types of publications on colorectal resection with natural orifice specimen extraction (NOSE). We only included studies reporting on left colectomy, sigmoidectomy, and high anterior resection with transrectal specimen extraction (TRSE), excluding transanal (TASE), transvaginal, or transcolonic specimen extraction. Surgical techniques, patient characteristics, and outcomes were reviewed in detail. RESULTS Thirty-five papers reported on TRSE (2 randomized clinical trials, 7 case-matched series, 19 case series, 5 case reports, and 2 articles on surgical technique). We found a wide variety of innovative anastomotic and specimen extraction techniques. After excluding duplicates and papers reporting mixed TRSE and TASE results, outcomes in patients undergoing TRSE from 23 publications showed a conversion rate to conventional laparoscopy of 3.7% (21/559), overall morbidity 9.5% (53/559) [major in 2.9% (16/559), intra-abdominal infection in 2.1% (12/559)]. No mortality was reported. Postoperative anal incontinence was rarely reported. Several studies showed a decrease in postoperative pain and some in length of hospital stay. CONCLUSIONS Colectomy with TRSE is feasible and seems safe in selected patients. Reported outcomes seem in general similar to conventional laparoscopic colectomy with a possible benefit in postoperative pain and length of hospital stay. Obvious selection bias and lack of high quality trials do not allow firm conclusions to be drawn.
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Affiliation(s)
- D Zattoni
- Department of General Surgery, Ospedale per gli Infermi di Faenza, 48018, Faenza, Italy.
| | - G S Popeskou
- Department of General Surgery, Queen Elisabeth University Hospital, Birmingham, UK
| | - D Christoforidis
- Department of General Surgery, Ospedale Civico di Lugano, 6900, Lugano, Switzerland
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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]
Abstract
BACKGROUND A minilaparotomy for specimen extraction during laparoscopy occasionally results in postoperative wound complications. We have performed a totally laparoscopic resection for early colorectal cancer using the natural orifice specimen extraction technique. METHODS From 2008 to 2013, we have performed a totally laparoscopic resection for clinical stage I and IIA low sigmoid colon and rectal cancers. A prospectively maintained database was reviewed to assess the outcomes after surgery. RESULTS In total, 40 patients had high anterior resections using transanal specimen extraction, and 32 patients had low anterior resections with transanal pull-through. Eight patients (11%) reported conversion to conventional laparoscopic colorectal resections; anastomotic leakages occurred in 4 patients (5.6%). No mortality or cancer recurrence was observed during 42.5±16.2 months of follow-up. CONCLUSIONS One natural orifice specimen extraction technique, known as transanal specimen extraction, has emerged as a promising form of totally laparoscopic surgical intervention for early-stage cancers of the low sigmoid colon and rectum.
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Bokor A, Lukovich P, Csibi N, D'Hooghe T, Lebovic D, Brubel R, Rigo J. Natural Orifice Specimen Extraction during Laparoscopic Bowel Resection for Colorectal Endometriosis: Technique and Outcome. J Minim Invasive Gynecol 2018; 25:1065-1074. [PMID: 29454144 DOI: 10.1016/j.jmig.2018.02.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 02/07/2018] [Accepted: 02/08/2018] [Indexed: 02/07/2023]
Abstract
STUDY OBJECTIVE To present a detailed description of a modified natural orifice specimen extraction (NOSE) colectomy technique. We also report the postoperative outcomes of our prospective case series when compared with conventional laparoscopic bowel resection in a relatively large series of patients. DESIGN Canadian Task Force classification II-1. SETTING A university tertiary referral center. PATIENTS The last 90 consecutive patients in our care with deep infiltrating endometriosis of the bowel are presented in this study. Patients were diagnosed at the 1st Department of Obstetrics and Gynecology, Semmelweis University, Budapest, Hungary. INTERVENTIONS We performed laparoscopic bowel resection using the transrectal NOSE technique and compared the results of the new operative method (n = 30) with traditional laparoscopic bowel resection (n = 60). MEASUREMENTS AND MAIN RESULTS The median duration of surgery was 121 minutes in the control group and 96 minutes in the NOSE group (p = .005). According to the Clavien-Dindo classification, we observed a severe, grade IIIb or higher, overall complication rate of 3.3% among all 90 patients. In the control group, anastomosis insufficiency occurred in 3.3% of patients (2/60 cases), and in 1 patient with anastomotic leakage a rectovaginal fistula was observed (1.7%). There was no significant difference in the rates of severe postoperative complications (p = .55). The length of hospital stay in the control group was a median of 7 days (range, 5-13 days), whereas in the NOSE group it was 6 days (range, 3-11 days) (p < .001). CONCLUSION According to our findings, the use of NOSE colectomy offers a shorter recovery time and can eventually lead to a shorter surgery duration compared with traditional laparoscopic bowel resection.
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Affiliation(s)
- Attila Bokor
- Department of Obstetrics and Gynecology, Semmelweis University, Budapest, Hungary.
| | - Peter Lukovich
- Department of Surgery, St John Hospital, Budapest, Hungary
| | - Noemi Csibi
- Department of Obstetrics and Gynecology, Semmelweis University, Budapest, Hungary
| | | | - Dan Lebovic
- Center for Reproductive Medicine, Minneapolis, Minnesota
| | - Reka Brubel
- Department of Obstetrics and Gynecology, Semmelweis University, Budapest, Hungary
| | - Janos Rigo
- Department of Obstetrics and Gynecology, Semmelweis University, Budapest, Hungary
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Takahashi R, Sakamoto K, Ro H, Kure K, Kawai M, Ishiyama S, Sugimoto K, Kojima Y, Okuzawa A, Tomiki Y. A case of total laparoscopic sigmoidectomy involving the use of needle forceps and transanal specimen extraction for sigmoid colon cancer. J Minim Access Surg 2018; 14:71-73. [PMID: 29067939 PMCID: PMC5749203 DOI: 10.4103/jmas.jmas_110_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
A 76-year-old male underwent endoscopic mucosal resection for a stage T1 tumour of the sigmoid colon. We performed laparoscopic sigmoidectomy through 5 ports using needlescopic instruments. The resected specimen was extracted from the abdominal cavity transanally. After attaching an anvil to the sigmoidal stump, the rectal stump was reclosed using an endoscopic linear stapler, and then, colorectal anastomosis was conducted using the double stapling technique. Performing transanal specimen extraction using needlescopic forceps improves aesthetic outcomes and reduces post-operative pain and the risk of abdominal incisional hernias. This method is an easy to introduce a form of reduced-port surgery because of its feasibility and conventional port arrangement. Hence, we consider that it is an option for minimally invasive surgery.
