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NOSE (Natural Orifice Specimen Extraction) in laparoscopic colorectal surgery


Authors: J. Dostalík 1;  P. Guňková 1;  L. Martínek 1;  M. Mazur 1;  I. Guňka 1;  V. Richter 2;  L. Tulinský 2
Authors‘ workplace: Katedra chirurgických oborů LFOU v Ostravě, vedoucí katedry: Doc. MUDr. Jan Dostalík, CSc 1;  Chirurgická klinika FN Ostrava, přednosta: Doc. MUDr. Jan Dostalík, CSc 2
Published in: Rozhl. Chir., 2012, roč. 91, č. 3, s. 141-145.
Category: Original articles

Overview

Introduction:
The aim of this study was to asses our initial first experience with NOSE techniques in laparoscopic colorectal surgery with both transanal and transvaginal extraction.

Material and methods:
In this prospective study, the authors analyzed data from patients in whom NOSE laparoscopic sigmoid, rectosigmoid and rectal resections were performed in the Department of Surgery, University Hospital Ostrava, from May 2011 to October 2011. A group of 7 patients was analyzed based on demographic characteristics (sex, age and BMI). Tumor localization, type of extraction (transanal/ transvaginal), the number of removed lymph nodes, tumor size, histology and length of the specimen were also assessed. Furthermore, the following intraoperative data were evaluated: duration of the procedure, frequency of intraoperative complications and conversion rate. During the postoperative period, duration of hospitalization and morbidity rates were evaluated.

Results:
The patient group included 2 male (28.6%) and 5 female (71.4%) subjects, their median age was 70 years (61–80), BMI 26,76 (24.76–34.67). The pathology was located in the sigmoid colon in 4 cases (57.1%) and in the proximal rectum in 3 cases (42.9%). Transanal extraction was performed in 5 patients (71.4%) and transvaginal extraction in 2 patients (28.6%). The average number of harvested lymph nodes was 13 (10–15), the average lenght of specimen was 16 cm (13–20) and the average tumor size was 4 cm (2–6). Histologically, adenocarcinoma was confirmed in 6 cases (85.7%), and low grade adenoma in 1 case (14.3%). The median duration of surgery was 205 min (140–300) and no intraoperative complications were recorded. No surgical conversion was required. No postoperative complications occured and the median duration of of hospital stay was 7 days (5–11).

Conslusion:
In the selected group of patients, NOSE technique proved to be a safe technique for laparoscopic colorectal procedures, reducing the risk of incisional complications while maintaining the principles of oncological radicality. Therefore, it may be considered a bridge towards NOTES (Natural Orifice Transluminal Endoscopic Surgery), surgery without scars.

Key words:
laparoscopic colorectal surgery – NOSE – transanal extraction – transvaginal extraction


Sources

1. Lacy A, Delgado S, Rojas OA, Almenara R, Blasi A, Llach J. MA-NOS radical sigmoidectomy: report of a transvaginal resection in human. Surg Endosc 2008;22:1717–1723.

2. Kahnamoui K, Cadeddu M, Farrokhyar F, Anvari M. Laparoscopic surgery for colon cancer: a systematic review. Can J Surg 2007;50:48–57.

3. Diana M, Perretta S, Wall J, Constantino FA, Leroy J, Demartines N, Marescaux J. Transvaginal specimen extraction in colorectal surgery: current state of the art. Colorectal Disease 2011;13:104–111.

4. Kalloo AN, Singh VK, Jagannath SB. Flexible transgastric peritoneoscopy: a novel approach to diagnostic and therapeutic interventions in the peritoneal cavity. Gastrointest Endosc 2004;60:114–117.

5. Tsin DA, Sequeria RJ, Giannikas G. Culdolaparoscopic cholecystectomy during vaginal hysterectomy. J Soc Laparoendosc Surg 2003;7:171–172.

6. Michek J, Nečas F, Reisinger H, Havlín I, Kašťák B, Kašpar Z. Transvaginální resekce karcinomů rekta. Rozhl Chir 62 1983; (3):176–180.

