Laparoscopic natural orifice specimen extraction-colectomy: A systematic review

Table 1 Studies reporting on natural orifice specimen extraction-colectomy

Author	Type of study	Patients (n)	Type of surgery	Type of NOSE	Indication
Akamatsu et al[36], 2009	Case series	16	Sigmoid resection	Transrectal	Malignant
Cheung et al[42], 2009	Case series	10	Sigmoid resection	Transrectal	Malignant
Christoforidis et al[44], 2013	Case-matched	11	Sigmoid resection	Transrectal	Benign
Costantino et al[45], 2012	Case-matched	17	Sigmoid resection	Transrectal	Benign
Franklin et al[49], 2013	Case series	277	Sigmoid and anterior resection	Transrectal	Benign and malignant
Fuchs et al[50], 2013	Case series	15	Sigmoid resection	Transrectal	Benign
Han et al[53], 2013	Case series	34	Sigmoid and anterior resection	Transrectal	Malignant
Leroy et al[58], 2011	Case series	16	Sigmoid resection	Transrectal	Diverticulitis
Nishimura et al[61], 2011	Case series	16	Sigmoid resection	Transrectal	Malignant
Saad et al[66], 2010	Case series	8	Sigmoid resection	Transrectal	Benign and malignant
Wolthuis et al[73], 2011	Case-matched	21	Sigmoid resection	Transrectal	Endometriosis
Wolthuis et al[74], 2011	Case series	21	Sigmoid resection	Transrectal	Benign and malignant
Akamatsu et al[37], 2009	Case series	7	TME	Transanal	Malignant
Bie et al[39], 2013	Case series	131	TME	Transanal	Malignant
Choi et al[43], 2009	Case series	13	TME	Transanal(11 patients)	Malignant
de Lacy et al[46], 2013	Case series	20	TME	Transanal	Malignant
Dumont et al[47], 2012	Case series	4	TME	Transanal	Malignant
Gaujoux et al[51], 2011	Case series	2	TME	Transanal	Malignant
Hara et al[54], 2011	Case series	9	Sigmoid resection	Transanal	Malignant
Kang et al[55], 2012	Comparative	53	TME	Transanal	Malignant
Lacy et al[56], 2013	Case series	3	TME	Transanal	Malignant
Lamadé et al[57], 2010	Case series	3	RPC	Transanal	IBD (UC)
Marks et al[59], 2010	Case series	79	TME	Transanal (36 TATA)	Malignant
Prete et al[64], 2007	Case series	10	TME	Transanal	Malignant
Rullier et al[65], 2003	Case series	32	TME	Transanal	Malignant
Sylla et al[67], 2013	Case series	5	TME	Transanal	Malignant
Velthuis et al[70], 2013	Case series	5	TME	Transanal	Malignant
Wang et al[71], 2013	Case series	21	TME	Transanal (16 patients)	Malignant
Watanabe et al[72], 2000	Case series	7	TME	Transanal	Malignant
Zorron et al[75], 2012	Case series	2	TME	Transanal	Malignant
Abrao et al[35], 2005	Case series	8	Sigmoid resection	Transvaginal	Endometriosis
Awad et al[38], 2011	Case series	14	Right hemicolectomy	Transvaginal	Benign and malignant
Boni et al[40], 2007	Case series	11	Sigmoid resection	Transvaginal	Endometriosis
Breitenstein et al[41], 2006	Case series	2	Sigmoid resection (+ hysterectomy)	Transvaginal	Diverticulitis
Franklin et al[49], 2013	Case series	26	Right hemicolectomy	Transvaginal	Benign and malignant
Ghezzi et al[52], 2008	Case series	33	Sigmoid resection	Transvaginal	Endometriosis
McKenzie et al[60], 2010	Case series	4	Right hemicolectomy	Transvaginal	Benign and malignant
Palanivelu et al[62], 2008	Case series	7	Restorative proctocolectomy	Transvaginal	Fap
Park et al[63], 2011	Case-matched	34	Right hemicolectomy	Transvaginal	Malignant
Tarantino et al[68], 2011	Case series	34	Sigmoid resection	Transvaginal	Diverticulitis
Torres et al[69], 2012	Case series	21	Sigmoid and high anterior resection	Transvaginal	Benign and malignant

FAP: Familial adenomatous polyposis; IBD: Inflammatory bowel disease; UC: Ulcerative colitis; TATA: Transanal transabdominal; TME: Total mesorectal excision; RPC: Restorative proctocolectomy.

Table 2 Operative details and outcome of natural orifice specimen extraction-colectomy