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Affiliation(s)
- Rina Takahashi
- Department of Coloproctological Surgery, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Kazuhiro Sakamoto
- Department of Coloproctological Surgery, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Hisashi Ro
- Department of Coloproctological Surgery, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Kazumasa Kure
- Department of Coloproctological Surgery, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Masaya Kawai
- Department of Coloproctological Surgery, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Shun Ishiyama
- Department of Coloproctological Surgery, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Kiichi Sugimoto
- Department of Coloproctological Surgery, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Yutaka Kojima
- Department of Coloproctological Surgery, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Atsushi Okuzawa
- Department of Coloproctological Surgery, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Yuichi Tomiki
- Department of Coloproctological Surgery, Faculty of Medicine, Juntendo University, Tokyo, Japan
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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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Steinemann DC, Zerz A, Germann S, Lamm SH. Anorectal Function and Quality of Life after Transrectal Rigid-Hybrid Natural Orifice Translumenal Endoscopic Sigmoidectomy. J Am Coll Surg 2016; 223:299-307. [DOI: 10.1016/j.jamcollsurg.2016.04.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 04/02/2016] [Accepted: 04/04/2016] [Indexed: 12/16/2022]
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Kvasha A, Khalifa M, Biswas S, Hamoud M, Nordkin D, Bramnik Z, Willenz U, Farraj M, Waksman I. Unlimited-Length Proctocolectomy Utilizing Sequential Intussusception and Pull-Through. Surg Innov 2016; 23:456-62. [DOI: 10.1177/1553350616643614] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Transanal, hybrid natural orifice translumenal endoscopic surgery (NOTES) and NOTES-assisted natural orifice specimen extraction techniques hold promise as leaders in the field of natural orifice surgery. We report the feasibility of a novel NOTES assisted technique for unlimited length, clean, endolumenal proctocolectomy in a porcine model. This technique is a modification of a transanal intussusception and pull-through procedure recently published by our group. Rectal mobilization was achieved laparoscopically; this was followed by a transanal recto-rectal intussusception and pull-through (IPT). IPT was established in a stepwise fashion. First, the proximal margin of resection was attached laparoscopically to the shaft of the anvil of an end-to-end circular stapler with a ligature around the rectum. Second, this complex was pulled transanally to produce IPT. To achieve an unlimited-length proctocolectomy, the IPT step was repeated several times prior to bowel resection. This was facilitated by removing the ligature applied in the first step of this procedure. Once sequential IPT established the desired length of bowel to be resected, a second ligature was placed around the rectum approximating the proximal and distal resection margins. The specimen was resected and extracted by making a full-thickness incision through the 2 bowel walls. The anastomosis was achieved by deploying the stapler. The technique was found to be feasible. Peritoneal samples, collected after transanal specimen extraction, did not demonstrate bacterial growth. The minimally invasive nature of this evolving technique as well as its aseptic bowel manipulation has the potential to limit the complications associated with abdominal wall incision and surgical site infection.
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33
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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
Affiliation(s)
- Hong Zhang
- Department of Colorectal Surgery, Shengjing Hospital, China Medical University, Shenyang, China
| | - Jin-chun Cong
- Department of Colorectal Surgery, Shengjing Hospital, China Medical University, Shenyang, China
| | - Yun-zhi Ling
- Department of Colorectal Surgery, Shengjing Hospital, China Medical University, Shenyang, China
| | - Ming-ming Cui
- Department of Colorectal Surgery, Shengjing Hospital, China Medical University, Shenyang, China
| | - Fang-yuan Zhang
- Department of Colorectal Surgery, Shengjing Hospital, China Medical University, Shenyang, China
| | - Yong Feng
- Department of Colorectal Surgery, Shengjing Hospital, China Medical University, Shenyang, China
| | - Chun-sheng Chen
- Department of Colorectal Surgery, Shengjing Hospital, China Medical University, Shenyang, China
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Takase Y, Tomizawa N, Enokida Y, Shiraishi T, Katoh R, Suto Y, Sato H, Muroya K, Kurosaki R, Kobayashi K, Arakawa K, Ando T, Takesyohi I. A case of splenic metastasis of ovarian cancer treated with complete laparoscopic splenectomy and transvaginal specimen extraction. Surg Case Rep 2016; 2:26. [PMID: 26976616 PMCID: PMC4791445 DOI: 10.1186/s40792-016-0150-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 03/03/2016] [Indexed: 01/22/2023] Open
Abstract
A 61-year-old woman was diagnosed with right inguinal lymph node and splenic metastasis of ovarian serous cystadenocarcinoma. We performed right inguinal lymph node dissection and total laparoscopic splenectomy in the supine position followed by transvaginal specimen extraction (TVSE). First, using three ports, we extracted the right inguinal lymph node. We repaired the posterior wall of the inguinal canal using a mesh plug. We added two ports and displaced the spleen from the retroperitoneum and lifted it using a snake retractor, disconnecting the hilum using an automatic suturing device. Next, the posterior wall of the vagina was intraperitoneally incised. And an Alexis® laparoscopic system was inserted into the vagina. The cap maintained aeroperitoneum, a collection bag was inserted in the abdominal cavity via the vagina, and the spleen was collected. When the spleen was removed from the body, partial fragmentation of the organ was required in the bag. Organ fragmentation was performed only within the bag, and we made sure not to tear the bag. The vaginal wound was laparoscopically sutured. The patient had no operative complications and was able to actively ambulate at the first day after surgery due to a slight postoperative pain. Total laparoscopic splenectomy with TVSE in the supine position may be a safe and feasible method for selected female patients. This technique enables minimally invasive surgery for female patients with splenic disease.
