Re-appraisal and consideration of minimally invasive surgery in colorectal cancer

Gazala, Mahmoud Abu; Wexner, Steven D.

doi:10.1093/gastro/gox001

Cited by 39 publications

(14 citation statements)

References 103 publications

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“…According to the routes for specimen extraction in colorectal surgery, NOSES is divided into two categories including transanal- and transvaginal-NOSES [14, 15]. A large amount of research literatures and clinical practice have fully confirmed that the anus is the most ideal orifice to extract colorectal specimen which is more in line with the basic requirements of minimally invasive surgery [16].…”

Section: Classificationmentioning

confidence: 99%

International consensus on natural orifice specimen extraction surgery (NOSES) for colorectal cancer

Guan

Liu

Longo

et al. 2019

Gastroenterology Report

126

128

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In recent years, natural orifice specimen extraction surgery (NOSES) in the treatment of colorectal cancer has attracted widespread attention. The potential benefits of NOSES including reduction in postoperative pain and wound complications, less use of postoperative analgesic, faster recovery of bowel function, shorter length of hospital stay, better cosmetic and psychological effect have been described in colorectal surgery. Despite significant decrease in surgical trauma of NOSES have been observed, the potential pitfalls of this technique have been demonstrated. Particularly, several issues including bacteriological concerns, oncological outcomes and patient selection are raised with this new technique. Therefore, it is urgent and necessary to reach a consensus as an industry guideline to standardize the implementation of NOSES in colorectal surgery. After three rounds of discussion by all members of the International Alliance of NOSES, the consensus is finally completed, which is also of great significance to the long-term progress of NOSES worldwide.

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Section: Classificationmentioning

confidence: 99%

International consensus on natural orifice specimen extraction surgery (NOSES) for colorectal cancer

Guan

Liu

Longo

et al. 2019

Gastroenterology Report

126

128

View full text Add to dashboard Cite

show abstract

“…Advantages of MAS over open surgery include lower blood loss, reduced incidence of post-operative adhesions, fewer wound complications, reduced post-operative pain, earlier recovery, shortened hospital stay and improved cosmesis [ 3 – 5 ]. However, competency in MAS, particularly within the confines of the pelvis, is generally associated with a long learning curve; anatomical challenges expose the limitations of conventional laparoscopy, such as restricted range of movement and two-dimensional vision, which make accurate dissection and suturing difficult [ 4 , 6 , 7 ].…”

mentioning

confidence: 99%

Preclinical evaluation of the versius surgical system, a new robot-assisted surgical device for use in minimal access general and colorectal procedures

et al. 2020

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Objective To evaluate the utility of a new robot-assisted surgical system (the Versius Surgical System, CMR Surgical, Cambridge, UK) for use in minimal access general and colorectal surgery, in a preclinical setting. Summary background data Robot-assisted laparoscopy has been developed to overcome some of the important limitations of conventional laparoscopy. The new system is designed to assist surgeons in performing minimal access surgery and overcome some of the challenges associated with currently available surgical robots. Methods Cadaveric sessions were conducted to evaluate the ability of the system to provide adequate surgical access and reach required to complete a range of general and colorectal procedures. Port and bedside unit positions were recorded, and surgical access and reach were evaluated by the lead surgeon using a visual analogue scale. A live animal (porcine) model was used to assess the surgical device’s safety in performing cholecystectomy or small bowel enterotomy. Results Nine types of procedure were performed in cadavers by nine lead surgeons; 35/38 procedures were completed successfully. The positioning of ports and bedside units reflected the lead surgeons’ preferred laparoscopic set-up and enabled good surgical access and reach. Cholecystectomy (n = 6) and small bowel enterotomy (n = 5) procedures performed in pigs were all completed successfully by two surgeons. There were no device-related intra-operative complications. Conclusions This preclinical study of a new robot-assisted surgical system for minimal access general and colorectal surgery demonstrated the safety and effectiveness of the system in cadaver and porcine models. Further studies are required to assess its clinical utility.

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“…Tumor metastasis at the puncture and incision sites after laparoscopic surgery for colorectal cancer is still a controversial issue [15][16][17][18][19] . Because there is no auxiliary incision on the abdominal wall in NOSE surgery, there is no chance of incision metastasis [20][21][22] . In addition, the incidence of postoperative complications of the NOSE surgery was lower than non-NOSE surgery.…”

Section: Discussionmentioning

confidence: 99%

Trans-rectal natural orifice specimen extraction (NOSE) during laparoscopic anterior resection: Chinese experience with a novel method

Zhou¹,

Wang²,

Du³

et al. 2019

Preprint

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Background: To introduce a novel method for double stapling technique in colorectal anastomosis during laparoscopic anterior resection of upper rectal or sigmoid colon cancer with trans-rectal natural orifice specimen extraction (NOSE). Methods: From June 2015 and May 2016, patients with upper-rectal or sigmoid colon cancer who received treatment in Shanghai East Hospital were enrolled. Preoperative and postoperative clinical variables were analyzed and compared between groups. Postoperative pain was analyzed utilizing a visual analog scale (VAS). Postoperative overall survival was analyzed using a K-M curve. Results: A total of 99 colorectal cancer cases were randomly divided into NOSE with novel method group (NOSE, n=48) and conventional laparoscopic group (non-NOSE, n=51). No statistically significant differences in preoperative demographics of the patients as sex, age, body mass index were found among the groups. The NOSE group had the longer operation time, but less blood loss than the non-NOSE group. The NOSE group had no abdominal incision and the lower postoperative VAS score. The time for intestinal function recovery and the length of hospital stay (LOS) was statistically significantly different, with the non-NOSE group having the longer time. The incidence of postoperative complications was lower in NOSE group (5/48, 10.4%) than in the non-NOSE group (8/51, 15.7%), the difference was statistically significant. The K-M survival curve showed no statistically significant difference in the disease free survival rate between the NOSE group and non-NOSE group. Conclusion: NOSE with novel method is safe and feasible to use in patients having colorectal cancer. Compared with traditional laparoscopic surgery, the postoperative complication rates of NOSE surgery were lower with an improved short-term clinical recovery.

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Re-appraisal and consideration of minimally invasive surgery in colorectal cancer

Cited by 39 publications

References 103 publications

International consensus on natural orifice specimen extraction surgery (NOSES) for colorectal cancer

International consensus on natural orifice specimen extraction surgery (NOSES) for colorectal cancer

Preclinical evaluation of the versius surgical system, a new robot-assisted surgical device for use in minimal access general and colorectal procedures

Trans-rectal natural orifice specimen extraction (NOSE) during laparoscopic anterior resection: Chinese experience with a novel method

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