Department of General Surgery, Ospedale per gli Infermi di Faenza, 48018, Faenza, Italy.
Department of General Surgery, Queen Elisabeth University Hospital, Birmingham, UK.
Tech Coloproctol. 2018 Jun;22(6):411-423. doi: 10.1007/s10151-018-1806-1. Epub 2018 Jun 12.
Full laparoscopic left colectomy with transrectal specimen extraction is proposed as an improvement of the minimally invasive surgical technique. This paper reviews in detail the current status of left-sided colectomy and upper rectum resection with transrectal specimen extraction.
A systematic review was performed of all types of publications on colorectal resection with natural orifice specimen extraction (NOSE). We only included studies reporting on left colectomy, sigmoidectomy, and high anterior resection with transrectal specimen extraction (TRSE), excluding transanal (TASE), transvaginal, or transcolonic specimen extraction. Surgical techniques, patient characteristics, and outcomes were reviewed in detail.
Thirty-five papers reported on TRSE (2 randomized clinical trials, 7 case-matched series, 19 case series, 5 case reports, and 2 articles on surgical technique). We found a wide variety of innovative anastomotic and specimen extraction techniques. After excluding duplicates and papers reporting mixed TRSE and TASE results, outcomes in patients undergoing TRSE from 23 publications showed a conversion rate to conventional laparoscopy of 3.7% (21/559), overall morbidity 9.5% (53/559) [major in 2.9% (16/559), intra-abdominal infection in 2.1% (12/559)]. No mortality was reported. Postoperative anal incontinence was rarely reported. Several studies showed a decrease in postoperative pain and some in length of hospital stay.
Colectomy with TRSE is feasible and seems safe in selected patients. Reported outcomes seem in general similar to conventional laparoscopic colectomy with a possible benefit in postoperative pain and length of hospital stay. Obvious selection bias and lack of high quality trials do not allow firm conclusions to be drawn.
全腹腔镜左半结肠切除术联合经直肠标本取出术被提议作为微创外科技术的改进。本文详细回顾了经直肠标本取出术治疗左半结肠和高位直肠的现状。
对所有经自然腔道取标本（NOSE）结直肠切除术的出版物进行了系统回顾。我们仅纳入了经直肠标本取出术（TRSE）行左半结肠切除术、乙状结肠切除术和高位前切除术的研究，排除经肛门（TASE）、经阴道或经结肠标本取出术。详细回顾了手术技术、患者特征和结果。
35 篇文献报道了 TRSE（2 项随机临床试验、7 项病例匹配研究、19 项病例系列研究、5 项病例报告和 2 项手术技术文章）。我们发现了各种各样的创新吻合和标本取出技术。排除重复和混合 TRSE 和 TASE 结果的论文后，23 项出版物中接受 TRSE 的患者的结局显示，转换为传统腹腔镜的比例为 3.7%（21/559），总发病率为 9.5%（53/559）[主要发病率为 2.9%（16/559），腹腔内感染为 2.1%（12/559）]。没有报告死亡率。术后肛门失禁很少报道。一些研究表明术后疼痛减轻，一些研究表明住院时间缩短。
在选择的患者中，TRSE 行结肠切除术是可行且安全的。报告的结果总体上似乎与传统腹腔镜结肠切除术相似，可能在术后疼痛和住院时间方面有获益。明显的选择偏倚和缺乏高质量的试验不允许得出明确的结论。
