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Laparoscopic sigmoid resection with transrectal specimen extraction: a systematic review.

A M Wolthuis¹, B Van Geluwe, S Fieuws

¹Department of Abdominal Surgery, University Hospital Gasthuisberg Leuven, Leuven, Belgium. albert.wolthuis@uzleuven.be

Colorectal Disease : the Official Journal of the Association of Coloproctology of Great Britain and Ireland

|October 26, 2011

Summary

Left-sided laparoscopic colectomy with transrectal specimen extraction is feasible, showing low morbidity and short hospital stays. However, evidence remains weak, necessitating standardized techniques and further research, including randomized controlled trials, to confirm its benefits.

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Area of Science:

Colorectal Surgery
Minimally Invasive Surgery
Surgical Oncology

Background:

Laparoscopic colectomy is a standard surgical approach.
Natural orifice specimen extraction (NOSE) aims to reduce invasiveness.
Transrectal NOSE for left-sided colectomy is an evolving technique.

Purpose of the Study:

To systematically review surgical techniques, postoperative morbidity, hospital stay, and safety of left-sided laparoscopic colectomy with transrectal specimen extraction.
To identify differences and assess the current evidence for this procedure.

Main Methods:

A systematic PubMed search was conducted for studies on left-sided laparoscopic colorectal resection with transrectal specimen extraction.
Six studies, primarily cohort studies, were included after quality assessment (Newcastle-Ottawa Scale).
Exclusion criteria included transanal, transvaginal, transcolonic extraction, and pediatric surgery.

Main Results:

Six papers involving 94 patients met the criteria.
Techniques were non-standardized, preventing pooled analysis and meta-analysis.
All included studies indicated the procedure is feasible with low morbidity and short hospital stays.
No instances of anal dysfunction were reported.

Conclusions:

Current evidence supporting left-sided laparoscopic colectomy with transrectal specimen extraction is limited (Level IV-V).
Standardization of surgical techniques is crucial for future research.
Randomized controlled trials are required to demonstrate superiority in outcomes like pain, morbidity, recovery, and cosmesis.