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

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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.


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.


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.


This variation of NOSE surgery was safe and effective in our patient population.

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  1. 1.

    Law WL, Foo DCC (2017) Comparison of short-term and oncologic outcomes of robotic and laparoscopic resection for mid- and distal rectal cancer. Surg Endosc 31:2798–2807

  2. 2.

    Pedziwiatr M, Malczak P, Mizera M et al (2017) There is no difference in outcome between laparoscopic and open surgery for rectal cancer: a systematic review and meta-analysis on short- and long-term oncologic outcomes. Tech Coloproctol 21:595–604

  3. 3.

    Ihedioha U, Mackay G, Leung E et al (2008) Laparoscopic colorectal resection does not reduce incisional hernia rates when compared with open colorectal resection. Surg Endosc 22:689–692

  4. 4.

    Emmertsen KJ, Laurberg S (2012) Low anterior resection syndrome score: development and validation of a symptom-based scoring system for bowel dysfunction after low anterior resection for rectal cancer. Ann Surg 255:922–928

  5. 5.

    Heckert J, Sankineni A, Hughes WB et al (2016) Gastric electric stimulation for refractory gastroparesis: a prospective analysis of 151 patients at a single center. Dig Dis Sci 61:168–175

  6. 6.

    Heald RJ, Ryall RD (1986) Recurrence and survival after total mesorectal excision for rectal cancer. Lancet 1:1479–1482

  7. 7.

    Han FH, Hua LX, Zhao Z et al (2013) Transanal natural orifice specimen extraction for laparoscopic anterior resection in rectal cancer. World J Gastroenterol 19:7751–7757

  8. 8.

    Winslow ER, Fleshman JW, Birnbaum EH et al (2002) Wound complications of laparoscopic vs open colectomy. Surg Endosc 16:1420–1425

  9. 9.

    Guan X, Liu Z, Longo A et al (2019) International consensus on natural orifice specimen extraction surgery (NOSES) for colorectal cancer. Gastroenterol Rep (Oxf) 7:24–31

  10. 10.

    Zattoni D, Popeskou GS, Christoforidis D (2018) Left colon resection with transrectal specimen extraction: current status. Tech Coloproctol 22:411–423.

  11. 11.

    Karagul S, Kayaalp C, Sumer F, Ertugrul I, Kirmizi S, Tardu A, Yagci MA (2017) Success rate of natural orifice specimen extraction after laparoscopic colorectal resections. Tech Coloproctol 21:295–300.

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Author information

SKE: conceptualization; data curation; investigation; supervision; writing—original draft. IAT: conceptualization; data curation; formal analysis; investigation; methodology; supervision; validation; writing—original draft. VDK: data curation; investigation; writing—original draft; writing—review and editing. KY: figure curation, conceptualization. AP: conceptualization; data curation; formal analysis; investigation; methodology; supervision; writing—original draft; writing—review and editing. PVT: first surgeon performing all operation; conceptualization; data curation; investigation; methodology; supervision; validation; writing—original draft.

Correspondence to S. K. Efetov.

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All human studies have been reviewed by the appropriate ethics committee and have therefore been performed in accordance with the ethical standards laid down in an appropriate version of the 1965 Declaration of Helsinki.

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Efetov, S.K., Tulina, I.A., Kim, V.D. et al. Natural orifice specimen extraction (NOSE) surgery with rectal eversion and total extra-abdominal resection. Tech Coloproctol 23, 899–902 (2019).

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  • Natural orifice surgery
  • Rectal neoplasms
  • Robotic surgical procedures
  • Laparoscopic surgical procedures