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Driouch J, Thaher O, Brinkmann S, Bausch D, Glatz T. Robotic-assisted rectosigmoid resection rectopexy with natural orifice specimen extraction (NOSE): technical notes, short-term results, and functional outcome. Langenbecks Arch Surg 2023; 408:177. [PMID: 37140719 DOI: 10.1007/s00423-023-02918-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 04/28/2023] [Indexed: 05/05/2023]
Abstract
PURPOSE Rectosigmoid resection rectopexy has been established as an effective therapy for obstructive defecation syndrome. The addition of the NOSE-technique provides an even less invasive approach avoiding minilaparotomy, but can be technically challenging. Application of a robotic platform has been proposed to facilitate the specimen extraction and fashioning of the intracorporeal anastomosis and has been proven to be effective in left-sided colectomies. METHODS After establishing laparoscopic rectosigmoid-resection-rectopexy with NOSE, we modified our technique by addition of the robotic platform. Whenever robotic capacity was available, elective patients scheduled for rectosigmoid resection rectopexy for obstructive defecation syndrome were operated robotically assisted. Demographic and intraoperative data were prospectively collected. Follow up was assessed using the Wexner constipation score, Wexner incontinence score, and Altomare ODS score. RESULTS The NOSE-RRR technique was completed in all 31 patients. The mean operative time was 166 min (range 67-230). No conversion was required. The median hospital stay was 5 days (range 3-28). Four patients had minor complications (Clavien I). Two patients were reoperated (Clavien IIIb). Functional scores improved significantly postoperatively. Mean Wexner incontinence score was 7.1 preoperatively, 6.9 after 1 month, and decreased significantly to 3.93 after 3 months (p < 0.001). Mean Altomare ODS score was 17.47 preoperatively and 6.93/5.03 after 1/3 months (p < 0.001). Wexner constipation score (12.83) also showed a significant improvement after 1/3 months (6.97/6.67; p < 0.001). CONCLUSION NOSE-RRR can be performed safely with a low rate of manageable complications. The technique provides a significant improvement for ODS-Symptoms.
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Affiliation(s)
- Jamal Driouch
- Department of Surgery, Marien Hospital Herne, Ruhr University of Bochum, Hölkeskampring 40, 44625, Herne, Germany
- Department of Surgery, St. Elisabeth Hospital, Iserlohn, Germany
| | - Omar Thaher
- Department of Surgery, Marien Hospital Herne, Ruhr University of Bochum, Hölkeskampring 40, 44625, Herne, Germany
| | - Sebastian Brinkmann
- Department of Surgery, Marien Hospital Herne, Ruhr University of Bochum, Hölkeskampring 40, 44625, Herne, Germany
| | - Dirk Bausch
- Department of Surgery, Marien Hospital Herne, Ruhr University of Bochum, Hölkeskampring 40, 44625, Herne, Germany
| | - Torben Glatz
- Department of Surgery, Marien Hospital Herne, Ruhr University of Bochum, Hölkeskampring 40, 44625, Herne, Germany.
- Department of Surgery, Südharzklinikum Nordhausen, Nordhausen, Germany.
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Ke Z, Zijian D, Hai H, Jin Y, Yuanyi R, Bo Y, Yangchun Z. The feasibility, safety and short-term clinical efficacy of laparoscopic anterior resection of rectal cancer with left colonic artery (LCA) preservation and natural orifice specimen extraction (NOSE). BMC Surg 2022; 22:308. [PMID: 35948902 PMCID: PMC9364571 DOI: 10.1186/s12893-022-01719-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 07/03/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Natural orifice specimen extraction surgery (NOSES) has the advantages of less postoperative pain, fast bowel function recovery, reduced hospital stay and better cosmetic effects. In our centre, anterior resection of rectal cancer with preservation of the left colonic artery (LCA) was performed using NOSES. The feasibility, safety and short-term clinical efficacy of the technique were discussed. METHODS A retrospective analysis was performed on 19 patients who underwent laparoscopic anterior resection of rectal cancer with left colonic artery preservation and natural orifice specimen extraction in the Gastrointestinal Surgery Center of Sichuan Cancer Hospital from September 2018 to December 2019. General information about the patients, perioperative data and short-term postoperative results were analysed. RESULTS All operations were completed smoothly, with an average operation duration of 304.36 ± 45.04 min, intraoperative bleeding of 76.31 ± 61.12 ml, first time off bed of 14.42 ± 3.56 h, first time to anus exhaust of 15.26 ± 8.92 h, first time to liquid diet of 2.94 ± 1.12 days, and average postoperative stay of 10.21 ± 3.13 days. Two patients developed temporary intestinal obstruction, and one patient developed pulmonary infection. All of them recovered well after active supportive treatment and were successfully discharged. CONCLUSION Laparoscopic NOSES for rectal cancer with left colon artery preservation is safe and feasible, with satisfactory short-term results, and is worthy of further clinical investigation.
