A Review of the Role of Natural Orifice Specimen Extraction Surgery in Laparoscopic Colorectal Surgery

Document Type : Review Article

Authors

1 Gastroenterology Department -, Hospital das Clinicas; University of Sao Paulo Medical School , Brazil

2 Post-Doctoral Research Fellow of Colorectal Surgery at AdventHealth Central Florida, Sanford, Florida

3 Private office

4 Unicamp Department of Surgery San Francisco University

10.30476/acrr.2024.101615.1204

Abstract

Context: The inclusion of minimally invasive techniques to colorectal surgery brought many advantages to patient’s recovery. However, conventional techniques for laparoscopic-assisted colectomy (LAC) still require a small abdominal incision for specimen extraction. Evidence acquisition: The present manuscript aimed to review the technical details, results and advantages of colorectal resections using different approaches to extract the resected specimen, including the abdominal wall, the vagina or the rectum. In order to analyse this data, we searched the literature for recent and important results concerning the use of different approaches to extract the specimen in minimally invasive colorectal procedures. Results: Besides the proved feasibility and safety associated with the Natural Orifice Specimen Extraction Surgery (NOSES) in colorectal surgery, there remain some unresolved issues to be unified and standardized. These issues are mainly represented by surgical technique and indications. Morbidity is not a common problem, although potentially there may be complications to affect quality of life. Conclusions: So far, the most important indication remains the management of intestinal endometriosis, as it is not a malignant disease and the specimen is not too large. Nevertheless, surgical experience and appropriate counselling are fundamental requirements when dealing with cancer patients. Eventual complications should be discussed with patients

