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Advanced Techniques for Specimen Extraction During Laparoscopic Colorectal Surgery

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The SAGES Manual of Colorectal Surgery

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Abstract

Natural orifice specimen extraction (NOSE) during laparoscopic colorectal surgery will be the way forward to avoid abdominal wall incisions and reduce access trauma. Avoidance of extraction site laparotomy is the most important characteristic of NOSE. The specimen is delivered via a natural orifice, and the anastomosis is created intracorporeally. Benefits of NOSE-procedures are less pain, lower analgesia requirements, faster recovery, shorter hospital stay, better cosmetic results, and lower incisional hernia rates. This chapter will focus on transrectal and transanal NOSE-techniques.

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References

  1. Kuhry E, Schwenk WF, Gaupset R, Romild U, Bonjer HJ. Long-term results of laparoscopic colorectal cancer resection. Cochrane Database Syst Rev. 2008;(2):CD003432.

    Google Scholar 

  2. Schwenk W, Haase O, Neudecker J, Muller JM. Short term benefits for laparoscopic colorectal resection. Cochrane Database Syst Rev. 2005;(3):CD003145.

    Google Scholar 

  3. Kehlet H. Fast-track colorectal surgery. Lancet. 2008;371(9615):791–3.

    Article  Google Scholar 

  4. Spanjersberg WR, Reurings J, Van Laarhoven CHJM. Fast track surgery versus conventional recovery strategies for colorectal surgery. Cochrane Database Syst Rev 2009(2): CD007635.

    Google Scholar 

  5. Vlug MS, Wind J, Hollmann MW, Ubbink DT, Cense HA, Engel AF, et al. Laparoscopy in combination with fast track multimodal management is the best perioperative strategy in patients undergoing colonic surgery: a randomized clinical trial (LAFA-study). Ann Surg. 2011;254(6):868–75.

    Article  Google Scholar 

  6. Laurent C, Leblanc F, Bretagnol F, Capdepont M, Rullier E. Long-term wound advantages of the laparoscopic approach in rectal cancer. Br J Surg. 2008;95(7):903–8.

    Article  CAS  Google Scholar 

  7. Franklin ME Jr, Ramos R, Rosenthal D, Schuessler W. Laparoscopic colonic procedures. World J Surg. 1993;17(1):51–6.

    Article  Google Scholar 

  8. Sylla P, Willingham FF, Sohn DK, Gee D, Brugge WR, Rattner DW. NOTES rectosigmoid resection using transanal endoscopic microsurgery (TEM) with transgastric endoscopic assistance: a pilot study in swine. J Gastrointest Surg. 2008;12(10):1717–23.

    Article  Google Scholar 

  9. Sylla P, Rattner DW, Delgado S, Lacy AM. NOTES transanal rectal cancer resection using transanal endoscopic microsurgery and laparoscopic assistance. Surg Endosc. 2010;24(5):1205–10.

    Article  Google Scholar 

  10. Marks J, Mizrahi B, Dalane S, Nweze I, Marks G. Laparoscopic transanal abdominal transanal resection with sphincter preservation for rectal cancer in the distal 3 cm of the rectum after neoadjuvant therapy. Surg Endosc. 2010;24(11):2700–7.

    Article  CAS  Google Scholar 

  11. Person B, Vivas DA, Wexner SD. Totally laparoscopic low anterior resection with transperineal handsewn colonic J-pouch anal anastomosis for low rectal cancer. Surg Endosc. 2006;20(4):700–2.

    Article  CAS  Google Scholar 

  12. Albert MR, Atallah SB, deBeche-Adams TC, Izfar S, Larach SW. Transanal minimally invasive surgery (TAMIS) for local excision of benign neoplasms and early-stage rectal cancer: efficacy and outcomes in the first 50 patients. Dis Colon Rectum. 2013;56(3):301–7.

    Article  Google Scholar 

  13. D’Hoore A, Wolthuis AM. Laparoscopic low anterior resection and transanal pull-through for low rectal cancer: a Natural Orifice Specimen Extraction (NOSE) technique. Color Dis. 2011;13(Suppl 7):28–31.

    Article  Google Scholar 

  14. Wolthuis AM, de Buck van Overstraeten A, Fieuws S, Boon K, D’Hoore A. Standardized laparoscopic NOSE-colectomy is feasible with low morbidity. Surg Endosc. 2014;29(5):1167–73.

    Article  Google Scholar 

  15. Wolthuis AM, Van Geluwe B, Fieuws S, Penninckx F, D’Hoore A. Laparoscopic sigmoid resection with transrectal specimen extraction: a systematic review. Color Dis. 2012;14(10):1183–8.

