A Review of the Role of Natural Orifice Specimen Extraction Surgery in Laparoscopic Colorectal Surgery

Abstract

Context: The inclusion of minimally invasive techniques to colorectal surgery brought many advantages to patient’s recovery. However, conventional techniques for laparoscopic-assisted colectomy (LAC) still require a small abdominal incision for specimen extraction. Evidence acquisition: The present manuscript aimed to review the technical details, results and advantages of colorectal resections using different approaches to extract the resected specimen, including the abdominal wall, the vagina or the rectum. In order to analyse this data, we searched the literature for recent and important results concerning the use of different approaches to extract the specimen in minimally invasive colorectal procedures. Results: Besides the proved feasibility and safety associated with the Natural Orifice Specimen Extraction Surgery (NOSES) in colorectal surgery, there remain some unresolved issues to be unified and standardized. These issues are mainly represented by surgical technique and indications. Morbidity is not a common problem, although potentially there may be complications to affect quality of life. Conclusions: So far, the most important indication remains the management of intestinal endometriosis, as it is not a malignant disease and the specimen is not too large. Nevertheless, surgical experience and appropriate counselling are fundamental requirements when dealing with cancer patients. Eventual complications should be discussed with patients

Keywords

• laparoscopy
• colorectal cancer
• minimally invasive surgery
• natural orifice specimen extraction surgery (noses)
• incisional hernia