Routine cholangiography during rigid-hybrid transvaginal natural orifice transluminal endoscopic cholecystectomy

Abstract Background Natural orifice specimen extraction surgery for colorectal cancer has been introduced in order to reduce the abdominal incision, demonstrating major development potential in minimally invasive surgery. We are conducting this randomized controlled trial to assess whether robotic NOSES is non-inferior to traditional robotic-assisted surgery for patients with colorectal cancer in terms of primary and secondary outcomes. Method/design Accordingly, a prospective, open-label, randomized controlled, parallel-group, multicenter, and non-inferiority trial will be conducted to discuss the safety and efficacy of robotic natural orifice extraction surgery compared to traditional robotic-assisted surgery. Here, 550 estimated participants will be enrolled to have 80% power to detect differences with a one-sided significance level of 0.025 in consideration of the non-inferiority margin of 10%. The primary outcome is the incidence of surgical complications, which will be classified using the Clavien-Dindo system. Discussion This trial is expected to reveal whether robotic NOSES is non-inferior to traditional robotic-assisted surgery, which is of great significance in regard to the development of robotic NOSES for patients with colorectal cancer in the minimally invasive era. Furthermore, robotic NOSES is expected to exhibit superiority to traditional robotic-assisted surgery in terms of both primary and secondary outcomes. Trial registration ClinicalTrials.govNCT04230772. Registered on January 15, 2020.

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Hybrid natural orifice transluminal endoscopy surgery ( NOTES ) to perform bilateral ovariectomy in mares

Veterinary Surgery ◽

10.1111/vsu.13687 ◽

2021 ◽

Author(s):

Ana Velloso Alvarez ◽

Lindsey Boone ◽

Katharine Horzmann ◽

R. Reid Hanson

Keyword(s):

Natural Orifice ◽

Bilateral Ovariectomy

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Natural orifice versus conventional mini-laparotomy for specimen extraction after reduced-port laparoscopic surgery for colorectal cancer: propensity score-matched comparative study

Surgical Endoscopy ◽

10.1007/s00464-020-08250-8 ◽

2021 ◽

Author(s):

Sheng-Chi Chang ◽

Tsung-Han Lee ◽

Yi-Chang Chen ◽

Mei-Tsz Chen ◽

Hung-Chang Chen ◽

...

Keyword(s):

Colorectal Cancer ◽

Laparoscopic Surgery ◽

Propensity Score ◽

Comparative Study ◽

Natural Orifice ◽

Specimen Extraction ◽

Reduced Port ◽

Mini Laparotomy

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Natural orifice specimen extraction in laparoscopic colorectal cancer surgery: A case series study

International Journal of Surgery Case Reports ◽

10.1016/j.ijscr.2020.12.059 ◽

2021 ◽

Vol 78 ◽

pp. 204-209

Author(s):

Shinsuke Masubuchi ◽

Junji Okuda ◽

Masashi Yamamoto ◽

Yoshihiro Inoue ◽

Keitaro Tanaka ◽

...

Keyword(s):

Colorectal Cancer ◽

Case Series ◽

Cancer Surgery ◽

Natural Orifice ◽

Specimen Extraction ◽

Colorectal Cancer Surgery ◽

Natural Orifice Specimen Extraction ◽

Case Series Study ◽

Series Study

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Robotic natural-orifice IntraCorporeal anastomosis with Extraction (NICE procedure) for complicated diverticulitis

Surgical Endoscopy ◽

10.1007/s00464-021-08350-z ◽

2021 ◽

Author(s):

Eric M. Haas ◽

Thais Reif de Paula ◽

Roberto Luna-Saracho ◽

Melissa Sara Smith ◽

Jean-Paul J. LeFave

Keyword(s):

Complicated Diverticulitis ◽

Intracorporeal Anastomosis ◽

Natural Orifice ◽

Abdominal Incision ◽

Stepwise Approach ◽

Stapling Device ◽

Video Recordings ◽

Conversion Rates ◽

Technical Modifications ◽

Instrument Control

Abstract Background Totally intracorporeal surgery for left-sided resection carries numerous potential advantages by avoiding crossing staple lines and eliminating the need for an abdominal incision. For those with complicated diverticulitis, minimally invasive surgery is known to be technically challenging due to inflamed tissue, distorted pelvic anatomy, and obliterated tissue planes, resulting in high conversion rates. We aim to illustrate the stepwise approach and modifications required to successful complete the robotic Natural-orifice IntraCorporeal anastomosis with transrectal specimen Extraction (NICE) procedure in this cohort. Methods Consecutive, elective, unselected patients presenting with complicated diverticulitis defined as fistula, abscess and stricture underwent the NICE procedure over a 24-month period. Demographic and intraoperative data were collected, and video recordings were reviewed and edited on encrypted server. Results A total of 60 patients (50% female) underwent the NICE procedure for complicated diverticulitis with a mean age of 58.9 years and mean BMI of 30.7 kg/m2. The mean operative time was 231.6 min. All cases (100%) were achieved with intracorporeal anastomosis using a circular stapling device. All but one patient (98.3%) had successful transrectal extraction of the specimen. Forty-four (73%) of the specimens required a specimen-thinning maneuver to successfully extract the specimen and there were no conversions. We identified seven key technical modifications and considerations to facilitate successful completion of the procedure which are illustrated, including early release of the disease, mesentery-sparing dissection, dual instrument control of the mesenteric vasculature, release of the rectal reflection, use of NICE back table, specimen-thinning maneuver, and closure of the rectal cuff. Conclusion We present a stepwise approach with key modifications to successfully achieve totally robotic intracorporeal resection for those presenting with complicated diverticulitis. This approach may help overcome the technical challenges and provide a foundation for reproducible results.

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