Ng Zi Qin, Lokuhetty Naradha, Macdonald Chloe, Warrier Satish
Department of Colorectal Surgery, The Alfred, Melbourne, Australia.
Turk J Surg. 2025 May 30;41(2):204-211. doi: 10.47717/turkjsurg.2025.6738. Epub 2025 May 13.
Natural orifice specimen extraction surgery (NOSE) is an extension of minimally invasive colorectal surgery. NOSE was introduced into the unit in January 2024 in selected group of patients. The aim of this study was to evaluate the initial experience of NOSE surgery in minimally invasive surgery colorectal surgery in terms of feasibility and safety outcomes. Prospective data was collated for all cases of NOSE in colorectal surgery from Jan 2024 to Dec 2024. Data collected included patient demographics, comorbidities, underlying pathology, pre-, intra- and post-operative outcomes. There were 17 cases considered for NOSE surgery. Eight cases had successful transvaginal NOSE and six cases had successful transanal NOSE. The median age was 68.5 years (range 36-87 years). The median ASA was 3 (range 1-4). All the transvaginal NOSE were performed with laparoscopic right hemicolectomy for neoplasia. Of the six transanal NOSE, four were performed for benign and two for malignant indications. There were no intraoperative complications with no conversion to open surgery. There were no post-operative complications especially anastomotic leak, ileus, wound infection, and extraction-site related complications in transvaginal NOSE cases. There was one anastomotic leak in transanal NOSE that required laparoscopic washout and defunctioning ileostomy. All the neoplasia cases achieved satisfactory oncological outcomes (R0 resection & adequate lymph node yield). The median follow-up was 6 months (range 2-11). The early experience of NOSE in colorectal surgery is safe and feasible in well selected group of patients. It avoids abdominal wall trauma from extraction with reduction of wound infection, pain and long-term risk of incisional hernia.
经自然腔道标本取出手术（NOSE）是微创结直肠手术的延伸。2024年1月，该手术被引入本单位，并应用于特定患者群体。本研究的目的是从可行性和安全性结果方面评估NOSE手术在微创结直肠手术中的初步经验。收集了2024年1月至2024年12月期间所有结直肠手术中NOSE病例的前瞻性数据。收集的数据包括患者人口统计学信息、合并症、基础病理、术前、术中和术后结果。共有17例患者考虑接受NOSE手术。8例经阴道NOSE手术成功，6例经肛门NOSE手术成功。中位年龄为68.5岁（范围36 - 87岁）。中位美国麻醉医师协会（ASA）分级为3级（范围1 - 4级）。所有经阴道NOSE手术均采用腹腔镜右半结肠切除术治疗肿瘤。在6例经肛门NOSE手术中，4例用于良性病变，2例用于恶性病变。术中无并发症，无需转为开放手术。经阴道NOSE手术病例术后无并发症，尤其是吻合口漏、肠梗阻、伤口感染和取出部位相关并发症。经肛门NOSE手术中有1例吻合口漏，需要进行腹腔镜冲洗和回肠造口转流术。所有肿瘤病例均取得了满意的肿瘤学结果（R0切除及足够的淋巴结清扫）。中位随访时间为6个月（范围2 - 11个月）。在精心挑选的患者群体中，结直肠手术中NOSE的早期经验是安全可行的。它避免了因标本取出导致的腹壁创伤，减少了伤口感染、疼痛和切口疝的长期风险。
