Skip to main content

Advertisement

SpringerLink
Log in

Left colon resection with transrectal specimen extraction: current status

  • Review
  • Published:
Techniques in Coloproctology Aims and scope Submit manuscript

Abstract

Background

Full laparoscopic left colectomy with transrectal specimen extraction is proposed as an improvement of the minimally invasive surgical technique. This paper reviews in detail the current status of left-sided colectomy and upper rectum resection with transrectal specimen extraction.

Methods

A systematic review was performed of all types of publications on colorectal resection with natural orifice specimen extraction (NOSE). We only included studies reporting on left colectomy, sigmoidectomy, and high anterior resection with transrectal specimen extraction (TRSE), excluding transanal (TASE), transvaginal, or transcolonic specimen extraction. Surgical techniques, patient characteristics, and outcomes were reviewed in detail.

Results

Thirty-five papers reported on TRSE (2 randomized clinical trials, 7 case-matched series, 19 case series, 5 case reports, and 2 articles on surgical technique). We found a wide variety of innovative anastomotic and specimen extraction techniques. After excluding duplicates and papers reporting mixed TRSE and TASE results, outcomes in patients undergoing TRSE from 23 publications showed a conversion rate to conventional laparoscopy of 3.7% (21/559), overall morbidity 9.5% (53/559) [major in 2.9% (16/559), intra-abdominal infection in 2.1% (12/559)]. No mortality was reported. Postoperative anal incontinence was rarely reported. Several studies showed a decrease in postoperative pain and some in length of hospital stay.

Conclusions

Colectomy with TRSE is feasible and seems safe in selected patients. Reported outcomes seem in general similar to conventional laparoscopic colectomy with a possible benefit in postoperative pain and length of hospital stay. Obvious selection bias and lack of high quality trials do not allow firm conclusions to be drawn.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Cristaudi A, Matthey-Gié ML, Demartines N, Christoforidis D (2014) Prospective assessment of trocar-specific morbidity in laparoscopy. World J Surg 38(12):3089–3096

    Article  PubMed  Google Scholar 

  2. Franklin ME, Ramos R, Rosenthal D, Schuessler W (1993) Laparoscopic colonic procedures. World J Surg 17(1):51–6

    Article  PubMed  Google Scholar 

  3. Wolthuis AM, De Buck van Overstraeten A, D’Hoore A (2014) Laparoscopic natural orifice specimen extraction-colectomy: a systematic review. World J Gastroenterol 28(36):12981–12992

    Article  Google Scholar 

  4. Akladios C, Faller E, Afors K, Puga M, Albornoz J, Redondo C, Leroy J, Wattiez A (2014) Totally laparoscopic intracorporeal anastomosis with natural orifice specimen extraction (NOSE) techniques, particularly suitable for bowel endometriosis. J Minim Invasive Gynecol 21(6):1095–102

    Article  PubMed  Google Scholar 

  5. Boni L, Tenconi S, Beretta P, Cromi A, Dionigi G, Rovera F, Dionigi R, Ghezzi F (2007) Laparoscopic colorectal resections with transvaginal specimen extraction for severe endometriosis. Surg Oncol 16:S157–60

    Article  PubMed  Google Scholar 

  6. Breitenstein S, Dedes KJ, Bramkamp M, Hess T, Decurtins M, Clavien PA (2006) Synchronous laparoscopic sigmoid resection and hysterectomy with transvaginal specimen removal. J Laparoendosc Adv Surg Tech A 16(3):286–289

    Article  PubMed  Google Scholar 

  7. Fleisch MC, Hepp P, Kaleta T, Schulte Am Esch J, Rein D, Fehm T, Beyer I (2014) Feasibility and first long-term results after laparoscopic rectal segment resection and vaginal specimen retrieval for deep infiltrating endometriosis. Arch Gynecol Obstet 289(6):1241–1247

    Article  PubMed  CAS  Google Scholar 

  8. García Flórez LJ, Argüelles J, Quijada B, Alvarez V, Galarraga MA, Graña JL (2010) Transvaginal specimen extraction in a laparoscopic anterior resection of a sigmoid colon neoplasia with en bloc right salpingo-oophorectomy. Tech Coloproctol 14(2):161–163

