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Updated: Jun 27, 2025
Clinical Application of Single-Surgeon, Three-Port, Laparoscopic Resection for Colorectal Cancer with Natural Orifice Specimen Extraction
Published on: March 24, 2023
Natural Orifice Specimen Extraction as a Promising Alternative for Minilaparotomy in Bowel Resection Due to
Emre Kar1, Chris Elizabeth Philip2, Karine Eskandar3
1Department of Obstetrics and Gynecology (Kar and Polat), Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey.
Objective:
This study focuses on evaluating the effectiveness, safety and efficacy of 2 surgical tissue extraction methods for treating bowel endometriosis: natural orifice specimen extraction (NOSE) and minilaparotomy.
Data Sources:
A systematic search was conducted in MedLine, Embase, and Cochrane Library databases in October 2023, without date restrictions.
Methods Of Study Selection:
This study included studies that directly compared NOSE and minilaparotomy in colectomy patients due to endometriosis. Primary outcomes were defined as operation duration, length of hospital stay, intraoperative blood loss, and major postoperative complication rates. The Clavien-Dindo classification was used to categorize complications. Statistical analysis was performed using Review Manager Software by Cochrane, with a DerSimonian and Laird random-effects model to account for anticipated high heterogeneity. Subgroup analysis was conducted for patients undergoing full laparoscopic (L/S) resection.
Tabulation, Integration And Results:
Out of 1236 identified studies, 6 met the inclusion criteria, comprising 372 patients. One study was a randomized controlled trial, and 5 were observational. Operation duration did not significantly differ between NOSE and minilaparotomy (MD: -10.85 min; 95% CI: [-23.33, 1.63]; p = .09). NOSE was associated with a significantly reduced length of hospital stay (MD: -0.76 day; 95% CI: [-1.21, -0.31]; p = .008). The major postoperative complication rates were 3.77% for NOSE and 5.55% for minilaparotomy, with no significant difference (OR: 0.84; 95% CI: [0.27, 2.60]; p = .76). Subgroup analysis revealed that Full L/S had significantly shorter operation duration (MD: -26.06 min; 95% CI: [-45.85, -6.27]; p = .01), reduced length of stay (MD: -0.75 day; 95% CI: [-1.25, -0.25]; p = .003), and lower blood loss (MD: -15.01 mL; 95% CI: [-29.64, -0.37]; p = .04).
Conclusion:
NOSE emerged as a potentially safer alternative to minilaparotomy for tissue extraction in colectomy for bowel endometriosis. However, standardization of the procedure and additional randomized controlled trials are needed to validate these findings.