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Affiliation(s)
- Yoshiaki Takase
- Maebashi Red Cross Hospital, 3-21-36 Asahi-chou, Maebashi, Gunma, 371-8511, Japan.,Department of Thoracic and Visceral Organ Surgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, 371-0014, Japan
| | - Naoki Tomizawa
- Maebashi Red Cross Hospital, 3-21-36 Asahi-chou, Maebashi, Gunma, 371-8511, Japan. .,Department of Thoracic and Visceral Organ Surgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, 371-0014, Japan.
| | - Yasuaki Enokida
- Maebashi Red Cross Hospital, 3-21-36 Asahi-chou, Maebashi, Gunma, 371-8511, Japan.,Department of Thoracic and Visceral Organ Surgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, 371-0014, Japan
| | - Takuya Shiraishi
- Maebashi Red Cross Hospital, 3-21-36 Asahi-chou, Maebashi, Gunma, 371-8511, Japan
| | - Ryuji Katoh
- Maebashi Red Cross Hospital, 3-21-36 Asahi-chou, Maebashi, Gunma, 371-8511, Japan.,Department of Thoracic and Visceral Organ Surgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, 371-0014, Japan
| | - Yujin Suto
- Maebashi Red Cross Hospital, 3-21-36 Asahi-chou, Maebashi, Gunma, 371-8511, Japan.,Department of Thoracic and Visceral Organ Surgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, 371-0014, Japan
| | - Hiroaki Sato
- Maebashi Red Cross Hospital, 3-21-36 Asahi-chou, Maebashi, Gunma, 371-8511, Japan.,Department of Thoracic and Visceral Organ Surgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, 371-0014, Japan
| | - Ken Muroya
- Maebashi Red Cross Hospital, 3-21-36 Asahi-chou, Maebashi, Gunma, 371-8511, Japan.,Department of Thoracic and Visceral Organ Surgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, 371-0014, Japan
| | - Ryo Kurosaki
- Maebashi Red Cross Hospital, 3-21-36 Asahi-chou, Maebashi, Gunma, 371-8511, Japan.,Department of Thoracic and Visceral Organ Surgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, 371-0014, Japan
| | - Katsumi Kobayashi
- Maebashi Red Cross Hospital, 3-21-36 Asahi-chou, Maebashi, Gunma, 371-8511, Japan.,Department of Thoracic and Visceral Organ Surgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, 371-0014, Japan
| | - Kazuhisa Arakawa
- Maebashi Red Cross Hospital, 3-21-36 Asahi-chou, Maebashi, Gunma, 371-8511, Japan.,Department of Thoracic and Visceral Organ Surgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, 371-0014, Japan
| | - Tatsumasa Ando
- Maebashi Red Cross Hospital, 3-21-36 Asahi-chou, Maebashi, Gunma, 371-8511, Japan.,Department of Thoracic and Visceral Organ Surgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, 371-0014, Japan
| | - Izumi Takesyohi
- Department of Thoracic and Visceral Organ Surgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, 371-0014, Japan
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Huang CC, Chen YC, Huang CJ, Hsieh JS. Totally Laparoscopic Colectomy with Intracorporeal Side-to-End Colorectal Anastomosis and Transrectal Specimen Extraction for Sigmoid and Rectal Cancers. Ann Surg Oncol 2015; 23:1164-8. [PMID: 26597363 DOI: 10.1245/s10434-015-4984-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2015] [Indexed: 12/20/2022]
Abstract
BACKGROUND The techniques of intracorporeal anastomosis and specimen extraction after laparoscopic colectomy via a natural orifice have gained interest increasingly. We evaluated the feasibility of our unique techniques for colorectal reconstruction and report immediate postoperative outcomes in patients with rectosigmoid cancer. METHODS Patients with sigmoid or rectal cancer were selected depending on the size of the tumor and its distance from the anal verge. Demographic data, operative parameters, and postoperative outcomes were assessed. After complete resection of the tumor, all patients underwent an intracorporeal side-to-end colorectal anastomosis following transrectal specimen extraction. RESULTS Laparoscopic resection with our technique of intracorporeal anastomosis was successful in 32 patients. The average operative time was 192 ± 29 min, and mean blood loss was 51 ± 18 ml. All patients experienced mild postoperative pain, and bowel function returned before postoperative day 3 in most patients. They had an uneventful postoperative course with a median hospital stay of 6 days. Major perioperative complications or anastomotic leak were not encountered in this study. The mean size of the lesion was 3.3 ± 1.8 cm, and the mean number of harvested nodes was 14 ± 6. During the follow-up period, there were no functional disorders associated with the intracorporeal anastomosis or transrectal specimen extraction. CONCLUSIONS Intracorporeal side-to-end colorectal anastomosis with transrectal specimen extraction in laparoscopic colorectal surgery is a safe and effective procedure for patients with rectosigmoid malignancy.
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Affiliation(s)
- Chao-Chun Huang
- Department of Surgery, Pingtung Hospital, Ministry of Health and Welfare, Pingtung, Taiwan
| | - Yin-Che Chen
- Department of Surgery, Pingtung Hospital, Ministry of Health and Welfare, Pingtung, Taiwan
| | - Che-Jen Huang
- Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Jan-Sing Hsieh
- Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
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Vahdad MR, Rahmanian E, Moslemi S, Najafi SM, Foroutan HR. Totally Transanal Laparo-Endoscopic Single-Site ProctoColectomy-Ileoanal J-Pouch (TLPC-J): An Experimental Study of a Novel Approach. IRANIAN JOURNAL OF MEDICAL SCIENCES 2015; 40:425-9. [PMID: 26379349 PMCID: PMC4567602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/06/2014] [Revised: 03/26/2014] [Accepted: 04/28/2014] [Indexed: 10/31/2022]
Abstract
BACKGROUND The natural orifice transluminal endoscopic surgery (NOTES) has become a commonly considered novel approach in the surgical field. The NOTES provide possibility of operation through the natural orifice and decreases the intentional puncture of the systemic organ and subsequent complications. Totally transanal laparo-endoscopic single-site proctoColectomy-Ileoanal J-Pouch (TLPC-J) is a novel method in minimally invasive surgery for total colectomy. The main goal of this study is to perform this new method on an animal model, to assess probable complication and to resolve probable issues by using patients that are candidate for total colectomy. METHOD Five dogs were prepared in lithotomy position. The TLPC-I procedure consists of endorectal technique with full thickness rectal dissection starting 1 cm orally from the dentate line above the peritoneal reflection and the proximal bowel was replaced into the abdominal cavity. Afterwards, the TriPort system was inserted in the anal canal and mesentrial resection of the total colon, mobilization of a distal ileal segment and intracorporeal suture of an ileal J-loop was accomplished by this system. An incision in the J-loop was conducted transanally. The J-pouch was created with an Endo-GIA® and sutured to the rectal wall. RESULTS All animals survived and passed stool with clear post operation situation. There was no infection in site of anastomosis. CONCLUSION The TLPC-I provides the possibility of surgery without abdominal wall incision and decreases post operation complication such as pain, abdominal wound infection and wound dehiscence. This technique increases the quality of life and surgeons can discharge the patients early.