    Article  PubMed  Google Scholar 

  9. Kim HJ, Choi GS, Park JS, Park SY, Ryuk JP, Yoon SH (2014) Transvaginal specimen extraction versus conventional minilaparotomy after laparoscopic anterior resection for colorectal cancer: mid-term results of a case-matched study. Surg Endosc 28(8):2342–2348

    Article  PubMed  Google Scholar 

  10. Nishimura A, Kawahara M, Honda K, Ootani T, Kakuta T, Kitami C, Makino S, Kawachi Y, Nikkuni K (2013) Totally laparoscopic anterior resection with transvaginal assistance and transvaginal specimen extraction: a technique for natural orifice surgery combined with reduced-port surgery. Surg Endosc 27(12):4734–4740

    Article  PubMed  PubMed Central  Google Scholar 

  11. Rausei S, Sambucci D, Spampatti S, Cassinotti E, Dionigi G, David G, Ghezzi F, Uccella S, Boni L (2015) Laparoscopic treatment of deep infiltrating endometriosis: results of the combined laparoscopic gynecologic and colorectal surgery. Surg Endosc 29(10):2904–2909

    Article  PubMed  Google Scholar 

  12. Stipa F, Giaccaglia V, Santini E, Tammaro L (2011) Totally double laparoscopic colon resection with intracorporeal anastomosis and transvaginal specimens extraction. Int J Colorectal Dis 26(6):815–816

    Article  PubMed  Google Scholar 

  13. Torres RA, Orban RD, Tocaimaza L, Vallejos Pereira G, Arévalo JR (2012) Transvaginal specimen extraction after laparoscopic colectomy. World J Surg 36(7):1699–702

    Article  PubMed  Google Scholar 

  14. Wang Z, Zhang XM, Zhou HT, Liang JW, Zhou ZX (2014) New technique of intracorporeal anastomosis and transvaginal specimen extraction for laparoscopic sigmoid colectomy. Asian Pac J Cancer Prev 15(16):6733–6736

    Article  PubMed  Google Scholar 

  15. Lamm SH, Andreas Zerz MD, Anastasios Efeoglou MD, Daniel MD, Steinemann C, MD (2015) Transrectal rigid-hybrid natural orifice translumenal endoscopic sigmoidectomy for diverticular disease: a prospective cohort study. J Am Coll Surg 221(4):789–97

    Article  PubMed  Google Scholar 

  16. Diana M, Perretta S, Wall J, Costantino FA, Leroy J, Demartines N, Marescaux J (2011) Transvaginal specimen extraction in colorectal surgery: current state of the art. Colorectal Dis 13(6):e104–11

    Article  PubMed  CAS  Google Scholar 

  17. Han FH, Hua LX, Zhao Z, Wu JH, Zhan WH (2013) Transanal natural orifice specimen extraction for laparoscopic anterior resection in rectal cancer. World J Gastroenterol 19(43):7751–7757

    Article  PubMed  PubMed Central  Google Scholar 

  18. Pai VD, Desouza A, De Menezes JL, Saklani AP (2015) Laparoscopic intersphincteric resection and hand-sewn coloanal anastomosis: a natural orifice specimen extraction technique. J Laparoendosc Adv Surg Tech A 25(5):396–400

    Article  PubMed  Google Scholar 

  19. Park JS, Choi GS, Kim HJ, Park SY, Jun SH (2011) Natural orifice specimen extraction versus conventional laparoscopically assisted right hemicolectomy. Br J Surg 98(5):710–715

    Article  PubMed  CAS  Google Scholar 

  20. Kayaalp C, Yagci MA (2015) Laparoscopic right colon resection with transvaginal extraction: a systematic review of 90 cases. Surg Laparosc Endosc Percutan Tech 25(5):384–91

    Article  PubMed  Google Scholar 

  21. Eshuis EJ, Voermans RP, Stokkers PC, van Berge Henegouwen MI, Fockens P, Bemelman WA (2010) Laparoscopic resection with transcolonic specimen extraction for ileocaecal Crohn’s disease. Br J Surg 97(4):569–74

