A Novel Method of Natural Orifice Specimen Extraction Surgery (NOSES) during Laparoscopic Anterior Resection for Rectal Cancer

Jun Wang,Jun Hong,Fen Luo,Fenghua Guo,Qianwei Wang,Zhihua Kang

doi:10.1155/2021/6610737

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.

Highlights

Laparoscopic anterior resection (LAR) is widely used for rectal cancer (RC) because of the minimally invasive nature and safety of the procedure, thereby supporting its use as an alternative to open surgery [1–3]
Current conventional laparoscopic-assisted procedures usually require additional abdominal incisions for specimen extraction and completing anastomosis, and minilaparotomy can often lead to postoperative pain, surgical site infection, incisional hernia, and poor cosmetic outcomes [4–6]
The study cohort consisted of 20 patients with RC [11 males and 9 females; median age, 63 years; age range, 40–75 years; mean body mass index (BMI), 23.5 kg/m2; BMI range, 19.2–27.8 kg/m2] who underwent complete LAR via Gastroenterology Research and Practice the transanal approach in the Department of General Surgery of Huashan Hospital from October 2017 to June 2018

Summary

Introduction

Laparoscopic anterior resection (LAR) is widely used for rectal cancer (RC) because of the minimally invasive nature and safety of the procedure, thereby supporting its use as an alternative to open surgery [1–3]. NOTES requires technological expertise and specialized devices, which limits its applicability in clinical practice [7, 8]. At this time, natural orifice specimen extraction surgery (NOSES) has been increasingly applied due to its advantage of a reduced risk of abdominal wounds [9–13]. In combination with clinical practice, our center introduced a modified surgical procedure, called “double-purse” NOSES, for reconstruction and collection of specimens from the anus. The aim of the present study was to evaluate the short-term efficacy of double-purse NOSES for resection of RC. This retrospective study was approved by the Ethics Committee of Huashan Hospital, Fudan University

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Discussion

Conclusion