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Affiliation(s)
- Mohammad Reza Vahdad
- Department of Pediatric Surgery, Catholic Foundation Marienhospital Herne, Ruhr-University of Bochum, Herne, Germany
| | - Ehsan Rahmanian
- Department of General Surgery, Shahid Faghihi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sam Moslemi
- Colorectal Research Center, Shahid Faghihi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sultan Mohsen Najafi
- Department of Pediatric Surgery, Namazi Hospital, Shiraz University Laparoscopy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hamid Reza Foroutan
- Department of Pediatric Surgery, Namazi Hospital, Shiraz University Laparoscopy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran,Correspondence: Hamid Reza Foroutan, MD; Department of Pediatric Surgery, Shiraz University Laparoscopy Research Center, Namazi Hospital, P.O. Box 7141995377, Shiraz, Iran Tel: +98 71 36279622 Fax: +98 71 32279721
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Hisada M, Katsumata K, Ishizaki T, Enomoto M, Matsudo T, Kasuya K, Tsuchida A. Complete laparoscopic resection of the rectum using natural orifice specimen extraction. World J Gastroenterol 2015. [PMID: 25469041 DOI: 10.3748/wjg.v20.i44.167071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM To investigate how complete laparoscopic anterior resection with natural orifice specimen extraction (NOSE), as a novel minimally invasive surgery, compares to conventional laparoscopic surgery. METHODS Twenty patients who underwent complete laparoscopic anterior resection with NOSE and 50 patients who underwent laparoscopic assisted anterior resection by the conventional method between 2011 and 2012 were studied. Selection for complete laparoscopic anterior resection with NOSE was decided on the basis of tumor size, localization of the tumor, and body mass index. Outcomes related to surgery, including operation time, postoperative wound pain, hospital stay after surgery, the number of totally dissected lymph nodes, postoperative complications (suture failure and wound infection), and anal function, were reviewed retrospectively. Anal function was assessed at 3 and 6 mo after surgery using the Wexner fecal incontinence scoring system. RESULTS Complete laparoscopic resection with NOSE was performed to completion in all 20 patients. There was no patient emergency that required conversion to conventional laparoscopic surgery or open surgery. The comparison between complete laparoscopic resection with NOSE and conventional laparoscopic surgery showed no significant differences in the maximal diameter of the tumor, number of totally dissected lymph nodes, bleeding volume, mean operation time, time to start of oral ingestion, postoperative hospital stay, and postoperative complications. On the other hand, with regard to pain after epidural anesthesia, the total usage of analgesia in this novel surgical technique was 1.85 ± 1.8 times, whereas it was 5.89 ± 2.86 in conventional laparoscopic surgery (P < 0.001). The postoperative pain period was 1.9 ± 1.9 d in this novel surgical technique, whereas it was 3.43 ± 1.41 d in conventional laparoscopic surgery (P < 0.004). In complete laparoscopic surgery with NOSE, the mean postoperative follow-up period was 20 mo (range: 12-30 mo). Neither local recurrence nor remote metastasis was observed during the follow-up period. CONCLUSION Complete laparoscopic anterior resection using NOSE does not require any incision and has excellent cosmetic properties, with mitigated postoperative pain.
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Affiliation(s)
- Masayuki Hisada
- Masayuki Hisada, Kenji Katsumata, Tetsuo Ishizaki, Masanobu Enomoto, Takaaki Matsudo, Kazuhiko Kasuya, Akihiko Tsuchida, Department of Digestive Surgery and Pediatric Surgery, Tokyo Medical University, Tokyo 160-0023, Japan
| | - Kenji Katsumata
- Masayuki Hisada, Kenji Katsumata, Tetsuo Ishizaki, Masanobu Enomoto, Takaaki Matsudo, Kazuhiko Kasuya, Akihiko Tsuchida, Department of Digestive Surgery and Pediatric Surgery, Tokyo Medical University, Tokyo 160-0023, Japan
| | - Tetsuo Ishizaki
- Masayuki Hisada, Kenji Katsumata, Tetsuo Ishizaki, Masanobu Enomoto, Takaaki Matsudo, Kazuhiko Kasuya, Akihiko Tsuchida, Department of Digestive Surgery and Pediatric Surgery, Tokyo Medical University, Tokyo 160-0023, Japan
| | - Masanobu Enomoto
- Masayuki Hisada, Kenji Katsumata, Tetsuo Ishizaki, Masanobu Enomoto, Takaaki Matsudo, Kazuhiko Kasuya, Akihiko Tsuchida, Department of Digestive Surgery and Pediatric Surgery, Tokyo Medical University, Tokyo 160-0023, Japan
| | - Takaaki Matsudo
- Masayuki Hisada, Kenji Katsumata, Tetsuo Ishizaki, Masanobu Enomoto, Takaaki Matsudo, Kazuhiko Kasuya, Akihiko Tsuchida, Department of Digestive Surgery and Pediatric Surgery, Tokyo Medical University, Tokyo 160-0023, Japan
| | - Kazuhiko Kasuya
- Masayuki Hisada, Kenji Katsumata, Tetsuo Ishizaki, Masanobu Enomoto, Takaaki Matsudo, Kazuhiko Kasuya, Akihiko Tsuchida, Department of Digestive Surgery and Pediatric Surgery, Tokyo Medical University, Tokyo 160-0023, Japan
| | - Akihiko Tsuchida
- Masayuki Hisada, Kenji Katsumata, Tetsuo Ishizaki, Masanobu Enomoto, Takaaki Matsudo, Kazuhiko Kasuya, Akihiko Tsuchida, Department of Digestive Surgery and Pediatric Surgery, Tokyo Medical University, Tokyo 160-0023, Japan
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Nakayama R, Mihara T, Miyamoto Y, Ka K. The association of hypotension with the insertion of an abdominal retractor during lower abdominal surgery in pediatric patients: a retrospective observational study. Paediatr Anaesth 2015; 25:824-828. [PMID: 25880338 DOI: 10.1111/pan.12656] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/06/2015] [Indexed: 01/23/2023]
Abstract
BACKGROUND The Alexis(®) wound retractor is composed of an inner- and outer-ring, with the inner-ring placed inside the abdominal cavity. This placement can constrict the internal organs and large vessels, especially in children, which can lead to hypotension. Our study aimed to investigate the relation between the incidence of hypotension and insertion of the wound retractor during lower abdominal surgery in pediatric patients. METHODS We retrospectively examined 161 pediatric patients (<4 years old), who underwent lower abdominal surgery, regardless of abdominal retractor type. Hypotension was defined as a decrease in systolic blood pressure of >15% from baseline. We used logistic regression to predict hypotension using the following nine parameters: age, height, weight, American Society of Anesthesiologists physical status (ASA-PS), sex, laterality of the operation (unilateral or bilateral), presence or absence of caudal block, wound length, and type of retractor (retractors with or without an inner-ring). RESULTS Logistic multivariate regression analysis revealed that a retractor with an inner-ring use (odds ratio 3.28, 95% CI 1.41-7.63, P = 0.006) and younger age (odds ratio 1.07 per month, 95% CI 1.02-1.12, P = 0.010) were independent risk factors associated with hypotension following lower abdominal surgery in this age group. CONCLUSIONS Patient age and use of a wound retractor with an inner-ring are independent risk factors associated with hypotension during insertion of the abdominal retractor in lower abdominal surgery.