    Article  PubMed  CAS  Google Scholar 

  22. Wolthuis AM, Fieuws S, Van Den Bosch A, de Buck van Overstraeten A, D’Hoore A (2015) Randomized clinical trial of laparoscopic colectomy with or without natural-orifice specimen extraction. Br J Surg 102(6):630–637

    Article  PubMed  CAS  Google Scholar 

  23. Leung AL, Cheung HY, Fok BK, Chung CC, Li MK, Tang CN (2013) Prospective randomized trial of hybrid NOTES colectomy versus conventional laparoscopic colectomy for left-sided colonic tomors. World J Surg 37(11):2678–2682

    Article  PubMed  Google Scholar 

  24. Christoforidis D, Clerc D, Demartines N (2013) Transrectal specimen extraction after laparoscopic left colectomy: a case-matched study. Colorectal Dis 15(3):347–53

    Article  PubMed  CAS  Google Scholar 

  25. Costantino FA, Diana M, Wall J, Leroy J, Mutter D, Marescaux J (2012) Prospective evaluation of peritoneal fluid contamination following transabdominal vs. transanal specimen extraction in laparoscopic left-sided colorectal resections. Surg Endosc 26(6):1495–500

    Article  PubMed  Google Scholar 

  26. Hisada M, Katsumata K, Ishizaki T, Enomoto M, Matsudo T, Kasuya K, Tsuchida A (2014) Complete laparoscopic resection of the rectum using natural orifice specimen extraction. World J Gastroenterol 20(44):16707–16713

    Article  PubMed  PubMed Central  Google Scholar 

  27. Wolthuis AM, Meuleman C, Tomassetti C, D’Hooghe T, Fieuws S, Penninckx F, D’Hoore A (2011) Laparoscopic sigmoid resection with transrectal specimen extraction: a novel technique for the treatment of bowel endometriosis. Hum Reprod 26(6):1348–1355

    Article  PubMed  CAS  Google Scholar 

  28. Zhang X, Zhou H, Liang J, Hou H, Hu J, Zhou Z (2014) Totally laparoscopic resection with natural orifice specimen extraction (NOSE) has more advantages comparing with laparoscopic-assisted resection for selected patients with sigmoid colon or rectal cancer. Int J Colorectal Dis 29(9):1119–1124

    Article  Google Scholar 

  29. Kim SJ, Choi BJ, Lee SC (2015) A novel single-port laparoscopic operation for colorectal cancer with transanal specimen extraction: a comparative study. BMC Surg 15:10

    Article  PubMed  PubMed Central  Google Scholar 

  30. Saurabh B, Chang SC, Ke TW, Huang YC, Kato T, Wang HM, Chen WTL, Fingerhut A (2017) Natural Orifice Specimen Extraction with single stapling colorectal anastomosis for laparoscopic anterior resection: feasibility, outcomes, and technical consideration. Dis Colon Rectum 60:43–50

    Article  PubMed  Google Scholar 

  31. Akamatsu H, Omori T, Oyama T, Tori M, Ueshima S, Nakahara M, Abe T, Nishida T (2009) Totally laparoscopic sigmoid colectomy: a simple and safe technique for intracorporeal anastomosis. Surg Endosc 23(11):2605–2609

    Article  PubMed  Google Scholar 

  32. Cheung HY, Leung AL, Chung CC, Ng DC, Li MK (2009) Endo-laparoscopic colectomy without mini-laparotomy for left-sided colonic tumors. World J Surg 33(6):1287–1291

    Article  PubMed  Google Scholar 

  33. Hara M, Takayama S, Sato M, Imafuji H, Takahashi H, Takeyama H (2011) Laparoscopic anterior resection for colorectal cancer without minilaparotomy using transanal bowel reversing retrieval. Surg Laparosc Endosc Percutan Tech 21(5):235–238

    Article  Google Scholar 

  34. Leroy J, Costantino F, Cahill RA, D’Agostino J, Morales A, Mutter D, Marescaux J (2011) Laparoscopic resection with transanal specimen extraction for sigmoid diverticulitis. Br J Surg 98(9):1327–1334

