Natural orifice specimen extraction (NOSE) surgery with rectal eversion and total extra-abdominal resection

Area of Science:

• Colorectal Surgery
• Minimally Invasive Surgery
• Surgical Innovation

Background:

• Natural orifice specimen extraction (NOSE) surgery is increasingly adopted by colorectal surgeons.
• Technical variations in NOSE procedures are actively being explored and debated.
• Standardization of techniques remains a challenge in the evolution of NOSE surgery.

Purpose of the Study:

• To present and evaluate a novel variation of transanal NOSE following laparoscopic or robotic total mesorectal excision (TME).
• To demonstrate the technical feasibility of rectal eversion for extracorporeal specimen retrieval.
• To assess the safety and efficacy of this NOSE technique using patient-reported outcome measures.

Main Methods:

• A new transanal NOSE technique involving rectal eversion using a specialized rod after laparoscopic/robotic TME was developed.
• Rectal eversion facilitates extracorporeal resection and anvil placement.
• Patient outcomes were assessed using the Clinical Patient Grading Assessment Scale and Low Anterior Resection Syndrome (LARS) score.

Main Results:

• Seven female patients with rectal cancer underwent the procedure (5 laparoscopic, 2 robotic TME) without intraoperative or postoperative complications.
• One month post-stoma closure, the median Clinical Patient Grading Assessment Scale indicated significant improvement ('a good deal better').
• Median LARS scores showed a trend towards improvement postoperatively compared to preoperative scores.

Conclusions:

• This specific variation of transanal NOSE surgery, incorporating rectal eversion, is safe and effective.
• The technique offers a viable option for specimen extraction in selected rectal cancer patients.
• Further research may validate this approach in larger patient cohorts.