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Affiliation(s)
- Zhang Ke
- Department of Gastrointestinal Surgery, Sichuan Cancer Hospital, Chengdu, 610041, China
| | - Deng Zijian
- Department of Gastrointestinal Surgery, Sichuan Cancer Hospital, Chengdu, 610041, China
| | - Hu Hai
- Department of Gastrointestinal Surgery, Sichuan Cancer Hospital, Chengdu, 610041, China
| | - Yan Jin
- Department of Gastrointestinal Surgery, Sichuan Cancer Hospital, Chengdu, 610041, China
| | - Rui Yuanyi
- Department of Gastrointestinal Surgery, Sichuan Cancer Hospital, Chengdu, 610041, China
| | - Yi Bo
- Department of Gastrointestinal Surgery, Sichuan Cancer Hospital, Chengdu, 610041, China
| | - Zheng Yangchun
- Department of Gastrointestinal Surgery, Sichuan Cancer Hospital, Chengdu, 610041, China.
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Kirmizi S, Kayaalp C, Karagul S, Tardu A, Ertugrul I, Sumer F. Comparison of stapled versus stapleless sleeve gastrectomy with natural orifice specimen extraction (NOSE). Niger J Clin Pract 2021; 24:1689-1693. [PMID: 34782510 DOI: 10.4103/njcp.njcp_388_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background Sleeve gastrectomy is a stapler dependent bariatric procedure. A stapleless sleeve gastrectomy can be necessary for certain circumstances. Aims Here, we aimed to show whether laparoscopic stapleless sleeve gastrectomy with natural orifice specimen extraction (NOSE) can be an alternative procedure to stapled sleeve gastrectomy. Patients and Methods In the stapleless group (n = 6), no staplers were used and after vertical resection of the stomach by energy devices, the stomach remnant was closed by two rows of intracorporeal sutures. The resected specimen was removed through the mouth using an endoscopic snare. In the stapler group (n = 7), sleeve gastrectomy was carried out with linear stapler under the guidance of 36 Fr bougie. The specimens were extracted from the left upper quadrant trocar site. Results A total of 13 patients were compared (stapleless = 6 and stapled group = 7). All the sleeve gastrectomies were completed laparoscopically. The operative time was longer at 200 minutes (range 120-300) versus 120 minutes, (range 90-200) p = 0.07) and the amount of bleeding was higher at 100 ml (range 50-200) versus 30 ml (range 10-50) (p = 0.004) in the stapleless group. Leakage and gastrointestinal bleeding were seen in the stapleless group but no complications were found in the stapler group. No statistically significant difference was found between the metabolic outcomes of the two groups after the operation (p > 0.05). Decrease in BMI at similar rates was observed in 5 postoperative year (stapleless group: 35 kg/m2 (range 31-39) versus stapled group: 36.5 kg/m2 (range 31-39), p > 0.05). Conclusion Laparoscopic stapleless sleeve gastrectomy with natural orifice specimen extraction has longer procedure time, more blood loss and complications.