    Article  PubMed  CAS  Google Scholar 

  35. Nishimura A, Kawahara M, Suda K, Makino S, Kawachi Y, Nikkuni K (2011) Totally laparoscopic sigmoid colectomy with transanal specimen extraction. Surg Endosc 25(10):3459–3463

    Article  PubMed  Google Scholar 

  36. Saad S, Hosogi H (2011) Laparoscopic left colectomy combined with natural orifice access: operative technique and initial results. Surg Endosc 25(8):2742–2747

    Article  PubMed  Google Scholar 

  37. Saad S, Hosogi H (2010) Natural orifice specimen extraction for avoiding laparotomy in laparoscopic left colon resections: a new approach using the McCartney tube and the tilt top anvil technique. J Laparoendosc Adv Surg Tech A 20(8):689–92

    Article  PubMed  Google Scholar 

  38. Wolthuis AM, de Buck van Overstraeten A, Fieuws S, Boon K, D’Hoore A (2015) Standardized laparoscopic NOSE-colectomy is feasible with low morbidity. Surg Endosc 29(5):1167–1173

    Article  PubMed  Google Scholar 

  39. Wolthuis AM, Penninckx F, D’Hoore A (2011) Laparoscopic sigmoid resection with transrectal specimen extraction has a good short-term outcome. Surg Endosc 25(6):2034–2038

    Article  PubMed  Google Scholar 

  40. Wolthuis AM, De B Van Overstraeten, D’Hoore A A (2015) Laparoscopic NOSE colectomy with a camera sleeve: a technique in evolution. Colorectal Dis 17(5):O123–5

    Article  PubMed  CAS  Google Scholar 

  41. Zhang X, Zhou H, Hou H, Hu J, Wang H, Zhou Z (2014) Totally laparoscopic resection with natural orifice specimen extraction for carcinoma of sigmoid colon and rectum: a feasible and innovative technique. J Clin Gastroenterol 48(7):e57–61

    Article  PubMed  Google Scholar 

  42. Zhang XM, Wang Z, Hou HR, Zhou ZX (2015) A new technique of totally laparoscopic resection with natural orifice specimen extraction (NOSE) for large rectal adenoma. Tech Coloproctol 19(6):355–60

    Article  PubMed  Google Scholar 

  43. Huang CC, Chen YC, Huang CJ, Hsieh JS (2016) Totally laparoscopic colectomy with intracorporeal side-to-end colorectal anastomosis and transrectal specimen extraction for sigmoid and rectal cancers. Ann Surg Oncol 23(4):1164–1168

    Article  PubMed  Google Scholar 

  44. Cai JC, Hong XY (2016) Laparoscopic-assisted natural orifice specimen extraction radical descending colectomy using a Cai tube. World J Surg 40:2803–2807

    Article  PubMed  Google Scholar 

  45. 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(4):295–300

    Article  PubMed  CAS  Google Scholar 

  46. Fuchs KH, Breithaupt W, Varga G, Schulz T, Reinisch A, Josipovic N (2013) Transanal hybrid colon resection: from laparoscopy to NOTES. Surg Endosc 27(3):746–52

    Article  PubMed  Google Scholar 

  47. Han Y, He YG, Zhang HB, Lv KZ, Zhang YJ, Lin MB, Yin L (2013) Total laparoscopic sigmoid and rectal surgery in combination with transanal endoscopic microsurgery: a preliminary evaluation in China. Surg Endosc 27(2):518–24

    Article  PubMed  Google Scholar 

  48. Shimizu H, Adachi K, Ohtsuka H, Osaka I, Takuma K, Takanishi K, Matsumoto J (2017) Totally laparoscopic resection for low sigmoid and rectal cancer using natural orifice specimen extraction techniques. Surg Laparosc Endosc Percutan Tech 27(4):e74–e79

    Article  PubMed  Google Scholar 

  49. Knol J, D’Hondt M, Dozois EJ, Vanden Boer J, Malisse P (2009) Laparoscopic-assisted sigmoidectomy with transanal specimen extraction: a bridge to NOTES? Tech Coloproctol 13(1):65–8

