Transrectal natural orifice specimen extraction in left hemicolectomy for tumours around the splenic flexure: Old wine in new bottles

Abstract

Aim: Laparoscopic anterior resection with natural orifice specimen extraction (NOSE) has favourable short-term outcomes. However, NOSE is rarely adopted for left hemicolectomy procedures. This study aimed to review the feasibility, safety and short-term outcomes of transrectal NOSE in patients undergoing laparoscopic left hemicolectomy. Method: All consecutive patients who underwent laparoscopic left hemicolectomy surgery with transrectal NOSE in a single institution between January 2018 and December 2020 were reviewed. Transrectal NOSE was performed with an enterotomy at the upper rectum. The specimen was brought out via a transanal endoscopic microsurgery scope inserted through the anus. A supplementary video demonstrates this technique. Surgical outcomes, including complications, postoperative short-term recovery and the level of pain intensity, are presented.Results: Twenty patients were reviewed. There were no immediate postoperative complications and no wound infections in these patients. The average time to tolerate a soft diet was 3.6 days, and the average postoperative hospital stay was 4.5 days. The average score on the numerical rating scale of postoperative pain was 3.0 on postoperative day 1. The median follow-up time was 23.5 months. Conclusion:Laparoscopic left hemicolectomy with transrectal NOSE is a safe and feasible procedure that leads to early postoperative recovery and a short hospital stay.

Comparison of short-term and medium-term outcomes between intracorporeal anastomosis and extracorporeal anastomosis for laparoscopic left hemicolectomy

“…Although the number of lymph nodes harvested on pathological examination was higher in the EA group than in the IA group, the difference was not statistically significant in our study (IA vs. EA: 25 vs. 32.2, p = 0.058). Similar to other studies, the mean numbers of harvested lymph nodes in both groups were higher than the recommended number (12). Notably, no previous study has compared the specimen length and the nearest margin to the tumor.…”

“…An opening was made in the upper rectum, and a wound protector was inserted to protect and shorten the rectum. After specimen retrieval, the rectal opening was closed by suturing, and an air leak test was performed to confirm that there was no mechanically insufficient suture [ 12 ].…”

Cutting-Edge Strategies in Minimal Invasive Left Hemicolectomy for Tumors around the Splenic Flexure: Analyzing the Short-term Outcomes Between Transrectal Natural Orifice Specimen Extraction and Conventional Laparoscopy

“…In the conventional surgery group, where specimen extraction was performed through a minilaparotomic wound, the specimen was removed either through a midline wound for EA or a Pfannenstiel incision for IA. In contrast, for the NOSE group, specimen extraction was carried out transrectally (25).…”

Cutting-Edge Strategies in Minimal Invasive Surgery in Left Hemicolectomy: Analyzing the Outcomes Between Transrectal Natural Orifice Specimen Extraction and Conventional Laparoscopy

“…In the conventional surgery group, where specimen extraction was performed through a mini-laparotomic wound, the specimen was removed either through a midline wound for EA or a Pfannenstiel incision for IA. In contrast, for the NOSE group, specimen extraction was carried out transrectally (25).…”