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Affiliation(s)
- Serdar Kirmizi
- Department of Surgery, Yozgat City Hospital, Yozgat, Turkey
| | - Cuneyt Kayaalp
- Department of Gastrointestinal Surgery, Inonu University, Malatya, Turkey
| | - Servet Karagul
- Department of Surgery, Samsun Training and Research Hospital, Samsun, Turkey
| | - Ali Tardu
- Department of Gastrointestinal Surgery, Inonu University, Malatya, Turkey
| | - Ismail Ertugrul
- Department of Surgery, Istanbul Kartal Dr. Lutfi Kirdar Education andResearch Hospital, Istanbul, Turkey
| | - Fatih Sumer
- Department of Gastrointestinal Surgery, Inonu University, Malatya, Turkey
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Masubuchi S, Okuda J, Yamamoto M, Inoue Y, Tanaka K, Uchiyama K. Natural orifice specimen extraction in laparoscopic colorectal cancer surgery: A case series study. Int J Surg Case Rep 2020; 78:204-209. [PMID: 33360631 PMCID: PMC7773675 DOI: 10.1016/j.ijscr.2020.12.059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 12/17/2020] [Accepted: 12/17/2020] [Indexed: 02/07/2023] Open
Abstract
Now that laparoscopic surgery is widespread, minimally invasive surgery is desired. Natural orifice specimen extraction is minimally invasive surgery. Transanal specimen extraction and transvaginal specimen extraction. Natural orifice specimen extraction appears to be feasible and safe.
Introduction In recent years, natural orifice specimen extraction (NOSE) has been attracting attention as a further minimally invasive operation for colorectal cancer, and not only improvement of appearance, but also reduction of pain and wound-related complications due to abdominal wall destruction has been reported. However, NOSE is technically complicated and difficult, and it has not yet been widely used. The aim of this study was to confirm the feasibility, safety, and short-term outcomes of total laparoscopic colon cancer surgery with NOSE. Case presentation From May 2018 to October 2019, eight patients with stage 0 or I colon cancer underwent NOSE surgery in our hospital. Transanal specimen extraction was performed in six cases, and transvaginal specimen extraction was performed in two cases. All operations were successfully accomplished without conversion to open surgery. The anastomosis method was double stapling technique in three cases and overlap method in five cases. The median operative time was 224 min. The median blood loss was 10 mL. The median time to first flatus was 1 day, and the median time to first stool was 2 days. The median postoperative observation period was 18 months, but there was no recurrence. There were no postoperative complications in these cases. Conclusion Total laparoscopic colon cancer surgery with NOSE appears to be feasible, safe, and show promising efficacy for selected patients.
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Affiliation(s)
- Shinsuke Masubuchi
- Department of General and Gastroenterological Surgery, Osaka Medical College, Takatsuki 569-8686, Japan; Department of Gastroenterological Surgery, Hirakata City Hospital, Hirakata 573-1013, Japan.
| | - Junji Okuda
- Cancer Center, Osaka Medical College, Takatsuki 569-8686, Japan.
| | - Masashi Yamamoto
- Department of General and Gastroenterological Surgery, Osaka Medical College, Takatsuki 569-8686, Japan.
| | - Yoshihiro Inoue
- Department of General and Gastroenterological Surgery, Osaka Medical College, Takatsuki 569-8686, Japan.
| | - Keitaro Tanaka
- Department of General and Gastroenterological Surgery, Osaka Medical College, Takatsuki 569-8686, Japan.
| | - Kazuhisa Uchiyama
- Department of General and Gastroenterological Surgery, Osaka Medical College, Takatsuki 569-8686, Japan.
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Zhuang CL, Zhang FM, Wang Z, Jiang X, Wang F, Liu ZC. Precision functional sphincter-preserving surgery (PPS) for ultralow rectal cancer: a natural orifice specimen extraction (NOSE) surgery technique. Surg Endosc 2020; 35:476-485. [PMID: 32989539 DOI: 10.1007/s00464-020-07989-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 09/14/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND In patients with ultralow rectal cancer, surgical resection of the tumor without impairing sphincter function remains a technical challenge. The purpose of this study was to describe a new technique of transanal natural orifice specimen extraction (NOSE) surgery using our independently developed devices, aiming to achieve precise cancer resection and preserve sphincter function in patients with ultralow rectal cancer. METHODS Precision functional sphincter-preserving surgery (PPS) was performed on nineteen patients with ultralow rectal cancer between June 2019 and April 2020. With the help of our independently developed devices, surgeons directly and accurately removed the lower edge of the tumor and retained healthy rectal tissue on the nontumorous side. Hand-sewn anastomosis with a mattress suture was used to achieve sturdy anastomosis. Preoperative baseline characteristics, operative details, 90-day postoperative complications, costs, and anal function score at 6 months after surgery were documented. RESULTS Nineteen ultralow rectal cancer patients with a median distance to the dentate line of 2.0 cm successfully underwent PPS without serious postoperative complications. Six out of nineteen patients (31.6%) received a prophylactic stoma. The average cost was 62164.1 yuan. At 6 months after surgery, the average Wexner anal function score and the average Vaizey score were both 3 points. CONCLUSIONS PPS can be employed to precisely resect rectal tumors and preserve sphincter function in ultralow rectal cancer patients. The use of our devices enhanced surgical efficiency, reduced the need for prophylactic stoma, reduced surgery-related costs, and prevented abdominal surgical incisions.
