Ahmad Nasir Zaheer, Swayamjoti Ray, Flashman Karen, Naqvi Syed Abul Hassan, Khan Jim
Department of General Surgery, University Hospital Limerick, Limerick, Ireland.
Department of Colorectal Surgery, Queen Alexandra Hospital, Portsmouth, United Kingdom.
Surg J (N Y). 2021 Aug 3;7(3):e203-e208. doi: 10.1055/s-0041-1733833. eCollection 2021 Jul.
Minimal access surgery is associated with improved cosmetic and other short-term outcomes. Conventionally, an abdominal incision is made for specimen extraction. We assessed the feasibility of specimen extraction through one of the natural orifices and analyzed its impact on short-term outcomes. A prospectively collected data were reviewed on consecutive patients who underwent natural orifice specimen extraction (NOSE) after laparoscopic colorectal surgery. The results were compared with a matched group who had transabdominal extraction (TAE) of the specimens. A systematic literature review was performed to compare our results. The combined median operating time for right and left colectomies was significantly higher in the NOSE group as compared with TAE group (260 vs. 150). There was no mortality in either group and no conversions to TAE in the NOSE group. No local metastasis or major iatrogenic injuries were reported at the time of retrieval. The results were comparable to those of a meta-analysis of randomized controlled trials. The results of NOSE are comparable to those of TAEs. The absence of a minilaparotomy for specimen extraction may lead to a speedy recovery and better cosmesis.
微创手术与改善美容效果及其他短期预后相关。传统上，需做腹部切口来取出标本。我们评估了通过自然腔道之一取出标本的可行性，并分析了其对短期预后的影响。
回顾前瞻性收集的连续接受腹腔镜结直肠手术后经自然腔道标本取出术（NOSE）患者的数据。将结果与经腹部取出标本（TAE）的匹配组进行比较。进行系统的文献综述以比较我们的结果。
与TAE组相比，NOSE组右半结肠切除术和左半结肠切除术的联合中位手术时间显著更长（260分钟对150分钟）。两组均无死亡病例，NOSE组无转为TAE的情况。取出标本时未报告局部转移或重大医源性损伤。结果与随机对照试验的荟萃分析结果相当。
NOSE的结果与TAE的结果相当。无需做小切口取出标本可能会带来更快的恢复和更好的美容效果。
