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Updated: Aug 4, 2025
Clinical Application of Single-Surgeon, Three-Port, Laparoscopic Resection for Colorectal Cancer with Natural Orifice Specimen Extraction
Published on: March 24, 2023
Robotic natural orifice specimen extraction surgery versus conventional robotic resection for patients with
Linye Li1, Kuijie Liu2, Tiegang Li2
1Department of General Surgery, The Second Xiangya Hospital of Central South University, Changsha, China.
Background:
Laparoscopic natural orifice specimen extraction surgery (NOSES) has been widely used in colorectal neoplasms. However, only a few studies have focused on robotic NOSES. This study compared the short-term clinical outcomes and long-term survival outcomes between robotic NOSES and conventional robotic resection (CRR) groups.
Methods:
From March 2016 to October 2018, a consecutive of 143 patients who underwent robotic sigmoid and rectal resection at the Department of Gastrointestinal Surgery, The Second Xiangya Hospital, Central South University, were considered for inclusion in this study. Propensity-score matching (PSM) was conducted to account for differences in the baseline characteristics. After PSM, 39 patients were included in the robotic NOSES group, and 39 patients in the CRR group. The baseline characteristics between the two groups were all balanced and comparable.
Results:
Patients in the NOSES group experienced less intraoperative blood loss (p=0.001), lower requirements for additional analgesia (p=0.020), shorter time to first flatus (p=0.010), and a shorter time to first liquid diet (p=0.003) than the CRR group. The 3-year overall survival rates (NOSES: 92.3% vs. CRR: 89.7% p=1.000) and 3-year disease-free survival rates (NOSES: 82.1% vs. CRR: 84.6% p=0.761) between the two groups were comparable.
Conclusion:
Robotic natural orifice specimen extraction surgery is a safe and feasible surgery for patients with colorectal neoplasms. Robotic NOSES is associated with better short-term clinical outcomes and similar long-term survival outcomes to conventional robotic resection.
Insights
Robotic natural orifice specimen extraction surgery (NOSES) offers better short-term recovery for colorectal cancer patients. This minimally invasive approach shows comparable long-term survival rates to conventional robotic resection.
Area of Science:
- Minimally Invasive Surgery
- Surgical Oncology
- Robotic Surgery
Background:
- Natural Orifice Specimen Extraction Surgery (NOSES) is established for colorectal neoplasms.
- Robotic applications in NOSES are less explored.
- This study evaluates robotic NOSES versus conventional robotic resection (CRR).
Purpose of the Study:
- To compare short-term clinical outcomes between robotic NOSES and CRR.
- To assess long-term survival differences between robotic NOSES and CRR.
- To determine the safety and feasibility of robotic NOSES for colorectal neoplasms.
Main Methods:
- Retrospective analysis of 143 patients undergoing robotic sigmoid and rectal resection.
- Propensity-score matching (PSM) to balance baseline characteristics.
- Comparison of outcomes between 39 patients in the robotic NOSES group and 39 in the CRR group.
Main Results:
- Robotic NOSES group showed significantly less blood loss, reduced need for analgesia, and faster return of bowel function and diet.
- The 3-year overall survival rates were comparable (92.3% vs. 89.7%).
- The 3-year disease-free survival rates were also similar (82.1% vs. 84.6%).
Conclusions:
- Robotic natural orifice specimen extraction surgery is safe and feasible for colorectal neoplasms.
- Robotic NOSES demonstrates superior short-term clinical outcomes compared to conventional robotic resection.
- Long-term survival outcomes are comparable between robotic NOSES and conventional robotic resection.
