Reduced-port laparoscopic colectomy with D3-lymph node dissection and transvaginal specimen extraction (NOSES VIIIa) for right colon cancer: clinical features

Abstract

Background: Reduced-port laparoscopic surgery (RPLS) is the minimum possible number of ports or small-sized ports in laparoscopic surgery. Although the damage has been reduced compared to conventional laparoscopic (CL) surgery, a mini-laparotomy (ML) is still required to extract the specimen. The combination of RPLS and natural orifice specimen extraction (NOSE) minimizes the damage of the procedure. Methods: First group, we present the surgical approach of RPLS and extract the specimen via vaginal. Second group, we present the CL and extract the specimen through mini-laparotomy. We highlight the first surgical approach that includes preoperative preparation, key steps during the operation, and postoperative outcomes Results: A total of 17 patients with right colon adenocarcinoma, 5 of them underwent RPLS-NOSE, and other 12 patients underwent conventional laparoscopic (CL) surgery and extract specimen by mini-laparotomy (CL-ML). Compare with CL-ML, RPLS-NOSE associated with longer operative time (289 min vs 231 min, P < 0.001), less bleeding (60 ml vs 90 ml, P = 0.025), short hospitalization (8.2 days vs 13.6 days, P<0.001), faster first flatus (1.8 days vs 3.4 days, P<0.001), less postoperative pain on first day (2.8 vs 4.25, P = 0.019). Regarding to lymph node harvest, bowal movement, R0 resection, postoperative comlications, postoperative pain on day 3 and day 5, no significant difference was observed. Conclusion: In selected patients, RPLS with D3-lymph node dissection and transvaginal specimen extraction is safe, results in fast recovery, and is indicated for colon cancer patients.