Keywords

References

  1. Kaiser AM. Evolution and future
    of laparoscopic colorectal surgery.
    World J Gastroenterol. 2014 Nov
    7;20(41):15119-24. doi: 10.3748/wjg.
    v20.i41.15119.
    2. Izquierdo KM, Unal E, Marks JH.
    Natural orifice specimen extraction
    in colorectal surgery: patient
    selection and perspectives. Clin Exp
    Gastroenterol 2018; 11:265-279. doi:
    10.2147/CEG.S135331.eCollection
    2018.
    3. Brown SR, Goodfellow PB. Transverse
    verses midline incisions for abdominal
    surgery. Cochrane Database Syst Rev.
    2005 Oct 19;2005(4):CD005199.
    doi: 10.1002/14651858.CD005199.
    pub2. PMID: 16235395. PMCID:
    PMC8866010
    4. Gundogan E, Kayaalp C, Alınak
    Gundogan G, Sumer F. Total 102
    natural orifice specimen extraction
    following laparoscopic colorectal
    resections.The Updates Surg. 2023
    Jan;75(1):197-203. doi: 10.1007/
    s13304-022-01412-4. Epub 2022 Nov
    1.PMID: 36319790 Clinical Trial.
    5. Grüter AAJ, Toorenvliet BR,
    Belgers EHJ, Betl EJT et al. Right
    collaborators group. Nationwide
    standardization of minimally invasive
    right hemicolectomy for colon cancer
    and development and validation of a
    video-based competency assessment
    tool (the Right study). Br J Surg 2024
    Jan 3;111(1):znad404. doi: 10.1093/
    bjs/znad404.
    6. Greemland I, Raveh G, Gavrielli
    S, Sadot E, Kashtan H, Wasserberg N. High
    Rates of Incisional Hernia After
    Laparoscopic Right Colectomy
    With Midline Extraction Site. Surg
    Laparosc Endosc Percutan Tech 2021
    Jul 28;31(6):722-728. doi: 10.1097/
    SLE.0000000000000977.
    7. Al Dhaheri M, Ibrahim M, Al-Yahri
    O, Amer I et al. Choice of specimen’s
    extraction site affects wound
    morbidity in laparoscopic colorectal
    cancer surgery. Langenbecks Arch
    Surg. 2022 Dec;407(8):3561-3565. doi:
    10.1007/s00423-022-02701-7.Epub
    2022 Oct 11.
    8. Benlice C, Stocchi L,Sapci I, Gorgun
    E, Kessler H, Liska D, Steele SR.
    Delaney CR. Impact of the extractionsite
    location on wound infections after
    laparoscopic colorectal resection. Am
    J Surg. 2019 Mar;217(3):502-506.Doi:
    10.1016/j.amjsurg.2018.10.034.
    9. Campos FG. Complications and
    conversions in laparoscopic colorectal
    surgery. Results of a multicenter
    Brazilian Trial. Surg Laparosc Endosc
    Percutan Tech 2003; 13 (3) 173-179.
    10. Campos FG. Cirurgia laparoscópica
    assistida com a mão. Indicações
    e Resultados preliminares em
    procedimentos colo-retais. Rev Bras
    Coloproct. (JCOL) 2005;25(1):94-101.
    11. Choi HB, Chung D, Kim JS, Lee
    TH, Baek SJ, Kwak JM, Kim J, Kim
    SH. Midline incision vs. transverse
    incision for specimen extraction
    is not a significant risk factor for
    developing incisional hernia after
    minimally invasive colorectal
    surgery: multivariable analysis of a
    large cohort from a single tertiary
    center in Korea. Surg Endosc
    2022;36(2):1199-1205. doi: 10.1007/
    s00464-021-08388-z.
    12. Lee L, Abou-Khalil M, Liberman
    S, Boutros M, Fried GM, Feldman
    LS. Incidence of incisional hernia
    in the specimen extraction site for
    laparoscopic colorectal surgery:
    systematic review and meta-analysis.
    Endosc 2017 Dec;31(12):5083-5093.
    DOI: 10.1007/s00464-017-5573-2
    13. Remzi FH, Kirat HT, Kaouk JH,
    Geisler DP. Single-port laparoscopy
    in colorectal surgery. Colorectal Dis
    2008;10(08):823–826
    14. Clark M, Nann S, Kong J, Barker
    T. Effectiveness of NOTES versus
    traditional techniques on surgical
    outcomes in adults with diverticulitis:
    a systematic review protocol. JBI Evid
    Synth. 2023 Nov 9. doi: 10.11124/
    JBIES-23-00324.
    15. Seow-En I, Khor SN, Koo CH,
    Wee IJY, Tan EK. Transvaginal
    Natural Orifice Specimen Extraction
    (NOSE) in LaparoscopicColorectal
    Cancer Surgery With New Insights
    on Technique and Patient Selection.
    Surg Laparosc Endosc Percutan
    Tech. 2023 Oct 1;33(5):571-575. doi:
    10.1097/SLE.0000000000001208.
    PMID: 37523505
    16. Stewart EA, Liau AS, Friedman AJ.
    Operative laparoscopy followed by
    colpotomy for resecting a colonic
    leiomyosarcoma: a case report. J
    Reprod Med 1991;36:883–4.
    17. Franklin ME, Ramos R, Rosenthal D
    et al. Laparoscopic colonic procedures.
    World J Surg 1993;17:51–6.
    18. Guan X, Sheng L, Longo A, Cai
    JC, Chen W, Chen LC, Chun HK,
    Pereira JMC et al. International
    consensus on natural orifice specimen
    extraction surgery (NOSES) for
    colorectal cancer. Gastroenterology
    Report 2019; 7 (1): 24–31. https://doi.
    org/10.1093/gastro/goy055
    19. Zheng W, Zhang M, Hu X, Tan W,
    Liu S, Ren J. Influence of transvaginal
    laparoscopic surgery on sexual
    function, life quality and short-term
    efficacy of patients diagnosed with
