Related Experiment Video
Updated: May 26, 2026
Caudal-to-cranial Approach in Laparoscopic Right Hemicolectomy with Complete Mesocolon Excision and D3 Lymph Node Dissection
Published on: January 9, 2026
Prospective evaluation of peritoneal fluid contamination following transabdominal vs. transanal specimen extraction
Federico A Costantino1, Michele Diana, James Wall
1IRCAD/EITS, Department of General, Digestive and Endocrine Surgery, University Hospital of Strasbourg, 1 Place de l'Hôpital, 67091 Strasbourg, France.
Background:
Natural orifice specimen extraction (NOSE) in colorectal surgery prevents the need for an enlarged port site or minilaparotomy to extract the surgical specimen. The downside of this technique may be an increased risk of bacterial contamination of the peritoneal cavity from the external milieu. The aim of this study was to prospectively analyze the peritoneal bacterial contamination in NOSE and non-NOSE laparoscopic colorectal procedures.
Methods:
Consecutive patients operated for sigmoid diverticulitis with laparoscopic approach and transanal extraction of the specimen from January to December 2010 at our university hospital were enrolled. Patients who underwent a laparoscopic sigmoidectomy in the same study period with conventional specimen extraction were used as reference. Peritoneal fluid samples were collected under sterile conditions at the end of the procedure and sent for gram stain as well as anaerobic, aerobic, and fungal cultures.
Results:
Twenty-nine patients underwent laparoscopic sigmoidectomy for diverticulitis with transanal NOSE, while 9 patients underwent laparoscopic sigmoidectomy with conventional specimen extraction during the same period. The two groups were successfully matched 1:2 (17 NOSE and 9 non-NOSE) according age, sex, ASA, and Charlson comorbidity score. The contamination rate of peritoneal fluid was 100% vs. 88.9% in NOSE and non-NOSE procedures, respectively (P = 0.23). Overall and major complications rates were 27.6% vs. 11.10% (P = 0.41) and 5.08% vs. 11.1% (P = 1) in NOSE vs. non-NOSE procedures, respectively. In the NOSE group there was a statistically significant lower consumption of oral paracetamol (P = 0.007) and of oral tramadol (P = 0.02).
Conclusions:
Although a higher peritoneal contamination was found in the NOSE procedures, there were no significant differences in clinical outcomes relative to standard approach. Avoiding a minilaparotomy to extract the specimen resulted in a significantly lower postoperative analgesic requirement in the NOSE group.
Insights
Natural orifice specimen extraction (NOSE) in colorectal surgery may increase peritoneal contamination but reduces postoperative pain. This study compared NOSE with conventional methods, finding no significant difference in complications despite higher contamination rates with NOSE.
Area of Science:
- Colorectal Surgery
- Minimally Invasive Procedures
- Surgical Site Contamination
Background:
- Natural orifice specimen extraction (NOSE) avoids larger incisions for specimen removal in colorectal surgery.
- Potential for increased bacterial contamination of the peritoneal cavity is a concern with NOSE.
- This study aimed to compare peritoneal bacterial contamination between NOSE and conventional laparoscopic colorectal procedures.
Purpose of the Study:
- To prospectively analyze peritoneal bacterial contamination in natural orifice specimen extraction (NOSE) versus non-NOSE laparoscopic colorectal procedures.
- To evaluate the clinical outcomes and complication rates associated with NOSE.
- To assess the impact of NOSE on postoperative analgesic requirements.
Main Methods:
- Prospective enrollment of patients undergoing laparoscopic sigmoidectomy for diverticulitis with transanal NOSE or conventional specimen extraction.
- Collection of peritoneal fluid samples for Gram stain and microbial cultures (anaerobic, aerobic, fungal).
- Matching of NOSE and non-NOSE groups by age, sex, ASA, and Charlson comorbidity score for comparison.
Main Results:
- A higher peritoneal contamination rate was observed in the NOSE group (100%) compared to the non-NOSE group (88.9%), though not statistically significant (P = 0.23).
- Overall and major complication rates did not differ significantly between the NOSE and non-NOSE groups.
- The NOSE group showed significantly lower consumption of oral paracetamol (P = 0.007) and tramadol (P = 0.02).
Conclusions:
- Natural orifice specimen extraction (NOSE) in laparoscopic colorectal surgery is associated with increased peritoneal contamination but does not lead to significant differences in clinical outcomes or complications.
- NOSE procedures result in a significantly lower need for postoperative analgesics compared to conventional specimen extraction.
- NOSE offers a viable alternative for specimen extraction, potentially improving patient comfort by reducing analgesic requirements.
More Related Videos
08:26Clinical Application of Single-Surgeon, Three-Port, Laparoscopic Resection for Colorectal Cancer with Natural Orifice Specimen Extraction
Published on: March 24, 2023
07:22Surgical Robot-Assisted Transanal Specimen Extraction Radical Sigmoidectomy Without an Auxiliary Abdominal Incision
Published on: June 13, 2025