Author	Ports	Protection	Anastomosis	Duration of surgery (min)	Morbidity (n, Dindo-score)	LOS (d)
Transrectal NOSE
Akamatsu et al[36], 2009	4	None	TS	Mean 180 (137-257)	Wound infection (1, 1)	Mean 11 (8-14)
Cheung et al[42], 2009	5	TEO	TS	Median 127.5 (105-170)	None	Median 7 (4-18)
Christoforidis et al[44], 2013	4	Camera sleeve	TS	Median 200 (120-360)	Abscess (1, 3a), leakage (3b) and trocar hernia (3b)	Median 6 (4-33)
Costantino et al[45], 2012	3	None	TS	122 ± 36.5	Bleeding (1, 1), fever (2, 2), abscess (1, 2), leakage (1, 3b)	7.2 ± 4.9
Franklin et al[49], 2013	4	Retrieval bag	TS	164.7 ± 47.5	Leakage (3, 3b)	6.9 ± 2.8
Fuchs et al[50], 2013	3	TEA	TS	Mean 131 (55-184)	Bleeding (1, 1), ileus (1, 2)	NA
Han et al[53], 2013	5	TEM and bag	DS	Mean 151.6 (125-185)	Leakage (6, 3b)	Median 9 (7-66)
Leroy et al[58], 2011	3	None	TS	Mean 120.9 (std 41.9)	Epigastric pain (1, 1) and transient fever (3, 2)	6.1 ± 2.4
Nishimura et al[61], 2011	5	Wound retractor	DS	Mean 241 (188-309)	Leakage (1, 2)	Median 6 (4-16)
Saad et al[66], 2010	4	McCarteny Tube	TS	95-180	None	4-8 d
Wolthuis et al[73], 2011	4	Retrieval bag	TS	Median 90 (85-105)	UTI (1, 2)	Median 6 (5-7)
Wolthuis et al[74], 2011	4	Retrieval bag	TS	Median 105 (90-110)	Leakage (1, 3b)	Median 6 (5-7)
Transanal NOSE
Akamatsu et al[37], 2009	5	None	DS	Median 299 (255-343)	None	Mean 25 (14-49)
Bie et al[39], 2013	NA	None	SS	Median 166 (120-280)	None	Median 10 (8-17)
Choi et al[43], 2009	5	Retrieval bag	SS	260.8 ± 62.9	Bleeding (1, 3a), leakage and bleeding (1, 3b/3b)	Median 7 (6-14)
de Lacy et al[46], 2013	3	None	DS	235 ± 56	Retention (2, 1), ileus (1, 2), dehydration (1, 2)	6.5 ± 3.1
Dumont et al[47], 2012	1	None	Hand-sewn	Median 360 (270-460)	Leakage (1, 3b)	Median 13 (10-21)
Gaujoux et al[51], 2011	1	None	Hand-sewn	195 and 210	None	5 and 6
Hara et al[54], 2011	4	None	DS	Median 293 (220-342)	None	NA
Kang et al[55], 2012	5 (6)	Retrieval bag	SS	Mean 357 std 66.8	Leakage (4), abscess (2)	9 ± 4.8
Lacy et al[56], 2013	3	None	SS	125, 150, and 155	Dehydration (1, 2)	4, 5, and 5
Lamadé et al[57], 2010	1 + TV assistance	None	DS	NA	None	11, 12, and 14
Marks et al[59], 2010	3-6	None	Hand-sewn	NA	19% minor, 11% major	Median 5 (3-24)
Prete et al[64], 2007	NA	None	Hand-sewn	NA	Leakage (1, 3b), hemorrhagic gastropathy (1, 2)	Mean 8.5 (6-10)
Rullier et al[65], 2003	NA	None	Hand-sewn	Median 420 (300-600)	22% major	Median 9 (7-29)
Sylla et al[67], 2013	4 (5)	None	Hand-sewn	274.6 ± 85.4	Urinary dysfunction (2, 2), ileus (1, 2)	4, 4, 4, 4, and 10
Velthuis et al[70], 2013	1	Wound retractor	Hand-sewn and SS	Median 175 (160-194)	Ileus and pneumonia (1, 2), abscess (1, 3b)	NA
Wang et al[71], 2013	3	Retrieval bag	DS	187 ± 35	Ileus (1, 2)	Mean 7.5 (2-11)
Watanabe et al[72], 2000	5	None	Hand-sewn	280-450	Leakage (1, 3b)	NA
Zorron et al[75], 2012	3	None	Hand-sewn	350 and 360	None	6
Transvaginal NOSE
Abrao et al[35], 2005	4	None	DS	Mean 177.5 (119-251)	None	Mean 4.13 (2-5)
Awad et al[38], 2011	5	Retrieval bag	DS	Mean 229 (172-360)	Bleeding (1, 3b), ileus (3, 2)	Mean 9.6 (2-30)
Boni et al[40], 2007	4	Retrieval bag	DS	240 ± 63	None	5 ± 2
Breitenstein et al[41], 2006	4	None	DS	NA	C. difficile-colitis (1, 2), UTI (1, 2)	15 and 9
Franklin et al[49], 2013	4	Retrieval bag	DS	159 ± 27.1	None	5.5 ± 2.5
Ghezzi et al[52], 2008	4	None	DS	Median 290 (200-390)	Seroma (1, 3b), retention (3, 2)	6.7 ± 1.8
McKenzie et al[60], 2010	4	Retrieval bag	DS	Mean 212.3	Internal hernia (1, 3b)	3, 4, 5 and 34
Palanivelu et al[62], 2008	5	Retrieval bag	DS	Mean 222.5 (165-280)	Leakage (1, 2)	Mean 25.5 (11-40)
Park et al[63], 2011	5	Retrieval bag	DS	Mean 170.8 (std 46.4)	Ileus (1, 2), retention (1, 1), bleeding (2, 2)	7.9 ± 0.8
Tarantino et al[68], 2011	4	Wound retractor	DS	Median 172.5 (107-312)	Leakage (1, 3b)	Median 6 (3-23)
Torres et al[69], 2012	4	Wound retractor	DS	NA	NA	3-6

C. difficile: Clostridium difficile; DS: Double stapled; LOS: Length of stay; NA: Not available; SS: Single stapled; TEA: Transanal endoscopic applicator; TEM: Transanal endoscopic microsurgery; TEO: Transanal endoscopic operation; TS: Triple stapled; TV: Transvaginal; UTI: Urinary tract infection.