Transanal Natural Orifice Specimen Extraction Research Articles

Transanal natural orifice specimen extraction (NOSE) in laparoscopic colorectal surgery is feasible and safe

Transanal natural orifice specimen extraction (NOSE) in laparoscopic colorectal surgery is feasible and safe

Short-term outcomes of incisionless laparoscopic low anterior resection using prolapsing technique for rectal cancer

Laparoscopic-assisted surgery for colorectal cancer has been widely spread worldwide. To avoid the invasiveness of abdominal wound and get better good-looking, incisionless laparoscopic low anterior resection with transanal natural orifice specimen extraction using prolapsing technique for rectal cancer has been developed in our center. The aim of this study was to evaluate the feasibility, safety and short-term outcomes of this technique. From January 2013 to October 2013, twenty-seven patients with rectal carcinoma were treated by incisionless laparoscopic low anterior resection, and the data of these patients were collected and retrospectively analyzed to assess the value of this technique. All operations were successfully accomplished without conversion to open surgery or laparoscopic-assisted surgery. The mean operation time was 135 minutes. The mean blood loss was 50 ml. The mean first bowel movement was 48 hours. The post-operative hospital stay was 9 days. All patients had clean distal margin and the mean number of dissected lymph nodes was 18. One patient had anastomotic leakage. Incisionless laparoscopic low anterior resection with transanal natural orifice specimen extraction using prolapsing technique for rectal cancer appears to be feasible, safe and oncologically acceptable with a satisfactory short-term outcome for selected cases.

Analysis of 21 cases treated by total laparoscopic rectosigmoid cancer surgery with transanal natural orifice specimen extraction

To evaluate the feasibility, safety and short-term outcomes of total laparoscopic rectosigmoid cancer surgery with transanal natural orifice specimen extraction. From July 2012 to February 2013, 21 patients underwent total laparoscopic surgery with transanal natural orifice specimen extraction. There were 12 males and 9 females with a median age of 53 (48-77) years.Rectal cancer (n = 11) and sigmoid cancer (n = 10) were diagnosed. The clinical data such as bowel function recovery time, number of lymph nodes harvested and an incidence of anastomotic leakage was collected and retrospectively analyzed to assess the value of this technique. Operation was successfully accomplished without conversion into open surgery or conventional laparoscopic-assisted surgery. The median operative duration was 105 (80-165) min, the median volume of blood loss 50 (20-300) ml, the median number of lymph nodes harvested 16(8-29) and the time of first bowl movement was 48 (24-72) h. The postoperative hospitalization stay was 9 (6-12) d. There were abdominal hemorrhage (n = 1) and anastomotic leakage (n = 1). Total laparoscopic rectosigmoid cancer surgery with transanal natural orifice specimen extraction appears to be feasible, and oncologically acceptable for selected patients.

Transanal natural orifice specimen extraction for laparoscopic anterior resection in rectal cancer

To investigate whether transanal natural orifice specimen extraction (NOSE) is a better technique for rectal cancer resection. A prospectively designed database of a consecutive series of patients undergoing laparoscopic low anterior resection for rectal cancer with various tumor-node-metastasis classifications from March 2011 to February 2012 at the First Affiliated Hospital of Sun Yat-Sen University was analyzed. Patient selection for transanal specimen extraction and intracorporeal anastomosis was made on the basis of tumor size and distance of rectal lesions from the anal verge. Demographic data, operative parameters, and postoperative outcomes were assessed. None of the patients was converted to laparotomy. Respectively, there were 16 cases in the low anastomosis and five in the ultralow anastomosis groups. Mean age of the patients was 45.4 years, and mean body mass index was 23.1 kg/m². Mean distance of the lower edge of the lesion from the anal verge was 8.3 cm. Mean operating time was 132 min, and mean intraoperative blood loss was 84 mL. According to the principle of rectal cancer surgery, we performed D2 lymph node dissection in 13 cases and D3 in eight. Mean lymph nodes harvest was 17.8, and the number of positive lymph nodes was 3.4. Median hospital stay was 6.7 d. No serious postoperative complication occurred except for one anastomotic leakage. All patients remained disease free. Mean Wexner score was 3.7 at 11 mo after the operation. Transanal NOSE for total laparoscopic low/ultralow anterior resection is feasible, safe and oncologically sound. Further studies with long-term outcomes are needed to explore its potential advantages.