    Article  PubMed  CAS  Google Scholar 

  50. Leroy J, Diana M, Wall J, Costantino F, D’Agostino J, Marescaux J (2011) Laparo-endoscopic single-site (LESS) with transanal natural orifice specimen extraction (NOSE) sigmoidectomy: a new step before pure colorectal natural orifices transluminal endoscopic surgery (NOTES®). J Gastrointest Surg 15(8):1488–1492

    Article  PubMed  Google Scholar 

  51. Leroy J, Costantino F, Cahill RA, Donnatelli GF, Kawai M, Wu HS, Marescaux J (2010) Fully laparoscopic colorectal anastomosis involving percutaneous endoluminal colonic anvil control (PECAC). Surg Innov 17(2):79–84

    Article  PubMed  Google Scholar 

  52. Ooi BS, Quah HM, Fu CW, Eu KW (2009) Laparoscopic high anterior resection with natural orifice specimen extraction (NOSE) for early rectal cancer. Tech Coloproctol 13(1):61–4

    Article  PubMed  CAS  Google Scholar 

  53. Takayama S, Takahashi H, Takeyama H (2011) Pure laparoscopic sigmoidectomy. Surg Laparosc Endosc Percutan Tech 21(2):104–106

    Article  Google Scholar 

  54. Darzi A, Super P, Guillou PJ, Monson JR (1994) Laparoscopic sigmoid colectomy: total laparoscopic approach. Dis Colon Rectum 37(3):268–71

    Article  PubMed  CAS  Google Scholar 

  55. Makris KI, Rieder E, Kastenmeier AS, Swanström LL (2012) Transanal specimen retrieval using the transanal endoscopic microsurgery (TEM) system in minimally invasive colon resection. Surg Endosc 26(4):1161–1162

    Article  PubMed  Google Scholar 

  56. Steinemann DC, Zerz A, Germann S, Lamm SH (2016) Anorectal function and quality of life after transrectal rigid-hybrid natural orifice translumenal endoscopic sigmoidectomy. J Am Coll Surg 223(2):299–307

    Article  PubMed  Google Scholar 

  57. Winter DC, Murphy A, Kell MR, Shields CJ, Redmond HP, Kirwan WO (2004) Perioperative topical nitrate and sphincter function in patients undergoing transanal stapled anastomosis: a randomized, placebo-controlled, double-blinded trial. Dis Colon Rectum 47(5):697–703

    Article  PubMed  CAS  Google Scholar 

  58. Ho YH, Tan M, Leong A, Eu KW, Nyam D, Seow-Choen F (1999) Anal pressures impaired by stapler insertion during colorectal anastomosis: a randomized, controlled trial. Dis Colon Rectum 42(1):89–95

    Article  PubMed  CAS  Google Scholar 

  59. Allaix ME, Rebecchi F, Giaccone C, Mistrangelo M, Morino M (2011) Long-term functional results and quality of life after transanal endoscopic microsurgery. Br J Surg 98(11):1635–1643

    Article  PubMed  CAS  Google Scholar 

Download references

Funding

None.

Author information

Authors and Affiliations

  1. Department of General Surgery, Ospedale per gli Infermi di Faenza, 48018, Faenza, Italy

    D. Zattoni

  2. Department of General Surgery, Queen Elisabeth University Hospital, Birmingham, UK

    G. S. Popeskou

  3. Department of General Surgery, Ospedale Civico di Lugano, 6900, Lugano, Switzerland

    D. Christoforidis

Authors
  1. D. Zattoni
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. G. S. Popeskou
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. D. Christoforidis
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

DC designed the research; DZ performed the research; DZ, SGP, and DC analyzed the data; DZ, SGP, and DC wrote the paper.

Corresponding author

Correspondence to D. Zattoni.

Ethics declarations

Conflict of interest

All authors, Drs. Davide Zattoni, Georgios Sotirios Popeskou, and Dimitri Christoforidis declare no conflicting interests, including commercial, personal, political, intellectual or religious interests or financial ties to disclose.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

For this type of study formal consent is not required.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Zattoni, D., Popeskou, G.S. & Christoforidis, D. Left colon resection with transrectal specimen extraction: current status. Tech Coloproctol 22, 411–423 (2018). https://doi.org/10.1007/s10151-018-1806-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10151-018-1806-1

Keywords

Search

Navigation