    Article  CAS  Google Scholar 

  16. Marks G, Mohiuddin M, Rakinic J. New hope and promise for sphincter preservation in the management of cancer of the rectum. Semin Oncol. 1991;18(4):388–98.

    CAS  PubMed  Google Scholar 

  17. Teramoto T, Watanabe M, Kitajima M. Per anum intersphincteric rectal dissection with direct coloanal anastomosis for lower rectal cancer: the ultimate sphincter-preserving operation. Dis Colon Rectum. 1997;40(10 Suppl):S43–7.

    Article  CAS  Google Scholar 

  18. Watanabe M, Teramoto T, Hasegawa H, Kitajima M. Laparoscopic ultralow anterior resection combined with per anum intersphincteric rectal dissection for lower rectal cancer. Dis Colon Rectum. 2000;43(10 Suppl):S94–7.

    Article  CAS  Google Scholar 

  19. Rullier E, Sa Cunha A, Couderc P, Rullier A, Gontier R, Saric J. Laparoscopic intersphincteric resection with coloplasty and coloanal anastomosis for mid and low rectal cancer. Br J Surg. 2003;90(4):445–51.

    Article  CAS  Google Scholar 

  20. Denost Q, Adam JP, Pontallier A, Celerier B, Laurent C, Rullier E. Laparoscopic total mesorectal excision with coloanal anastomosis for rectal cancer. Ann Surg. 2015;261(1):138–43.

    Article  Google Scholar 

  21. Zattoni D, Popeskou GS, Christoforidis D. Left colon resection with transrectal specimen extraction: current status. Tech Coloproctol. 2018;22(6):411–23.

    Article  CAS  Google Scholar 

  22. Ris F, Liot E, Buchs NC, Kraus R, Ismael G, Belfontali V, et al. Multicentre phase II trial of near-infrared imaging in elective colorectal surgery. Br J Surg. 2018;105(10):1359–67.

    Article  CAS  Google Scholar 

  23. Wolthuis AM, Penninckx F, D’Hoore A. Laparoscopic sigmoid resection with transrectal specimen extraction has a good short-term outcome. Surg Endosc Other Interv Tech. 2011;25(6):2034–8.

    Article  Google Scholar 

  24. Wolthuis AM, Bislenghi G, de Buck van Overstraeten A, D’Hoore A. Transanal total mesorectal excision: towards standardization of technique. World J Gastroenterol. 2015;21(44):12686–95.

    Article  Google Scholar 

  25. Wolthuis AM, Cini C, Penninckx F, D’Hoore A. Transanal single port access to facilitate distal rectal mobilization in laparoscopic rectal sleeve resection with hand-sewn coloanal anastomosis. Tech Coloproctol. 2012;16(2):161–5.

    Article  CAS  Google Scholar 

  26. Wolthuis AM, de Buck van Overstraeten A, D’Hoore A. Dynamic article: transanal rectal excision: a pilot study. Dis Colon Rectum. 2014;57(1):105–9.

    Article  Google Scholar 

  27. Penna M, Knol JJ, Tuynman JB, Tekkis PP, Mortensen NJ, Hompes R. Four anastomotic techniques following transanal total mesorectal excision (TaTME). Tech Coloproctol. 2016;20(3):185–91.

    Article  CAS  Google Scholar 

  28. Akamatsu H, Omori T, Oyama T, Tori M, Ueshima S, Nishida T, et al. Totally laparoscopic low anterior resection for lower rectal cancer: combination of a new technique for intracorporeal anastomosis with prolapsing technique. Dig Surg. 2009;26(6):446–50.

    Article  Google Scholar 

  29. Leroy J, Costantino F, Cahill RA, D’Agostino J, Morales A, Mutter D, et al. Laparoscopic resection with transanal specimen extraction for sigmoid diverticulitis. Br J Surg. 2011;98(9):1327–34.

    Article  CAS  Google Scholar 

  30. Wolthuis AM, Meuleman C, Tomassetti C, D’Hooghe T, Fieuws S, Penninckx F, et al. Laparoscopic sigmoid resection with transrectal specimen extraction: a novel technique for the treatment of bowel endometriosis. Hum Reprod. 2011;26(6):1348–55.

    Article  CAS  Google Scholar 

  31. Franklin ME, Jr., Liang S, Russek K. Natural orifice specimen extraction in laparoscopic colorectal surgery: transanal and transvaginal approaches. Tech Coloproctol. 2013;17 Suppl 1(1):S63–7.

