Natural orifice specimen extraction (NOSE) surgery with rectal eversion and total extra-abdominal resection

• Published in: Techniques in coloproctology Vol. 23; no. 9; pp. 899 - 902
• Main Authors: Efetov, S. K., Tulina, I. A., Kim, V. D., Kitsenko, Y., Picciariello, A., Tsarkov, P. V.
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01-09-2019; Springer Nature B.V
• Subjects: Abdomen - surgery; Abdominal Surgery; Adult; Colorectal cancer; Colorectal Surgery; Female; Gastroenterology; Humans; Laparoscopy; Laparoscopy - adverse effects; Laparoscopy - methods; Lymph Node Excision - adverse effects; Lymph Node Excision - methods; Medicine; Medicine & Public Health; Middle Aged; Multimedia Article; Natural Orifice Endoscopic Surgery - adverse effects; Natural Orifice Endoscopic Surgery - methods; Ostomy; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Proctology; Rectal Diseases - epidemiology; Rectal Diseases - etiology; Rectal Neoplasms - surgery; Rectum - surgery; Robotic Surgical Procedures - adverse effects; Robotic Surgical Procedures - methods; Surgery; Surgical Stomas - statistics & numerical data; Syndrome; Treatment Outcome; Laparoscopic surgical procedures; Natural orifice surgery; Rectal neoplasms; Robotic surgical procedures
• ISSN: 1123-6337; 1128-045X
• DOI: 10.1007/s10151-019-02058-y

Background
Natural orifice specimen extraction (NOSE)surgery is gaining popularity among colorectal surgeons. The technical aspects of this new procedure are still debated and many variations have been presented in the last decade.
Methods
We propose a new variation of transanal NOSE after robotic and laparoscopic LAR consisting of rectal eversion by using a special rod after laparoscopic TME. Eversion makes it possible to perform resection and placement of the anvil extracorporeally. We included a video demonstration of the technique. Clinical Patient Grading Assessment Scale was calculated 1 month after stoma closure and the Low Anterior Resection Syndrome (LARS )score was calculated preoperatively and 1 month after stoma closure.
Results
Seven female patients with rectal cancer, all with normal BMI, underwent laparoscopic (
n
 = 5) or robotic (
n
 = 2) TME with rectal eversion. No intraoperative and postoperative complications were reported. One month after stoma closure, the median Clinical Patient Grading Assessment Scale was 5 (range 3–7), which means “a good deal better”. The median LARS score was 14 (IQR 14–19,5) preoperatively and 19 (IQR 19–21,5) 1 month after stoma closure.
Conclusions
This variation of NOSE surgery was safe and effective in our patient population.