Published in:
01-09-2019 | Rectal Cancer | MULTIMEDIA ARTICLE
Natural orifice specimen extraction (NOSE) surgery with rectal eversion and total extra-abdominal resection
Published in: Techniques in Coloproctology | Issue 9/2019
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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.