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

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Abstract

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.

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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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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

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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Informed consent was obtained from all individual participants included in the study.

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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). https://doi.org/10.1007/s10151-019-02058-y

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Keywords

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