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Affiliation(s)
- Cheng-Le Zhuang
- Department of Gastrointestinal Surgery, Shanghai Tenth People's Hospital Affiliated to Tongji University, 301 Yanchang Road, Shanghai, 200072, China
| | - Feng-Min Zhang
- Department of Gastrointestinal Surgery, Shanghai Tenth People's Hospital Affiliated to Tongji University, 301 Yanchang Road, Shanghai, 200072, China
| | - Zheng Wang
- Department of Gastrointestinal Surgery, Shanghai Tenth People's Hospital Affiliated to Tongji University, 301 Yanchang Road, Shanghai, 200072, China
| | - Xun Jiang
- Department of Gastrointestinal Surgery, Shanghai Tenth People's Hospital Affiliated to Tongji University, 301 Yanchang Road, Shanghai, 200072, China
| | - Feng Wang
- Department of Gastrointestinal Surgery, Shanghai Tenth People's Hospital Affiliated to Tongji University, 301 Yanchang Road, Shanghai, 200072, China
| | - Zhong-Chen Liu
- Department of Gastrointestinal Surgery, Shanghai Tenth People's Hospital Affiliated to Tongji University, 301 Yanchang Road, Shanghai, 200072, China.
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Cheng CC, Hsu YR, Chern YJ, Tsai WS, Hung HY, Liao CK, Chiang JM, Hsieh PS, You JF. Minimally invasive right colectomy with transrectal natural orifice extraction: could this be the next step forward? Tech Coloproctol 2020; 24:1197-1205. [PMID: 32632708 PMCID: PMC7536150 DOI: 10.1007/s10151-020-02282-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 06/23/2020] [Indexed: 12/15/2022]
Abstract
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
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Affiliation(s)
- C-C Cheng
- Division of Colon and Rectal Surgery, Chang Gung Memorial Hospital, Linkou, Chang Gung University College of Medicine, No. 5, Fu-Hsing St., Kuei-Shan, Taoyuan, Taiwan.,School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Y-R Hsu
- Division of Colon and Rectal Surgery, Chang Gung Memorial Hospital, Linkou, Chang Gung University College of Medicine, No. 5, Fu-Hsing St., Kuei-Shan, Taoyuan, Taiwan.,School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Y-J Chern
- Division of Colon and Rectal Surgery, Chang Gung Memorial Hospital, Linkou, Chang Gung University College of Medicine, No. 5, Fu-Hsing St., Kuei-Shan, Taoyuan, Taiwan.,School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - W-S Tsai
- Division of Colon and Rectal Surgery, Chang Gung Memorial Hospital, Linkou, Chang Gung University College of Medicine, No. 5, Fu-Hsing St., Kuei-Shan, Taoyuan, Taiwan.,School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - H-Y Hung
- Division of Colon and Rectal Surgery, Chang Gung Memorial Hospital, Linkou, Chang Gung University College of Medicine, No. 5, Fu-Hsing St., Kuei-Shan, Taoyuan, Taiwan.,School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - C-K Liao
- Division of Colon and Rectal Surgery, Chang Gung Memorial Hospital, Linkou, Chang Gung University College of Medicine, No. 5, Fu-Hsing St., Kuei-Shan, Taoyuan, Taiwan.,School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - J-M Chiang
- Division of Colon and Rectal Surgery, Chang Gung Memorial Hospital, Linkou, Chang Gung University College of Medicine, No. 5, Fu-Hsing St., Kuei-Shan, Taoyuan, Taiwan.,School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - P-S Hsieh
- Division of Colon and Rectal Surgery, Chang Gung Memorial Hospital, Linkou, Chang Gung University College of Medicine, No. 5, Fu-Hsing St., Kuei-Shan, Taoyuan, Taiwan.,School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - J-F You
- Division of Colon and Rectal Surgery, Chang Gung Memorial Hospital, Linkou, Chang Gung University College of Medicine, No. 5, Fu-Hsing St., Kuei-Shan, Taoyuan, Taiwan. .,School of Medicine, Chang Gung University, Taoyuan, Taiwan.