7. Franklin ME, Ramos R, Rosenthal D, Schuessler W. Laparoscopic colonic procedures. World J Surg 1993;17:51–56.

8. Darzi A, Super P, Guillou PJ, Monson JR (1994) Laparoscopic sigmoid colectomy: total laparoscopic approach. Dis Colon Rectum 37:268–271.

9. Franklin ME, Kazantsev GB, Abrego D. Laparoscopic surgery for stage III colon cancer. Long-term follow up. Surg Endosc 2000; 14:612–616.

10. Knol J, Dę Hondt M, Dozois EJ, Boer JV, Malisse P. Laparoscopic-assisted sigmoidectomy with transanal specimen extraction: a bridge to NOTES? Tech Coloproctol 2009;13:65–68.

11. Leroy J, Constantino F, Cahill RA, Dę Agostino J, Morales A, Mutter D, Marescaux J. Laparoscopic resection with transanal specimen extraction for sigmoid diverticulitis. Br J Surg 2011; 98:1327–1334.

12. Saida Y, Nagao J, Nakamura Y, Enomoto T, Katagiri M, Kusachi S, Watanabe M, Sumiyama Y. A comparison of abdominal cavity bacterial contamination of laparoscopy and laparotomy for colorectal cancers. Dig Surg 2008;25:198–201.

13. Braga M, Vignali A, Gianotti L. Laparoscopic versus open colorectal surgery: a randomized trial on short-term outcome. Ann Surg 2002;236:759–766.

14. Ooi BS, Quah HM, Fu CWP, Eu KW. Laparoscopic high anterior resection with natural orifice specimen extraction (NOSE) for early rectal cancer. Tech Coloproctol 2009;13:61–64.

15. Wolthuis AM, Van Geluse B, Fieuws S, Penninckx F, Dę Hoore A. Laparoscopic sigmoid resection with transrectal specimen extraction: a systematic review. doi: 10.1111/j.1463–1318. 2011. 02869.x.

16. Knight CD, Griffen FD. An improved technique for low anterior resection of the rectum using the EEA stapler. Surgery 1980;88:710–714.

17. Kelly H. Treatment of ectopic pregnancy by vaginal puncture. Bull Johns Hopkins Hosp 1896;7:208.

18. Wilson JI, Dogiparthi KK, Hebblethwaite N, Clarke MD. Laparoscopic right hemicolectomy with posterior colpotomy for transvaginal specimen retrieval. Colorectal Disease 2007;9:662.

19. Franklin ME, Kelley H, Kelley M, Brestan L, Portillo G, Torres J. Transvaginal extraction of the specimen after total laparoscopic rihgt hemicolectomy with intracorporeal anastomosis. Surg Laparosc Endosc Percutan Tech 2008;18:294–298.

20. Gill IS, Cherullo EE, Meraney AM, Borsuk F, Murphy DP, Falcone T. Vaginal extraction of the intact specimen following laparoscopic radical nephrectomy. J Urol 2002;167:238–41.

21. Vereczkei A, Illenyi L, Arany A. Transvaginal extraction of the laparoscopically removed spleen. Surg Endosc 2003;17:157.

22. Delvaux G, Devroey P, De Waele B, Willems G. Transvaginal removal of gallbladders with large stones after laparoscopic cholecystectomy. Surg Laparosc Endosc 1993;3:307–309.

23. Lakshman N, Chany R, Ho Y. Laparoscopic combined rectal anterior resection and total hysterectomy with bilateral salpingo-oophorectomy. Tech Coloproctol 2006;10(4):350–2.

24. Yuan LH, Chung HJ, Chen KK. Laparoscopic radical cystectomy combined with bilateral nephroureterectomy and specimen extraction through the vagina. J Chin Med Assoc 2007;70:260–261.

25. Dozois EJ, Larson DW, Dowdy SC, Poola VP, Holubar SD, Cima RR. Transvaginal colonic extraction following combined hysterectomy and laparoscopic total colectomy: a natural orifice approach. Tech Coloproctol 2008;12:251–254.

26. Palanivelu Ch, Rangarajan M, Jategaonkar PA, Anand NY. An innovative technique for colorectal specimen retrieval: a new era of „Natural Orifice Specimen Extraction“ (N.O.S.E.). Dis Colon Rectum 2008;51: 1120–1124.

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