Endolumenal Rectal Resection and Transanal Natural Orifice Specimen Extraction (NOSE) Without Rectal Stump Opening

Minimally invasive surgery has been continuously evolving over the past 20 years. The use of natural orifice specimen extraction (NOSE) is one of the most recent contributions to minimally invasive methods. The anus has been widely used in NOSE procedures. However, an open rectal stump carries the highest risk of contamination compared with other translumenal approaches to the peritoneal cavity. In this study, the feasibility of a novel NOSE method was tested in a porcine model. This technique combined abdominal and transanal approaches. The abdominal approach was used in rectal mobilization; 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 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. The specimen was resected and extracted by making a full-thickness incision through 2 bowel walls distal to the previously placed ligatures. Anastomosis was achieved by applying the stapler. The technique was found to be feasible. A substantial length of bowel was resected in all experiments. Peritoneal samples, collected after transanal specimen extraction, did not demonstrate bacterial growth. Although more investigation is warranted, this procedure has the potential to limit surgical site infections by using aseptic bowel manipulation during colorectal resection and transanal specimen extraction.

Prospective evaluation of peritoneal fluid contamination following transabdominal vs. transanal specimen extraction in laparoscopic left-sided colorectal resections

Natural orifice specimen extraction (NOSE) in colorectal surgery prevents the need for an enlarged port site or minilaparotomy to extract the surgical specimen. The downside of this technique may be an increased risk of bacterial contamination of the peritoneal cavity from the external milieu. The aim of this study was to prospectively analyze the peritoneal bacterial contamination in NOSE and non-NOSE laparoscopic colorectal procedures. Consecutive patients operated for sigmoid diverticulitis with laparoscopic approach and transanal extraction of the specimen from January to December 2010 at our university hospital were enrolled. Patients who underwent a laparoscopic sigmoidectomy in the same study period with conventional specimen extraction were used as reference. Peritoneal fluid samples were collected under sterile conditions at the end of the procedure and sent for gram stain as well as anaerobic, aerobic, and fungal cultures. Twenty-nine patients underwent laparoscopic sigmoidectomy for diverticulitis with transanal NOSE, while 9 patients underwent laparoscopic sigmoidectomy with conventional specimen extraction during the same period. The two groups were successfully matched 1:2 (17 NOSE and 9 non-NOSE) according age, sex, ASA, and Charlson comorbidity score. The contamination rate of peritoneal fluid was 100% vs. 88.9% in NOSE and non-NOSE procedures, respectively (P = 0.23). Overall and major complications rates were 27.6% vs. 11.10% (P = 0.41) and 5.08% vs. 11.1% (P = 1) in NOSE vs. non-NOSE procedures, respectively. In the NOSE group there was a statistically significant lower consumption of oral paracetamol (P = 0.007) and of oral tramadol (P = 0.02). Although a higher peritoneal contamination was found in the NOSE procedures, there were no significant differences in clinical outcomes relative to standard approach. Avoiding a minilaparotomy to extract the specimen resulted in a significantly lower postoperative analgesic requirement in the NOSE group.

Laparo-Endoscopic Single-Site (LESS) with Transanal Natural Orifice Specimen Extraction (NOSE) Sigmoidectomy: A New Step before Pure Colorectal Natural Orifices Transluminal Endoscopic Surgery (NOTES®)

IntroductionWe present the first human case of laparo-endoscopic single-site sigmoidectomy with transanal natural orifice specimen extraction. DiscussionThis technical achievement is a new step toward pure colorectal Natural Orifices Transluminal Endoscopic Surgery. It is the product of a gradual development with critical steps being conceived and standardised in years of experimental and clinical procedures.