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Affiliation(s)
- Rika Nakayama
- Department of Anesthesia, Kanagawa Children's Medical Center, Yokohama, Japan
| | - Takahiro Mihara
- Department of Anesthesia, Kanagawa Children's Medical Center, Yokohama, Japan
| | - Yoshihisa Miyamoto
- Department of Anesthesia, Kanagawa Children's Medical Center, Yokohama, Japan
| | - Koui Ka
- Department of Anesthesia, Kanagawa Children's Medical Center, Yokohama, Japan
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Lamm SH, Zerz A, Efeoglou A, Steinemann DC. Transrectal Rigid-Hybrid Natural Orifice Translumenal Endoscopic Sigmoidectomy for Diverticular Disease: A Prospective Cohort Study. J Am Coll Surg 2015; 221:789-97. [PMID: 26282488 DOI: 10.1016/j.jamcollsurg.2015.07.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 07/13/2015] [Accepted: 07/13/2015] [Indexed: 12/18/2022]
Abstract
BACKGROUND Our goal was to evaluate the feasibility of transrectal rigid hybrid natural orifice translumenal endoscopic surgery (NOTES) sigmoidectomy (trNS) in a series of consecutive prospective patients with diverticular disease. The NOTES for left colectomy offers patients reduced pain and easier recovery. Limited data are available for trNS, which is considered safe for various indications. However, the technique is not standardized, and patients in the reported series are highly selected. STUDY DESIGN Patients scheduled for trNS were entered into a prospective registry on an intention-to-treat basis. The primary endpoint was trNS feasibility, and secondary endpoints were morbidity, pain, length of stay, and inflammatory response. A medial-to-lateral dissection with full mobilization of the splenic flexure and total intracorporeal anastomosis was performed. The rectum was covered with a wound protector for transrectal extraction. RESULTS Of 95 elective sigmoidectomies, 81% (n = 77) were enrolled for either transvaginal NOTES resection (n = 37) or trNS (n = 40). There was no difference in body mass index or indication between patients undergoing laparoscopic-assisted sigmoidectomy (LAS), transvaginal resection, or trNS, although trNS patients were younger. Mainly because of a mismatch of bulky specimen and narrow pelvis, 17.5% of trNS were converted to LAS. Major morbidity was 10%, including 2 septic complications. During the study, the anastomosis technique was changed from double stapled end-to-end to side-to-end anastomosis. CONCLUSIONS Transrectal rigid hybrid natural orifice translumenal endoscopic sigmoidectomy is feasible and safe in a high proportion of unselected consecutive patients with diverticular disease undergoing elective treatment. Intracorporeal side-to-end anastomosis is the preferred technique, and trNS should be offered for elective sigmoidectomy presupposing advanced laparoscopic experience.
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Affiliation(s)
- Sebastian H Lamm
- Department of Surgery, Cantonal Hospital Baselland, Bruderholz, Switzerland
| | - Andreas Zerz
- Department of Surgery, Cantonal Hospital Baselland, Bruderholz, Switzerland
| | | | - Daniel C Steinemann
- Department of Surgery, Cantonal Hospital Baselland, Bruderholz, Switzerland.
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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]
Abstract
BACKGROUND Natural-orifice transluminal endoscopic surgery (NOTES) represents one of the most significant innovations in surgery to emerge since the advent of laparoscopy. A decade of progress with this approach has now been catalogued, and yet its clinical application remains controversial. METHODS A PubMed search was carried out for articles describing NOTES in both the preclinical and the clinical setting. Public perceptions and expert opinion regarding NOTES in the published literature were analysed carefully. RESULTS Two hundred relevant articles on NOTES were studied and the outcomes reviewed. A division between direct- and indirect-target NOTES was established. The areas with the most promising clinical application included direct-target NOTES, such as transanal total mesorectal excision and peroral endoscopic myotomy. The clinical experience with distant-target NOTES, such as for appendicectomy and cholecystectomy, showed feasibility; however, NOTES-specific morbidity was introduced and this represents an important limitation. CONCLUSION NOTES experimentation in the preclinical setting has increased substantially. There has also been a significant increase in the application of NOTES in humans in the past decade. Enthusiasm for NOTES should be tempered by the risk of incurring NOTES-specific morbidity. Surgeons should carefully consider patient preferences regarding this new minimally invasive option, as opinions are not unanimously supportive of NOTES. As technical limitations are overcome, the clinical application of NOTES is predicted to increase. It is paramount that, when this complex technique is performed on humans, it is applied judiciously by appropriately trained experts with outcomes recorded in a registry.
