Laparoscopic natural orifice specimen extraction-colectomy: a systematic review

Area of Science:

• Colorectal Surgery
• Minimally Invasive Surgery
• Surgical Innovation

Background:

• Laparoscopic colorectal surgery offers comparable efficacy to open surgery with reduced morbidity.
• Minimizing surgical access trauma is key to improving patient recovery.
• Natural orifice specimen extraction (NOSE) is an emerging technique to reduce access trauma.

Purpose of the Study:

• To systematically review the role and outcomes of Natural Orifice Specimen Extraction (NOSE) in minimally invasive colorectal surgery.
• To describe various NOSE techniques and their associated challenges.
• To identify areas for future research, particularly randomized controlled trials.

Main Methods:

• Systematic review of existing literature on NOSE in laparoscopic colorectal surgery.
• Analysis of different specimen extraction methods (transcolonic, transrectal, transanal, transvaginal).
• Evaluation of reported benefits, concerns, and outcomes associated with NOSE procedures.

Main Results:

• NOSE aims to reduce postoperative pain, analgesic requirements, and hospital stay, while improving cosmetic outcomes and lowering hernia rates.
• Key characteristic of NOSE is the avoidance of extraction site laparotomy.
• Concerns include potential bacterial contamination, inflammatory response, and impact on functional and oncologic outcomes.

Conclusions:

• NOSE presents a promising approach to further minimize trauma in laparoscopic colorectal surgery.
• Further investigation through prospective randomized controlled trials is essential to validate presumed benefits and address safety concerns.
• Understanding operative techniques and application issues is crucial for the widespread adoption of NOSE.