Skip to main content

Advertisement

SpringerLink
Log in

Standardized laparoscopic NOSE-colectomy is feasible with low morbidity

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

An Erratum to this article was published on 10 January 2015

Abstract

Background

In laparoscopic colorectal surgery, extraction site laparotomy can be avoided by natural orifice specimen extraction (NOSE) resulting in less postoperative pain, shorter length of stay, and less morbidity such as wound complications. To date, short-term outcome of a large prospective cohort of patients has not been studied. The aim of this prospective cohort study was to assess short-term outcome of laparoscopic left-sided NOSE-colectomy.

Methods

Prospectively collected data of patients who had undergone elective laparoscopic NOSE-colectomy between July 2009 and December 2013 were analyzed retrospectively. Primary endpoint was short-term morbidity.

Results

A total of 110 patients were included in this study. Median age was 38 years (IQR: 32–56), median BMI was 23 kg/m2 (IQR: 21–25), and 88 % of the patients were female. Sixty-three patients (57 %) underwent resection for endometriosis, 29 patients (26 %) for diverticular disease, 16 patients (15 %) for a tumor, and 2 patients for other indications. Median operating time was 85 min (IQR: 70–100) and median length of the extracted specimen was 20 cm (IQR: 16–25). Overall, 14 patients had a postoperative complication (13 %), of which 9 were Clavien-Dindo grade 1 or 2 (8 %). Four patients (3.6 %) had an intraluminal bleeding from the anastomosis, which was treated endoscopically. There was 1 anastomotic leak (1 %), treated by emergency laparotomy and creation of a new colorectal anastomosis (grade 3b). The median hospital stay was 5 days (IQR: 4–6).

Conclusion

Laparoscopic NOSE-colectomy is safe and feasible with good short-term outcome. This study concerning a standardized operative technique is the first in literature reporting on a large group of patients.

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. Palanivelu C, Rangarajan M, Jategaonkar PA, Anand NV (2008) An innovative technique for colorectal specimen retrieval: a new era of “natural orifice specimen extraction” (N.O.S.E). Dis Colon Rectum 51:1120–1124

    Article  PubMed  Google Scholar 

  2. 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 tumors. World J Surg 37:2678–2682

    Article  PubMed  Google Scholar 

  3. Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213

    Article  PubMed Central  PubMed  Google Scholar 

  4. 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 26:1348–1355

    Article  CAS  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  6. Darzi A, Super P, Guillou PJ, Monson JR (1994) Laparoscopic sigmoid colectomy: total laparoscopic approach. Dis Colon Rectum 37:268–271

    Article  CAS  PubMed  Google Scholar 

  7. Franklin ME Jr, Ramos R, Rosenthal D, Schuessler W (1993) Laparoscopic colonic procedures. World J Surg 17:51–56

    Article  PubMed  Google Scholar 

  8. 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 98:1327–1334

    Article  CAS  PubMed  Google Scholar 

  9. Kehlet H, Wilmore DW (2008) Evidence-based surgical care and the evolution of fast-track surgery. Ann Surg 248:189–198

    Article  PubMed  Google Scholar 

  10. Spanjersberg WR, Reurings J, Keus F, van Laarhoven CJ (2011) Fast track surgery versus conventional recovery strategies for colorectal surgery. Cochrane Database Syst Rev. doi:10.1002/14651858.CD007635

    PubMed  Google Scholar 

  11. Vlug MS, Wind J, Hollmann MW, Ubbink DT, Cense HA, Engel AF, Gerhards MF, van Wagensveld BA, van der Zaag ES, van Geloven AA, Sprangers MA, Cuesta MA, Bemelman WA (2011) Laparoscopy in combination with fast track multimodal management is the best perioperative strategy in patients undergoing colonic surgery: a randomized clinical trial (LAFA-study). Ann Surg 254:868–875

    Article  PubMed  Google Scholar 

  12. Franklin ME Jr, Liang S, Russek K (2013) Natural orifice specimen extraction in laparoscopic colorectal surgery: transanal and transvaginal approaches. Tech Coloproctol 17:012–0938

    Article  Google Scholar 

  13. Wolthuis AM, Van Geluwe B, Fieuws S, Penninckx F, D’Hoore A (2012) Laparoscopic sigmoid resection with transrectal specimen extraction: a systematic review. Colorectal Dis 14:1183–1188

    Article  CAS  PubMed  Google Scholar 

  14. 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 23:2605–2609

    Article  PubMed  Google Scholar 

  15. 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 33:1287–1291

    Article  PubMed  Google Scholar 

  16. Christoforidis D, Clerc D, Demartines N (2013) Transrectal specimen extraction after laparoscopic left colectomy: a case-matched study. Colorectal Dis 15:347–353

    Article  CAS  PubMed  Google Scholar 

  17. 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 26:1495–1500

    Article  PubMed  Google Scholar 

  18. Fuchs KH, Breithaupt W, Varga G, Schulz T, Reinisch A, Josipovic N (2013) Transanal hybrid colon resection: from laparoscopy to NOTES. Surg Endosc 27:746–752

    Article  PubMed  Google Scholar 

  19. 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 27:518–524

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  21. 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 20:689–692

    Article  PubMed  Google Scholar 

Download references

Disclosures

Drs. A. Wolthuis, A. de Buck van Overstraeten, K. Boon, and A. D’Hoore, and Mr. S. Fieuws have no conflicts of interest and no financial ties to disclose.

Author information

Authors and Affiliations

  1. Department of Abdominal Surgery, University Hospital Gasthuisberg Leuven, Herestraat 49, 3000, Louvain, Belgium

    Albert M. Wolthuis, Anthony de Buck van Overstraeten, Katrien Boon & André D’Hoore

  2. Interuniversity Centre for Biostatistics and Statistical Bioinformatics, University Hospital Leuven, Louvain, Belgium

    Steffen Fieuws

Authors
  1. Albert M. Wolthuis
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Anthony de Buck van Overstraeten
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Steffen Fieuws
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Katrien Boon
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. André D’Hoore
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Albert M. Wolthuis.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Wolthuis, A.M., de Buck van Overstraeten, A., Fieuws, S. et al. Standardized laparoscopic NOSE-colectomy is feasible with low morbidity. Surg Endosc 29, 1167–1173 (2015). https://doi.org/10.1007/s00464-014-3784-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-014-3784-3

Keywords

Search

Navigation