    Google Scholar 

  32. Han Y, He YG, Zhang HB, Lv KZ, Zhang YJ, Lin MB, et al. Total laparoscopic sigmoid and rectal surgery in combination with transanal endoscopic microsurgery: a preliminary evaluation in China. Surg Endosc. 2013;27(2):518–24.

    Article  Google Scholar 

  33. Leung AL, Cheung HY, Fok BK, Chung CC, Li MK, Tang CN. Prospective randomized trial of hybrid NOTES colectomy versus conventional laparoscopic colectomy for left-sided colonic tumors. World J Surg. 2013;37(11):2678–82.

    Article  Google Scholar 

  34. Xingmao Z, Haitao Z, Jianwei L, Huirong H, Junjie H, Zhixiang Z. Totally laparoscopic resection with natural orifice specimen extraction (NOSE) has more advantages comparing with laparoscopic-assisted resection for selected patients with sigmoid colon or rectal cancer. Int J Color Dis. 2014;29(9):1119–24.

    Article  Google Scholar 

  35. Lamm SH, Zerz A, Efeoglou A, Steinemann DC. Transrectal rigid-hybrid natural orifice translumenal endoscopic sigmoidectomy for diverticular disease: a Prospective Cohort Study. J Am Coll Surg. 2015;221(4):789–97.

    Article  Google Scholar 

  36. Huang CC, Chen YC, Huang CJ, Hsieh JS. Totally laparoscopic colectomy with intracorporeal side-to-end colorectal anastomosis and transrectal specimen extraction for sigmoid and rectal cancers. Ann Surg Oncol. 2016;23(4):1164–8.

    Article  Google Scholar 

  37. Saurabh B, Chang SC, Ke TW, Huang YC, Kato T, Wang HM, et al. Natural orifice specimen extraction with single stapling solorectal anastomosis for laparoscopic anterior resection: feasibility, outcomes, and technical considerations. Dis Colon Rectum. 2017;60(1):43–50.

    Article  Google Scholar 

  38. Shimizu H, Adachi K, Ohtsuka H, Osaka I, Takuma K, Takanishi K, et al. Totally laparoscopic resection for low sigmoid and rectal cancer using natural orifice specimen extraction techniques. Surg Laparosc Endosc Percutan Tech. 2017;27(4):e74–e9.

    Article  Google Scholar 

  39. Kang J, Min BS, Hur H, Kim NK, Lee KY. Transanal specimen extraction in robotic rectal cancer surgery. Br J Surg. 2012;99(1):133–6.

    Article  CAS  Google Scholar 

  40. Bie M, Wei ZQ. A new colorectal/coloanal anastomotic technique in sphincter-preserving operation for lower rectal carcinoma using transanal pull-through combined with single stapling technique. Int J Color Dis. 2013;8:8.

    Google Scholar 

  41. Rasulov AO, Mamedli ZZ, Gordeyev SS, Kozlov NA, Dzhumabaev HE. Short-term outcomes after transanal and laparoscopic total mesorectal excision for rectal cancer. Tech Coloproctol. 2016;20(4):227–34.

    Article  CAS  Google Scholar 

  42. Wolthuis A. Transrectal specimen extraction: should this be catching on? In: Schlachta CM, Sylla P, editors. Current common dilemmas in colorectal surgery. Cham: Springer International Publishing; 2018. p. 227–37.

    Chapter  Google Scholar 

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Author information

Authors and Affiliations

  1. University Hospital Leuven, Department of Abdominal Surgery, Catholic University Leuven, Leuven, Belgium

    Albert M. Wolthuis

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  1. Albert M. Wolthuis
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Correspondence to Albert M. Wolthuis .

Editor information

Editors and Affiliations

  1. Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA

    Patricia Sylla

  2. Keck School of Medicine of USC, Los Angeles, CA, USA

    Andreas M. Kaiser

  3. Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA

    Daniel Popowich

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© 2020 Society of American Gastrointestinal and Endoscopic Surgeons (SAGES)

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Wolthuis, A.M. (2020). Advanced Techniques for Specimen Extraction During Laparoscopic Colorectal Surgery. In: Sylla, P., Kaiser, A., Popowich, D. (eds) The SAGES Manual of Colorectal Surgery. Springer, Cham. https://doi.org/10.1007/978-3-030-24812-3_40

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  • DOI: https://doi.org/10.1007/978-3-030-24812-3_40

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-24811-6

  • Online ISBN: 978-3-030-24812-3

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