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Zhu Z, Wang KJ, Orangio GR, Han JY, Lu B, Zhou ZQ, Gao W, Fu CG. Clinical efficacy and quality of life after transrectal natural orifice specimen extraction for the treatment of middle and upper rectal cancer. J Gastrointest Oncol 2020; 11:260-268. [PMID: 32399267 DOI: 10.21037/jgo.2020.03.05] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Background Laparoscopic anterior resection with natural orifice specimen extraction (NOSE) avoids extra abdominal extraction incision during colorectal surgery. Some surgeons realized the benefits of NOSE on clinical efficacy. We compared the clinical efficacy of laparoscopic NOSE, laparoscopic non-NOSE and open surgery (OS) for short-term recovery and quality of life (QoL). Methods A single randomized controlled trial of NOSE for middle and upper rectal cancer between April 2014 and February 2018. Preoperative and postoperative clinical variables were analyzed and compared between the groups. Preoperative and 6 months postoperative QoL was assessed with the SF-36 QoL questionnaire. Results A total of 378 patients were enrolled, 334 patients randomly divided into NOSE group (n=104), non-NOSE group (n=119), OS group (n=111). The NOSE group was superior to the other two groups on the QoL after surgery. The NOSE group had the lowest postoperative VAS score between three groups. The postoperative time for bowel function recovery and the length of hospital stay was statistically significantly different among the three groups, with the NOSE group having the shortest time. The incidence of postoperative complications was lower in the NOSE group (12/104, 11.5%) than in the non-NOSE group (20/119, 16.8%), the difference was statistically significant. The Kaplan-Meier (K-M) survival curve showed no statistically significant difference in the disease-free survival (DFS) rate between the three groups. Conclusions Comparing NOSE to non-NOSE and OS, the NOSE had significantly better functional recovery and better QoL. The NOSE group had a significant lower surgical complication rate than the non-NOSE group.
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Affiliation(s)
- Zhe Zhu
- Department of Colorectal Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200120, China
| | - Kai-Jing Wang
- Department of Colorectal Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200120, China
| | - Guy R Orangio
- Department of Surgery, Louisiana State University, New Orleans, LA, USA
| | - Jun-Yi Han
- Department of Colorectal Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200120, China
| | - Bing Lu
- Department of Colorectal Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200120, China
| | - Zhu-Qing Zhou
- Department of Colorectal Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200120, China
| | - Wei Gao
- Department of Colorectal Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200120, China
| | - Chuan-Gang Fu
- Department of Colorectal Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200120, China
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Xu H, Zhang GX, Zou XF, Wang XN, Wu GQ, Xia W, Yuan YH, Xiao RH, Wu YT, Liao YF, Jiang B, Chen HM, Liu QL, Xie TP. [Suprapubic-assisted laparoendoscopic single-site surgery in nephroureterectomy A case series of 4 patients]. Zhonghua Yi Xue Za Zhi 2019; 99:2840-2843. [PMID: 31550813 DOI: 10.3760/cma.j.issn.0376-2491.2019.36.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To evaluate the feasibility and clinical value of suprapubic-assisted laparoendoscopic single-site surgery (SA-LESS) in nephroureterectomy using method of transvaginal natural orifice specimen extraction (NOSE) (SA-LESS+TV-NOSE NU). Methods: Four patients (three cases of renal pelvic carcinoma and one case of ureteral carcinoma) undergoing SA-LESS+TV-NOSE NU were enrolled between April 2015 and January 2016. After general anesthesia, the patients were placed in the lithotomy position with the affected side elevated by 60°. Two trocars were inserted at the medial margin of umbilicus, and the third one was inserted into abdominal cavity at the superior margin of pubic symphysis. The operation was performed under a direct vision with a 5.4 mm 0° flexible-tip laparoscope. Firstly, the distal ureter was isolated completely and