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Affiliation(s)
- S Atallah
- Department of Colon and Rectal Surgery, Florida Hospital, Orlando, Florida
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Transanal total mesorectal excision in rectal cancer: short-term outcomes in comparison with laparoscopic surgery. Ann Surg 2015; 261:221-7. [PMID: 25185463 DOI: 10.1097/sla.0000000000000865] [Citation(s) in RCA: 207] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE The aim of this study was to compare short-term results obtained with transanal total mesorectal excision (TME) and laparoscopic surgery. BACKGROUND Transanal TME appears as an alternative in the treatment of rectal cancer and other rectal disease. Natural orifices transluminal endoscopic surgery using the rectum as access in colorectal surgery is intuitively better suited than other access routes. METHODS All consecutive patients with middle or low rectal cancer submitted to surgery were included into a prospective cohort and treated by transanal TME assisted by laparoscopy. They were compared with a retrospective cohort of consecutive patients of identical characteristics treated by laparoscopic TME in the immediate chronological period. RESULTS Thirty-seven patients were included in both study groups. No differences were observed between them with respect to baseline characteristics, thus emphasizing the comparability of both cohorts. Surgical time was higher in the laparoscopy group (252 ± 50 minutes) than in the transanal group (215 ± 60 minutes) (P < 0.01). Moreover, coloanal anastomosis was performed less frequently (16% vs 43%, respectively; P = 0.01) and distal margin was lower (1.8 ± 1.2 mm vs 2.7 ± 1.7 mm, respectively; P = 0.05) in the laparoscopy group than in the transanal one. Although there was no significant difference in 30-day postoperative complication rate (laparoscopy, 51% vs transanal, 32%; P = 0.16), early readmissions were more frequent in the laparoscopy group than in the transanal one (22% vs 6%, respectively; P = 0.03). CONCLUSIONS Evaluation of short-term outcomes demonstrated that transanal TME is a feasible and safe technique associated with a shorter surgical time and a lower early readmission rate.
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Hisada M, Katsumata K, Ishizaki T, Enomoto M, Matsudo T, Kasuya K, Tsuchida A. Complete laparoscopic resection of the rectum using natural orifice specimen extraction. World J Gastroenterol 2014; 20:16707-16713. [PMID: 25469041 PMCID: PMC4248216 DOI: 10.3748/wjg.v20.i44.16707] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Revised: 07/13/2014] [Accepted: 08/28/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate how complete laparoscopic anterior resection with natural orifice specimen extraction (NOSE), as a novel minimally invasive surgery, compares to conventional laparoscopic surgery.
METHODS: Twenty patients who underwent complete laparoscopic anterior resection with NOSE and 50 patients who underwent laparoscopic assisted anterior resection by the conventional method between 2011 and 2012 were studied. Selection for complete laparoscopic anterior resection with NOSE was decided on the basis of tumor size, localization of the tumor, and body mass index. Outcomes related to surgery, including operation time, postoperative wound pain, hospital stay after surgery, the number of totally dissected lymph nodes, postoperative complications (suture failure and wound infection), and anal function, were reviewed retrospectively. Anal function was assessed at 3 and 6 mo after surgery using the Wexner fecal incontinence scoring system.
RESULTS: Complete laparoscopic resection with NOSE was performed to completion in all 20 patients. There was no patient emergency that required conversion to conventional laparoscopic surgery or open surgery. The comparison between complete laparoscopic resection with NOSE and conventional laparoscopic surgery showed no significant differences in the maximal diameter of the tumor, number of totally dissected lymph nodes, bleeding volume, mean operation time, time to start of oral ingestion, postoperative hospital stay, and postoperative complications. On the other hand, with regard to pain after epidural anesthesia, the total usage of analgesia in this novel surgical technique was 1.85 ± 1.8 times, whereas it was 5.89 ± 2.86 in conventional laparoscopic surgery (P < 0.001). The postoperative pain period was 1.9 ± 1.9 d in this novel surgical technique, whereas it was 3.43 ± 1.41 d in conventional laparoscopic surgery (P < 0.004). In complete laparoscopic surgery with NOSE, the mean postoperative follow-up period was 20 mo (range: 12-30 mo). Neither local recurrence nor remote metastasis was observed during the follow-up period.
CONCLUSION: Complete laparoscopic anterior resection using NOSE does not require any incision and has excellent cosmetic properties, with mitigated postoperative pain.
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Sakamoto K, Okazawa Y, Takahashi R, Sugimoto K, Komiyama H, Takahashi M, Kojima Y, Goto M, Okuzawa A, Tomiki Y. Laparoscopic intersphincteric resection using needlescopic instruments. J Minim Access Surg 2014; 10:221-4. [PMID: 25336828 PMCID: PMC4204271 DOI: 10.4103/0972-9941.141535] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Accepted: 07/31/2014] [Indexed: 12/02/2022] Open
Abstract
Intersphincteric resection (ISR) is a procedure designed to preserve anal function in cases with very low rectal cancer. We report our clinical experience with laparoscopic ISR (Lap ISR) performed using needlescopic instruments. First, a camera port is created at the umbilicus. Two 5-mm ports are then inserted at the right upper and lower quadrants. Two needlescopic forceps (Endo-Relief™ Hope Denshi Co., Chiba, Japan) are inserted at the left upper and lower quadrants. We then perform the following procedures; ligation of the inferior mesenteric artery and vein, total mesorectal excision and dissection of the intersphincteric space. After the transanal intersphincteric dissection, the specimen is extracted through the anus and a hand —sewn coloanal anastomosis is performed. The covering ileostomy is finally created at the right upper port. We performed Lap ISR using needlescopic forceps in two patients with very low rectal cancer. In both cases, we were able to perform this procedure without insertion of an additional port or to change the needlescopic forceps to conventional 5-mm forceps. Lap ISR with needlescopic instruments is a feasible procedure for minimally invasive surgery.