    colorectal cancer. Am J Transl Res
    2022 Jul 15;14(7):5098-5106.
    20. Diana M, Perretta S, Wall J, Costantino
    FA, Leroy J, Demartines N, Marescaux
    J. Transvaginal specimen extraction
    in colorectal surgery: current state
    of the art. Colorectal Dis 2011
    Jun;13(6):e104-11. doi: 10.1111/j.1463-
    1318.2011.02599.x.PMID: 21564461.
    21. Zhang M, Liu Z, Wang X. Is natural
    orifice specimen extraction surgery
    the future direction of minimally
    invasive colorectal surgery? Review
    article. Surgery Open Science 2022;
    10: 106–110.
    22. Abrao MS, Sagae UE, Gonzales M,
    Podgaec S, Dias Jr JA. Treatment
    of rectosigmoid endometriosis by
    laparoscopically assisted vaginal
    rectosigmoidectomy. Int J Gynecol
    Obst 2005; 91: 27-31.
    23. Si Yu , Yong Ji , Tedong Luo ,
    Pengjie Xu, Zuojun Zhen, Jianzhong
    Deng. A modified technique of
    transanal specimen extraction in the
    laparoscopic anterior rectal resection
    for upper rectal or lower sigmoid
    colon cancer: a retrospective study.
    BMC Surg. 2021 Feb 12;21(1):82. doi:
    10.1186/s12893-021-01085-7.
    24. Cheng CC, Hsu Y-R, Chern YJ, Tsai
    WS, Hung HY, Liao CK, Chiang JM,
    Hsieh PS, You JF. Minimally invasive
    right colectomy with transrectal
    natural orifice extraction: could
    this be the next step forward? Tech
    Coloproctol 2020 Nov;24(11):1197-
    1205. doi: 10.1007/s10151-020-
    02282-x.Epub 2020 Jul 6.
    25. Wang P, Liang JW, Zhou HT, Wang
    Z, Zhou ZX. Surgical specimen
    extraction via a prophylactic
    ileostomy procedure: A minimally
    invasive technique for laparoscopic
    rectal cancer surgery. World J
    Gastroenterol 2018 Jan 7;24(1):104-
    111. doi: 10.3748/wjg.v24.i1.104.
    26. Lee KY, Park JW, Lee KY, Cho S,
    Kwon YH, Kim MJ, Ryoo SB, Jeong
    SY, Park KJ. Safety of temporary
    ileostomy via specimen extraction
    site in rectal cancer patients who
    underwent laparoscopic low anterior
    resection. Sci Rep. 2019 Feb
    19;9(1):2316. doi: 10.1038/s41598-
    019-38790-6.PMID: 30783181
    27. Campos FG, Real Martinez
    CA, Monteiro de Camargo MG,
    Cesconetto DM, Nahas SC,
    Cecconello I. Laparoscopic Versus
    Open Restorative Proctocolectomy
    for Familial Adenomatous Polyposis.J
    Laparoendosc Adv Surg Tech A.2018 Jan;28(1):47-52. doi: 10.1089/
    lap.2017.0397.
    28. Zhao Z, Chen Q, Zheng H, Jianjun
    Li, Zheng S, Zhao E. Retrospective
    Study of Natural Orifice Specimen
    Extraction Surgery in Resection
    of Sigmoid and Rectal Tumors.
    Laparoendosc Adv Surg Tech A
    2021; 31(11):1227-1231. doi: 10.1089/
    lap.2020.0780.Epub 2020 Nov 9.
    PMID: 33164666 DOI: 10.1089/
    lap.2020.0780.
    29. Guan X, Lu Z, Wang S, Liu E et al.
    Comparative short- and long-term
    outcomes of three techniques of
    natural orifice specimen extraction
    surgery for rectal cancer. Eur J Surg
    Oncol 2020; 46(10 Pt B):e55-e61. DOI:
    10.1016/j.ejso.2020.06.023.
    30. Chen MZ, Cartmill J, Gilmore A.
    Natural orifice specimen extraction
    for colorectal surgery: Early adoption
    in a Western population Colorectal
    Dis 2021; 23(4):937-943. DOI: 10.1111/
    codi.15455.
    31. Park JS, Kang H, Park SY et al.
    Long-term outcomes after Natural
    Orifice Specimen Extraction versus
    conventional laparoscopy-assisted
    surgery for rectal cancer: a matched
    case-control study. Ann Surg Treat
    Res 2018; 94:26–35.
    32. Fu CG, Zhou ZQ, Huang B. Low
    Anterior Resection with Transanal
    Specimen Extraction Using Rectal
    Eversion Technique. Publish ahead of
    Print Dis Colon Rectum, 2022. DOI:
    10.1097/DCR.0000000000002497
    33. Franklin Jr ME , Liang S, Russek K. Natural
    orifice specimen extraction in
    laparoscopic colorectal surgery:
    transanal and transvaginal approaches.
    Tech Coloproctol 2013; 7 (1): S63-7.
    DOI: 10.1007/s10151-012-0938-y
    34. Wolthuis AM, Fieuws S, Van Den
    Bosch A et al. Randomized clinical
    trial of laparoscopic colectomy with
    or without natural-orifice specimen
    extraction. Br J Surg 2015; 102:630–7.
    35. Leung AL, Cheung HY, Fok BK et
    al. Prospective randomized trial of
    hybrid NOTES colectomy versus
    conventional laparoscopic colectomy
    for left-sided colonic tumors. World J
    Surg 2013; 37:2678–82.
    36. Ma B, Huang XZ, Gao P et al.
    Laparoscopic resection with natural
    orifice specimen extraction versus
    conventional laparoscopy for
    colorectal disease: a meta-analysis.
    Int J Colorectal Dis 2015; 30:1479–88.
    37. Palanivelu C, Rangarajan M,
    Jategaonkar PA, Anand NV. An
    innovative technique for colorectal
    specimen retrieval: a new era of
    “natural orifice specimen extraction”
    (N.O.S.E). Dis Colon Rectum
    2008;51(07):1120–1124.

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