Minimally invasive right colectomy with transrectal natural orifice extraction: could this be the next step forward?

Background The transvaginal natural orifice specimen extraction (NOSE) approach for right-side colon surgery has been proven to exhibit favorable short-term outcomes. However, thus far, no study has reported the advantages of transrectal NOSE for right-side colon surgery. The aim of this study was t...

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Published in:Techniques in coloproctology 2020-11, Vol.24 (11), p.1197-1205
Main Authors: Cheng, C.-C., Hsu, Y.-R., Chern, Y.-J., Tsai, W.-S., Hung, H.-Y., Liao, C.-K., Chiang, J.-M., Hsieh, P.-S., You, J.-F.
Format: Article
Language:English
Subjects:
Abdominal Surgery
Aged
Colectomy
Colon
Colorectal Surgery
Gastroenterology
Humans
Laparoscopy
Laparotomy
Length of Stay
Male
Medicine
Medicine & Public Health
Middle Aged
Multimedia
Multimedia Article
Natural Orifice Endoscopic Surgery
Pain
Proctology
Surgery
Surgical outcomes
Treatment Outcome
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Summary:Background The transvaginal natural orifice specimen extraction (NOSE) approach for right-side colon surgery has been proven to exhibit favorable short-term outcomes. However, thus far, no study has reported the advantages of transrectal NOSE for right-side colon surgery. The aim of this study was to compare the technical feasibility, safety, and short-term outcomes of minimally invasive right hemicolectomy using the transrectal NOSE method and those of conventional mini-laparotomy specimen extraction. Methods A study was conducted on consecutive patients who had minimally invasive right hemicolectomy either for malignancy or benign disease at Chang Gung Memorial Hospital, Linkou, Taiwan, between January 2017 and December 2018. The patients were divided into two groups: conventional surgery with specimen extraction using mini-laparotomy and NOSE surgery. Surgical outcomes, including complications, postoperative short-term recovery, and pain intensity, were analyzed. Results We enrolled 297 patients (151 males, mean age 64.9 ± 12.8 years) who had minimally invasive right hemicolectomy. Of these 297 patients, 272 patients had conventional surgery with specimen extraction through mini-laparotomy and 25 patients had NOSE surgery (23 transrectal, 2 transvaginal). The diagnosis of colon disease did not differ significantly between the conventional and NOSE groups. Postoperative morbidity and mortality rates were comparable. The postoperative hospital stay was significantly ( p  = 0.004) shorter in the NOSE group (median 5 days, range 3–17 days) than in the conventional group (median 7 days, range 3–45 days). Postoperative pain was significantly ( p  = 0.026 on postoperative day 1 and p  = 0.002 on postoperative day 2) greater in the conventional group than in the NOSE group. Conclusions NOSE was associated with acceptable short-term surgical outcomes that were comparable to those of conventional surgery. NOSE results in less postoperative wound pain and a shorter hospital stay than conventional surgery. Larger studies are needed
ISSN:1123-6337
1128-045X
DOI:10.1007/s10151-020-02282-x