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Affiliation(s)
- Kazuhiro Sakamoto
- Department of Coloproctological Surgery, Juntendo University, Faculty of Medicine, Tokyo, Japan
| | - Yu Okazawa
- Department of Coloproctological Surgery, Juntendo University, Faculty of Medicine, Tokyo, Japan
| | - Rina Takahashi
- Department of Coloproctological Surgery, Juntendo University, Faculty of Medicine, Tokyo, Japan
| | - Kiichi Sugimoto
- Department of Coloproctological Surgery, Juntendo University, Faculty of Medicine, Tokyo, Japan
| | - Hiromitsu Komiyama
- Department of Coloproctological Surgery, Juntendo University, Faculty of Medicine, Tokyo, Japan
| | - Makoto Takahashi
- Department of Coloproctological Surgery, Juntendo University, Faculty of Medicine, Tokyo, Japan
| | - Yutaka Kojima
- Department of Coloproctological Surgery, Juntendo University, Faculty of Medicine, Tokyo, Japan
| | - Michitoshi Goto
- Department of Coloproctological Surgery, Juntendo University, Faculty of Medicine, Tokyo, Japan
| | - Atsushi Okuzawa
- Department of Coloproctological Surgery, Juntendo University, Faculty of Medicine, Tokyo, Japan
| | - Yuichi Tomiki
- Department of Coloproctological Surgery, Juntendo University, Faculty of Medicine, Tokyo, Japan
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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
Abstract
Over the last 20 years, laparoscopic colorectal surgery has shown equal efficacy for benign and malignant colorectal diseases when compared to open surgery. However, a laparoscopic approach reduces postoperative morbidity and shortens hospital stay. In the quest to optimize outcomes after laparoscopic colorectal surgery, reduction of access trauma could be a way to improve recovery. To date, one method to reduce access trauma is natural orifice specimen extraction (NOSE). NOSE aims to reduce access trauma in laparoscopic colorectal surgery. The specimen is delivered via a natural orifice and the anastomosis is created intracorporeally. Different methods are used to extract the specimen and to create a bowel anastomosis. Currently, specimens are delivered transcolonically, transrectally, transanally, or transvaginally. Each of these NOSE-procedures raises specific issues with regard to operative technique and application. The presumed benefits of NOSE-procedures are less pain, lower analgesia requirements, faster recovery, shorter hospital stay, better cosmetic results, and lower incisional hernia rates. Avoidance of extraction site laparotomy is the most important characteristic of NOSE. Concerns associated with the NOSE-technique include bacterial contamination of the peritoneal cavity, inflammatory response, and postoperative outcomes, including postoperative pain and the functional and oncologic outcomes. These issues need to be studied in prospective randomized controlled trials. The aim of this systematic review is to describe the role of NOSE in minimally invasive colorectal surgery.
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Xingmao Z, Haitao Z, Jianwei L, Huirong H, Junjie H, Zhixiang Z. Totally laparoscopic resection with natural orifice specimen extraction (NOSE) has more advantages comparing with laparoscopic-assisted resection for selected patients with sigmoid colon or rectal cancer. Int J Colorectal Dis 2014; 29:1119-24. [PMID: 24986143 DOI: 10.1007/s00384-014-1950-7] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/22/2014] [Indexed: 02/04/2023]
Abstract
PURPOSE The purposes of this study were to compare the short-term outcomes of natural orifice specimen extraction (NOSE) and laparoscopic-assisted resection for sigmoid colon cancer or rectal cancer and to appraise whether totally laparoscopic resection with NOSE had more advantages compared with conventional laparoscopic-assisted resection. METHODS Sixty-five patients who underwent totally laparoscopic resection with NOSE were assigned to NOSE group, and 132 patients who underwent laparoscopic-assisted resection were assigned to laparoscopic-assisted (LA) group. Data of all 197 cases were reviewed. Short-term outcomes (including operative outcomes, gastrointestinal recovery, hospital stay, and complication) of the two groups were compared. RESULTS Mean numbers of lymph nodes harvested were 17.0 ± 8.3 and 18.9 ± 11.6 in NOSE group and LA group, respectively, (P = 0.248); mean operative times were 111.6 ± 25.4 min and 115.3 ± 23.0 min in the two groups (P = 0.384); and the mean blood losses in these two groups were 70.2 ± 66.1 ml and 126.3 ± 58.6 ml, respectively, (P < 0.001). Times to first flatus were 2.7 ± 0.8 and 3.4 ± 0.9 days (P < 0.001), and times to first defecation were 3.3 ± 0.6 and 3.9 ± 1.1 days (P = 0.002) in NOSE group and LA group, respectively. Hospital stay in NOSE group were 9.0 ± 1.9 and 9.9 ± 2.0 days in LA group. Incidences of peri-operative complications were 6.2 and 17.2% in the two groups, respectively (P = 0.031). CONCLUSIONS Without compromising oncologic outcome, totally laparoscopic resection with NOSE had more advantages including less blood loss, less pain, faster recovery of intestinal function and shorter hospital stay compared with laparoscopic-assisted resection for selected patients with sigmoid colon cancer or rectal cancer.
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Affiliation(s)
- Zhang Xingmao
- Department of Gastrointestinal Surgery, Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, 17 Panjiayuan Nanli Chaoyang District, Beijing, 100021, China
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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]
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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
Abstract
OBJECTIVE To review the published studies reporting various specimen retrieval incisions being used by colorectal surgeons in patients undergoing laparoscopic colorectal resections (LCR). METHODS Standard medical electronic databases were searched to find relevant articles and a summary conclusion was generated. RESULTS There were 43 studies reporting various approaches used for the purpose of specimen retrieval in 2388 patients undergoing LCR. The most common approaches were periumbilical midline incision (1260 reported case in the literature), transverse incision (583 reported cases in the literature) in the right- or left iliac fossa, depending on the side of colonic resection, and Pfannensteil incision (293 reported cases in the literature). Periumbilical midline incision was associated with the higher risk of developing incisional hernia (odds ratio 53.72; 95% confidence interval 7.48-386.04; Z = 3.96; P = 0.0001). In terms of surgical site infection (SSI), there was no difference between the three common approaches to specimen retrieval. Transanal and transvaginal approaches were associated with higher risk of SSI. CONCLUSIONS Midline, transverse and Pfannensteil incisions were the most commonly used approaches for specimen retrieval following LCR. Midline incision was associated with higher risk of incisional hernia. Risk of SSI was similar in all three common approaches. The transanal and transvaginal approaches pose a higher risk of SSI. These conclusions are based on the combined outcome of published case series, case reports and comparative studies. Randomized, controlled trials with longer follow-up are required before recommending the routine use of any approach for specimen retrieval in patients undergoing LCR.