blocked by a Hem-O-lok clip. Then, the laparoscopic nephrectomy was performed according to the standard method. Finally, the bladder cuff excision was executed and the incision was sutured. The intact specimen was placed inside a homemade bag and removed through the incision at posterior vaginal fornix. Results: All the procedures were successfully performed. The median operative time was 150 (range: 120 to 210) minutes, and the median estimated blood loss was 180 (range: 80 to 350) ml. No major perioperative complications occurred. The mean visual analogue score (VAS) of 24 hours and 48 hours after operation were 3.25 (range: 2 to 5) and 2.25 (range: 2 to 3). All the patients resumed ambulation on postoperative day 1. Pelvic drainage tube was removed on postoperative day 2-4. On postoperative day 7, urethral catheter was removed. The patients were discharged on postoperative day 7-9. During the follow-up of 20-29 months, the patient recovered well with no case of incisional hernia and pelvic, abdominal infections. The vaginal fornix incision healed well, and the umbilical and suprapubic puncture scars were not obvious. All the patients completed the patient-assessed acromegaly symptom questionnaire PASQ. The average PSAQ score of 3 months after surgery was 34.5. Three of them restarted their sex lives, with an average female sexual function index score of 16.0, which was not significantly different with that of preoperation (15.6). There was no tumor recurrence, metastasis and implantation in all cases. Conclusion: SA-LESS+TV-NOSE NU is safe and feasible for upper tract urothelial carcinoma with faster postoperative recovery, less pain, shorter hospitalization time, better cosmetic results, and does not cause negative effect on the female sexual function.
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Affiliation(s)
- H Xu
- Department of Urology, First Affiliated Hospital of Gannan Medical University; Institute of Urology, Gannan Medical University, Ganzhou, Jiangxi 341000, China
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Katsuno G, Fukunaga M, Nagakari K, Yoshikawa S, Ouchi M, Hirasaki Y, Azuma D. Natural orifice specimen extraction using prolapsing technique in single-incision laparoscopic colorectal resections for colorectal cancers. Asian J Endosc Surg 2014; 7:85-8. [PMID: 24450353 DOI: 10.1111/ases.12063] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Revised: 08/20/2013] [Accepted: 09/04/2013] [Indexed: 12/15/2022]
Abstract
INTRODUCTION It is often technically difficult to cut the lower rectum with an endoscopic linear stapler in single-incision laparoscopic colorectal resections (SILC) because some surgical devices are inserted through the same access platform. If the rectum is cut incorrectly, it may cause anastomotic leakage. We recently applied natural orifice specimen extraction (NOSE) using the prolapsing technique to overcome this technical difficulty in SILC procedures in selected patients. MATERIALS AND SURGICAL TECHNIQUE The access platform is placed in the small umbilical incision area. SILC is performed using a surgical technique similar to the conventional laparoscopic medial-to-lateral approach. The proximal part of the tumor site is transected with laparoscopic staplers. Then, the tumor lesion and bowel are pulled out of the body through the anus by means of inversion. Next, the distal side of the bowel is cut with a stapler and the rectal stump is reinforced with sutures under direct vision. The distal side of the bowel is then pushed back into the body. NOSE with prolapsing technique is then complete. After that, the anvil is attached to the proximal part of the bowel at the umbilical incision site, and intracorporeal anastomosis is performed. DISCUSSION NOSE with prolapsing technique was applied in 14 SILC procedures for colorectal cancer patients. All procedures were successful, and there were no anastomotic leakages in the series. This technique enabled us to perform pure SILC safely without affecting cosmesis, even in cases where we needed to cut the lower rectum.
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Affiliation(s)
- Goutaro Katsuno
- Department of Surgery, Juntendo Urayasu Hospital, Juntendo University, Urayasu, Japan
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