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Transanal natural orifice specimen extraction in colorectal surgery: bacteriological and oncological concerns James Ngu and Andrew Siang Yih Wong Department of General Surgery, Changi General Hospital, Singapore
Key words colorectal, laparoscopic, natural orifice, surgery. Correspondence Dr James Ngu, Department of General Surgery, Changi General Hospital, 2 Simei Street 3, Singapore 529889. Email: [email protected] J. Ngu MBBS, FRCS (Edin); A. S. Y. Wong MBBS, FRCS (Edin). Accepted for publication 8 October 2015. doi: 10.1111/ans.13383
Abstract Introduction: Natural orifice techniques have been developed to reduce incisionrelated morbidity in laparoscopic colorectal surgery. We describe our method of performing transanal specimen extraction in laparoscopic colorectal surgery, addressing bacteriological and oncological concerns in its implementation. Methods: Data of consecutive patients undergoing natural orifice specimen extraction (NOSE) laparoscopic colorectal surgery in our institution were retrospectively analysed. All specimens were extracted transanally via a wound protector, followed by intracorporeal end-to-end colorectal anastomosis. Perioperative details, microbiological and oncological findings were reviewed. Results: Between November 2014 and February 2015, five patients underwent NOSE laparoscopic colorectal procedures in our institution. All cases were completed laparoscopically and specimens were extracted transanally via a wound protector. There were no cases of post-operative anastomotic leaks, wound infections, intraabdominal sepsis or faecal incontinence. Oncological margins and lymph node harvest were adequate for malignant cases. Transanal specimen extraction did not result in a malignant yield on peritoneal fluid cytology. Conclusions: Early bacteriological, oncological and functional results show that NOSE is safe and feasible. Follow-up is required to establish that long-term oncological outcome is not compromised.
Introduction Natural orifice techniques have been developed to reduce incisionrelated morbidity in laparoscopic colorectal surgery. Earlier publications have focused on the feasibility and post-operative benefits of the technique, with recent studies demonstrating reduced pain and lower analgesic requirements compared with conventional laparoscopic colectomies.1–3 There remain concerns regarding the bacteriological and oncological safety of such procedures. We describe our early experience with transanal specimen extraction in laparoscopic colorectal surgery, focusing on these issues and highlighting pertinent considerations in performing the procedure.
Methods Data of the first five patients undergoing natural orifice specimen extraction (NOSE) laparoscopic colorectal surgery in our institution were retrospectively analysed. All operations were performed by the same attending surgeon using a standardized technique. Patients were counselled for NOSE if (i) the size of their lesions did not © © 2015 2015 Royal Royal Australasian Australasian College of Surgeons
exceed 4 cm, as measured on colonoscopy, computed tomography (CT) or magnetic resonance imaging (MRI); (ii) the location of their lesions was between the intraperitoneal rectum and sigmoid, as determined by CT or MRI; (iii) transanal minimally invasive surgery (TAMIS) was deemed not suitable; and (iv) the patients did not have significant pre-existing faecal incontinence (Wexner score
Transanal natural orifice specimen extraction in colorectal surgery: bacteriological and oncological concerns James Ngu and Andrew Siang Yih Wong Department of General Surgery, Changi General Hospital, Singapore
Key words colorectal, laparoscopic, natural orifice, surgery. Correspondence Dr James Ngu, Department of General Surgery, Changi General Hospital, 2 Simei Street 3, Singapore 529889. Email: [email protected] J. Ngu MBBS, FRCS (Edin); A. S. Y. Wong MBBS, FRCS (Edin). Accepted for publication 8 October 2015. doi: 10.1111/ans.13383
Abstract Introduction: Natural orifice techniques have been developed to reduce incisionrelated morbidity in laparoscopic colorectal surgery. We describe our method of performing transanal specimen extraction in laparoscopic colorectal surgery, addressing bacteriological and oncological concerns in its implementation. Methods: Data of consecutive patients undergoing natural orifice specimen extraction (NOSE) laparoscopic colorectal surgery in our institution were retrospectively analysed. All specimens were extracted transanally via a wound protector, followed by intracorporeal end-to-end colorectal anastomosis. Perioperative details, microbiological and oncological findings were reviewed. Results: Between November 2014 and February 2015, five patients underwent NOSE laparoscopic colorectal procedures in our institution. All cases were completed laparoscopically and specimens were extracted transanally via a wound protector. There were no cases of post-operative anastomotic leaks, wound infections, intraabdominal sepsis or faecal incontinence. Oncological margins and lymph node harvest were adequate for malignant cases. Transanal specimen extraction did not result in a malignant yield on peritoneal fluid cytology. Conclusions: Early bacteriological, oncological and functional results show that NOSE is safe and feasible. Follow-up is required to establish that long-term oncological outcome is not compromised.
Introduction Natural orifice techniques have been developed to reduce incisionrelated morbidity in laparoscopic colorectal surgery. Earlier publications have focused on the feasibility and post-operative benefits of the technique, with recent studies demonstrating reduced pain and lower analgesic requirements compared with conventional laparoscopic colectomies.1–3 There remain concerns regarding the bacteriological and oncological safety of such procedures. We describe our early experience with transanal specimen extraction in laparoscopic colorectal surgery, focusing on these issues and highlighting pertinent considerations in performing the procedure.
Methods Data of the first five patients undergoing natural orifice specimen extraction (NOSE) laparoscopic colorectal surgery in our institution were retrospectively analysed. All operations were performed by the same attending surgeon using a standardized technique. Patients were counselled for NOSE if (i) the size of their lesions did not © © 2015 2015 Royal Royal Australasian Australasian College of Surgeons
exceed 4 cm, as measured on colonoscopy, computed tomography (CT) or magnetic resonance imaging (MRI); (ii) the location of their lesions was between the intraperitoneal rectum and sigmoid, as determined by CT or MRI; (iii) transanal minimally invasive surgery (TAMIS) was deemed not suitable; and (iv) the patients did not have significant pre-existing faecal incontinence (Wexner score