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Affiliation(s)
- Muhammad S Sajid
- Department of General & Laparoscopic Colorectal Surgery, Worthing Hospital, Worthing, UK and Department of General Surgery, Queen Elizabeth Hospital, Kings Lynn NHS Foundation Trust, Kings Lynn, UK
| | - Muhammad I Bhatti
- Department of General & Laparoscopic Colorectal Surgery, Worthing Hospital, Worthing, UK and Department of General Surgery, Queen Elizabeth Hospital, Kings Lynn NHS Foundation Trust, Kings Lynn, UK
| | - Parv Sains
- Department of General & Laparoscopic Colorectal Surgery, Worthing Hospital, Worthing, UK and Department of General Surgery, Queen Elizabeth Hospital, Kings Lynn NHS Foundation Trust, Kings Lynn, UK
| | - Mirza K Baig
- Department of General & Laparoscopic Colorectal Surgery, Worthing Hospital, Worthing, UK and Department of General Surgery, Queen Elizabeth Hospital, Kings Lynn NHS Foundation Trust, Kings Lynn, UK
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Totally laparoscopic resection with natural orifice specimen extraction for carcinoma of sigmoid colon and rectum: a feasible and innovative technique. J Clin Gastroenterol 2014; 48:e57-61. [PMID: 24440933 DOI: 10.1097/mcg.0000000000000038] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
GOALS To testify the feasibility and safety of an innovative technique we performed. BACKGROUND An abdominal incision is required to extract a specimen for laparoscopic-assisted colorectal operation, and the incision brings some disadvantages for surgeons and patients. Natural orifice specimen extraction (NOSE) is developed to avoid these disadvantages. STUDY Between May 2012 and March 2013, we attempted to perform totally laparoscopic resection with NOSE in 27 patients with sigmoid colon cancer or rectal cancer. Procedure of this technique was described and clinic data of all 27 patients were collected and analyzed. RESULTS We successfully completed the technique of NOSE in 24 of these patients. Mean operation time was 110.0 minutes and mean intraoperative blood loss was 69.1 mL in 23 patients (not including one patient who received additional bilateral oophorectomy) who underwent NOSE. Of these 24 patients, the mean time to passing of first flatus was 3.1 days, the mean postoperative hospital stay was 9.2 days, and 2 patients used analgesics after operation; 22 patients were able to walk in first 2 days, 2 patients had postoperative complications. CONCLUSIONS Totally laparoscopic resection with NOSE is suited for selected patients with sigmoid colon cancer or rectal cancer, and this technique is worth to recommend and spread.
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Kvasha A, Hadary A, Biswas S, Szvalb S, Willenz U, Waksman I. Novel Totally Laparoscopic Endolumenal Rectal Resection With Transanal Natural Orifice Specimen Extraction (NOSE) Without Rectal Stump Opening: A Modification of Our Recently Published Clean Surgical Technique in a Porcine Model. Surg Innov 2014; 22:245-51. [PMID: 25057141 DOI: 10.1177/1553350614540812] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Our group has recently described a novel technique for clean endolumenal bowel resection, in which abdominal and transanal approaches were used. In the current study, 2 modifications of this procedure were tested for feasibility in a porcine model. A laparoscopic approach to the peritoneal cavity was employed in rectal mobilization; this was followed by a transanal rectorectal intussusception and pull-through (IPT). IPT was established in a stepwise fashion. First, the proximal margin of resection was attached to the shaft of the anvil of an end-to-end circular stapler with a ligature around the rectum. Second, this complex was pulled transanally to produce IPT. Once IPT was established, a second ligature was placed around the rectum approximating the proximal and distal resection margins. This was followed by a purse string suture through 2 bowel walls, encircling the shaft of the anvil just proximal to the ligatures. The specimen was resected and extracted by making a full-thickness incision through the 2 bowel walls distal to the previously placed purse string suture and ligatures. The anastomosis was achieved by applying the stapler. The technique was found to be feasible. Peritoneal samples, collected after transanal specimen extraction, did not demonstrate bacterial growth. Although, this is a novel and evolving procedure, its minimally invasive nature, as well as aseptic bowel manipulation during endolumenal rectal resection, has the potential to limit the complications associated with abdominal wall incision and surgical site infection.
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Affiliation(s)
- Anton Kvasha
- Ziv Medical Center, Zefad, Israel Bar Ilan Faculty of Medicine, Hanraita Sold, Zefad, Israel
| | - Amram Hadary
- Ziv Medical Center, Zefad, Israel Bar Ilan Faculty of Medicine, Hanraita Sold, Zefad, Israel
| | - Seema Biswas
- Ziv Medical Center, Zefad, Israel Bar Ilan Faculty of Medicine, Hanraita Sold, Zefad, Israel
| | - Sergio Szvalb
- Ziv Medical Center, Zefad, Israel Bar Ilan Faculty of Medicine, Hanraita Sold, Zefad, Israel
| | - Udi Willenz
- Lahav Contract Research Organization, Kibbutz Lahav, Israel
| | - Igor Waksman
- Ziv Medical Center, Zefad, Israel Bar Ilan Faculty of Medicine, Hanraita Sold, Zefad, Israel
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Leung ALH, Cheung HYS, Fok BKL, Chung CCC, Li MKW, Tang CN. Prospective randomized trial of hybrid NOTES colectomy versus conventional laparoscopic colectomy for left-sided colonic tumors. World J Surg 2014; 37:2678-82. [PMID: 23942527 DOI: 10.1007/s00268-013-2163-x] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND We conducted a randomized study of a laparoscopic technique for removing left-sided colon tumors that can reduce postoperative pain and other wound-related complications compared to the conventional technique. It is a novel technique of hybrid natural orifice translumenal endoscopic surgery (NOTES) colectomy (HNC) whereby laparoscopic colonic mobilization, transection, and anastomosis are performed intracorporeally. The specimen is then delivered through the anus using the transanal endoscopic operation (TEO) device, precluding the need for mini-laparotomy. We compared the short-term outcomes of patients who underwent HNC with those who underwent conventional laparoscopic colectomy (CL). METHODS Patients suffering left-sided colonic tumor were recruited and were randomized into two groups: HNC and CL. Operative data and complications were prospectively recorded and analyzed. RESULTS During a 3-year period, we recruited 70 patients (35 per group). No significant difference was observed between the two groups with respect to operating time (105 vs. 100 min, p = 0.851), blood loss (30 vs. 30 ml, p = 0.954), or length of hospital stay (5 vs. 5 days, p = 0.990). The maximum pain score during the first week was significantly lower in the HNC group (1 vs. 2, p = 0.017). No patients in the HNC group developed wound infection, whereas four patients in the CL group did so (p = 0.005). CONCLUSIONS With this hybrid NOTES technique, selected patients with left-sided colonic tumors can enjoy the full benefits of minimally invasive surgery with significantly less wound pain and a lower wound infection rate than are observed with CL.
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Affiliation(s)
- Alex Lik Hang Leung
- Department of Surgery, Pamela Youde Nethersole Eastern Hospital, 3 Lok Man Road, Chai Wan, Hong Kong SAR, China,
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