Department of General Surgery, The Second Xiangya Hospital of Central South University, Changsha, 410011, China.
Sci Rep. 2021 May 10;11(1):9818. doi: 10.1038/s41598-021-89323-z.
Natural 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.
经自然腔道取标本手术（NOSES）尤其适用于结直肠手术。到目前为止，大多数发表的报告都是关于腹腔镜下的 NOSES，而关于机器人辅助下的 NOSES 的报告极为罕见。本研究旨在探讨机器人辅助下结直肠肿瘤 NOSES 的安全性和可行性。我们回顾性分析了 2016 年 3 月至 2019 年 10 月期间在我院接受机器人辅助下 NOSES 的所有患者。收集并分析了包括患者特征、围手术期信息和病理信息在内的临床病理数据。根据肿瘤距肛门的距离和是否进行新辅助放化疗（nRCT），我们对病例进行分组，并研究其对机器人辅助下 NOSES 的影响。同时，我们将之前的腹腔镜下 NOSES 报告与我们的研究进行比较，揭示了机器人辅助下 NOSES 在安全性和可行性方面的优势。共纳入 180 例患者。肿瘤下缘至肛门的平均距离为（8.64±3.64）cm，标本最大环周直径（CDmax）为（3.5±1.6）cm。在安全性方面，平均手术时间、术中出血量和术后住院时间分别为（187.5±78.3）min、（47.4±34）mL 和（11.3±7.5）d。在可行性方面，平均淋巴结检出数为（14.8±5）枚。与腹腔镜下 NOSES 相比，机器人辅助下 NOSES 具有明显的优势。这种方法不仅安全，而且可以获得良好的肿瘤学结果。
