INTRODUCTION: Natural orifice techniques have been developed to reduce incision-related morbidity in laparoscopic colorectal surgery. We describe our method of performing transanal specimen extraction in laparoscopic colorectal surgery, addressing bacteriological and oncological concerns in its implementation. METHODS: Data of consecutive patients undergoing natural orifice specimen extraction (NOSE) laparoscopic colorectal surgery in our institution were retrospectively analysed. All specimens were extracted transanally via a wound protector, followed by intracorporeal end-to-end colorectal anastomosis. Perioperative details, microbiological and oncological findings were reviewed. RESULTS: Between November 2014 and February 2015, five patients underwent NOSE laparoscopic colorectal procedures in our institution. All cases were completed laparoscopically and specimens were extracted transanally via a wound protector. There were no cases of post-operative anastomotic leaks, wound infections, intra-abdominal sepsis or faecal incontinence. Oncological margins and lymph node harvest were adequate for malignant cases. Transanal specimen extraction did not result in a malignant yield on peritoneal fluid cytology. CONCLUSIONS: Early bacteriological, oncological and functional results show that NOSE is safe and feasible. Follow-up is required to establish that long-term oncological outcome is not compromised.
INTRODUCTION: Natural orifice techniques have been developed to reduce incision-related morbidity in laparoscopic colorectal surgery. We describe our method of performing transanal specimen extraction in laparoscopic colorectal surgery, addressing bacteriological and oncological concerns in its implementation. METHODS: Data of consecutive patients undergoing natural orifice specimen extraction (NOSE) laparoscopic colorectal surgery in our institution were retrospectively analysed. All specimens were extracted transanally via a wound protector, followed by intracorporeal end-to-end colorectal anastomosis. Perioperative details, microbiological and oncological findings were reviewed. RESULTS: Between November 2014 and February 2015, five patients underwent NOSE laparoscopic colorectal procedures in our institution. All cases were completed laparoscopically and specimens were extracted transanally via a wound protector. There were no cases of post-operative anastomotic leaks, wound infections, intra-abdominal sepsis or faecal incontinence. Oncological margins and lymph node harvest were adequate for malignant cases. Transanal specimen extraction did not result in a malignant yield on peritoneal fluid cytology. CONCLUSIONS: Early bacteriological, oncological and functional results show that NOSE is safe and feasible. Follow-up is required to establish that long-term oncological outcome is not compromised.
Authors: David A Westwood; Tahleesa J Cuda; A E Ricardo Hamilton; David Clark; Andrew R L Stevenson Journal: Tech Coloproctol Date: 2018-09-25 Impact factor: 3.781