Robotic NOSE (Natural Orifice Specimen Extraction) Surgery for Complicated Diverticulitis Requiring Sigmoid Colon Resection and Colovesical Fistulectomy Followed by Colorectal Anastomosis and Repair of Urinary Bladder

Abstract Background: To introduce a novel method for double stapling technique in colorectal anastomosis during laparoscopic anterior resection of upper rectal or sigmoid colon cancer with trans-rectal natural orifice specimen extraction (NOSE). Methods: From June 2015 and May 2016, patients with upper-rectal or sigmoid colon cancer who received treatment in Shanghai East Hospital were enrolled. Preoperative and postoperative clinical variables were analyzed and compared between groups. Postoperative pain was analyzed utilizing a visual analog scale (VAS). Postoperative overall survival was analyzed using a K-M curve. Results: A total of 99 colorectal cancer cases were randomly divided into NOSE with novel method group (NOSE, n=48) and conventional laparoscopic group (non-NOSE, n=51). No statistically significant differences in preoperative demographics of the patients as sex, age, body mass index were found among the groups. The NOSE group had the longer operation time, but less blood loss than the non-NOSE group. The NOSE group had no abdominal incision and the lower postoperative VAS score. The time for intestinal function recovery and the length of hospital stay (LOS) was statistically significantly different, with the non-NOSE group having the longer time. The incidence of postoperative complications was lower in NOSE group (5/48, 10.4%) than in the non-NOSE group (8/51, 15.7%), the difference was statistically significant. The K-M survival curve showed no statistically significant difference in the disease free survival rate between the NOSE group and non-NOSE group. Conclusion: NOSE with novel method is safe and feasible to use in patients having colorectal cancer. Compared with traditional laparoscopic surgery, the postoperative complication rates of NOSE surgery were lower with an improved short-term clinical recovery.

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Robotic natural orifice specimen extraction surgery versus traditional robotic-assisted surgery (NOTR) for patients with colorectal cancer: a study protocol for a randomized controlled trial

Trials ◽

10.1186/s13063-021-05077-z ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Rui Luo ◽

Fangfang Zheng ◽

Haobo Zhang ◽

Weiquan Zhu ◽

Penghui He ◽

...

Keyword(s):

Colorectal Cancer ◽

Randomized Controlled Trial ◽

Controlled Trial ◽

Natural Orifice ◽

Specimen Extraction ◽

Natural Orifice Specimen Extraction ◽

Robotic Assisted ◽

Randomized Controlled ◽

Robotic Assisted Surgery ◽

Secondary Outcomes

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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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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Role of robotic natural orifice specimen extraction surgery in colorectal neoplasms

Scientific Reports ◽

10.1038/s41598-021-89323-z ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Hongliang Yao ◽

Tiegang Li ◽

Weidong Chen ◽

Sanlin Lei ◽

Kuijie Liu ◽

...

Keyword(s):

Colorectal Neoplasms ◽

Average Distance ◽

Neoadjuvant Chemoradiotherapy ◽

Operation Time ◽

Patient Characteristics ◽

Safe Procedure ◽

Natural Orifice ◽

Specimen Extraction ◽

Natural Orifice Specimen Extraction

AbstractNatural orifice specimen extraction surgery (NOSES) is especially suitable for colorectal surgery. Until now, most of the reports published were about laparoscopic NOSES, the reports about robotic NOSES are extremely rare. This study aims to explore the safety and feasibility of robotic NOSES for colorectal neoplasms. All patients underwent robotic NOSES from March 2016 to October 2019 in our hospital were enrolled for retrospective analysis. Clinicopathological data including patient characteristics, perioperative information and pathological information were collected and analyzed. According to the distance between tumor and anus or whether neoadjuvant chemoradiotherapy (nRCT) is performed, we grouped the cases and studied its influence on robotic NOSES. Also, we compared the previous reports on laparoscopic NOSES with our study and revealed advantages of robotic NOSES in terms of safety and feasibility. A total of 180 patients were enrolled. The average distance from the lower edge of the tumor to the anus was (8.64 ± 3.64) cm and maximum circumferential diameter (CDmax) of specimen was (3.5 ± 1.6) cm. In terms of safety, the average operation time, intraoperative blood loss, and postoperative hospital stay were (187.5 ± 78.3) min, (47.4 ± 34) mL, and (11.3 ± 7.5) days, respectively. In terms of feasibility, the average number of lymph node harvested was (14.8 ± 5). Robotic NOSES shows advantages in terms of safety and feasibility compared with laparoscopic NOSES. This procedure could not only be a safe procedure but also could achieve good oncological outcomes.

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