BACKGROUND Natural orifice specimen extraction surgery(NOSES)has emerged as a promising alternative compared to conventional laparoscopic-assisted total gastrectomy(LATG)for treating gastric cancer(GC).However,evidenc...BACKGROUND Natural orifice specimen extraction surgery(NOSES)has emerged as a promising alternative compared to conventional laparoscopic-assisted total gastrectomy(LATG)for treating gastric cancer(GC).However,evidence regarding the efficacy and safety of NOSES for GC surgery is limited.This study aimed to compare the safety and feasibility,in addition to postoperative complications of NOSES and LATG.METHODS Dual circular staplers were used in Roux-en-Y digestive tract reconstruction for transvaginal specimen extraction LATG,and its outcomes were compared with LATG in a cohort of 51 GC patients with tumor size≤5 cm.The study was conducted from May 2018 to September 2020,and patients were categorized into the NOSES group(n=22)and LATG group(n=29).Perioperative parameters were compared and analyzed,including patient and tumor characteristics,postoperative outcomes,and anastomosis-related complications,postoperative hospital stay,the length of abdominal incision,difference in tumor type,postoperative complications,and postoperative survival.RESULTS Postoperative exhaust time,operation duration,mean postoperative hospital stay,length of abdominal incision,number of specific staplers used,and Brief Illness Perception Questionnaire score were significant in both groups(P<0.01).In the NOSES group,the postoperative time to first flatus,mean postoperative hospital stay,and length of abdominal incision were significantly shorter than those in the LATG group.Patients in the NOSES group had faster postoperative recovery,and achieved abdominal minimally invasive incision that met aesthetic requirements.There were no significant differences in gender,age,tumor type,postoperative complications,and postoperative survival between the two groups.CONCLUSION The application of dual circular staplers in Roux-en-Y digestive tract reconstruction combined with NOSES gastrectomy is safe and convenient.This approach offers better short-term outcomes compared to LATG,while long-term survival rates are comparable to those of conventional laparoscopic surgery.展开更多
BACKGROUND Robotic resection using the natural orifice specimen extraction surgery I-type F method(R-NOSES I-F)is a novel minimally invasive surgical strategy for the treatment of lower rectal cancer.However,the curre...BACKGROUND Robotic resection using the natural orifice specimen extraction surgery I-type F method(R-NOSES I-F)is a novel minimally invasive surgical strategy for the treatment of lower rectal cancer.However,the current literature on this method is limited to case reports,and further investigation into its safety and feasibility is warranted.AIM To evaluate the safety and feasibility of R-NOSES I-F for the treatment of low rectal cancer.METHODS From September 2018 to February 2022,206 patients diagnosed with low rectal cancer at First Affiliated Hospital of Nanchang University were included in this retrospective analysis.Of these patients,22 underwent R-NOSES I-F surgery(RNOSES I-F group)and 76 underwent conventional robotic-assisted low rectal cancer resection(RLRC group).Clinicopathological data of all patients were collected and analyzed.Postoperative outcomes and prognoses were compared between the two groups.Statistical analysis was performed using SPSS software.RESULTS Patients in the R-NOSES I-F group had a significantly lower visual analog score for pain on postoperative day 1(1.7±0.7 vs 2.2±0.6,P=0.003)and shorter postoperative anal venting time(2.7±0.6 vs 3.5±0.7,P<0.001)than those in the RLRC group.There were no significant differences between the two groups in terms of sex,age,body mass index,tumor size,TNM stage,operative time,intrao-perative bleeding,postoperative complications,or inflammatory response(P>0.05).Postoperative anal and urinary functions,as assessed by Wexner,low anterior resection syndrome,and International Prostate Symptom Scale scores,were similar in both groups(P>0.05).Long-term follow-up revealed no significant differences in the rates of local recurrence and distant metastasis between the two groups(P>0.05).CONCLUSION R-NOSES I-F is a safe and effective minimally invasive procedure for the treatment of lower rectal cancer.It improves pain relief,promotes gastrointestinal function recovery,and helps avoid incision-related complications.展开更多
AIM: To investigate whether transanal natural orifice specimen extraction (NOSE) is a better technique for rectal cancer resection.METHODS: A prospectively designed database of a consecutive series of patients undergo...AIM: To investigate whether transanal natural orifice specimen extraction (NOSE) is a better technique for rectal cancer resection.METHODS: A prospectively designed database of a consecutive series of patients undergoing laparoscopic low anterior resection for rectal cancer with various tumor-node-metastasis classi?cations from March 2011 to February 2012 at the First Affiliated Hospital of Sun Yat-Sen University was analyzed. Patient selection for transanal specimen extraction and intracorporeal anastomosis was made on the basis of tumor size and distance of rectal lesions from the anal verge. Demographic data, operative parameters, and postoperative outcomes were assessed.RESULTS: None of the patients was converted to laparotomy. Respectively, there were 16 cases in the low anastomosis and five in the ultralow anastomosis groups. Mean age of the patients was 45.4 years, and mean body mass index was 23.1 kg/m2. Mean distance of the lower edge of the lesion from the anal verge was 8.3 cm. Mean operating time was 132 min, and mean intraoperative blood loss was 84 mL. According to the principle of rectal cancer surgery, we performed D2 lymph node dissection in 13 cases and D3 in eight. Mean lymph nodes harvest was 17.8, and the number of positive lymph nodes was 3.4. Median hospital stay was 6.7 d. No serious postoperative complication occurred except for one anastomotic leakage. All patients remained disease free. Mean Wexner score was 3.7 at 11 mo after the operation.CONCLUSION: Transanal NOSE for total laparoscopic low/ultralow anterior resection is feasible, safe and oncologically sound. Further studies with long-term outcomes are needed to explore its potential advantages.展开更多
AIM:To introduce transvaginal or transanal specimen extraction in laparoscopic total mesorectal excision surgery to avoid an abdominal incision. METHODS:Between January 2009 and December 2011,21 patients with rectal c...AIM:To introduce transvaginal or transanal specimen extraction in laparoscopic total mesorectal excision surgery to avoid an abdominal incision. METHODS:Between January 2009 and December 2011,21 patients with rectal cancer underwent laparoscopic radical resection and the specimen was retrieved by two different ways:transvaginal or transanal rectal removal.Transvaginal specimen extraction approach was strictly limited to elderly post-menopausal women who need hysterectomy.Patients aged between 30 and 80 years,with a body mass index of less than 30 kg/m2, underwent elective surgery.The surgical technique and the outcomes related to the specimen extraction,such as duration of surgery,length of hospital stay,and the complications were retrospectively reviewed. RESULTS:Laparoscopic resection using a natural orifice removal approach was successful in all of the 21 patients.Median operating time was 185 min(range,122-260 min)and the estimated blood loss was 48 mL. The mean length of hospital stay was 7.5 d(range,2-11 d).One patient developed postoperative ileus and had an extended hospital stay.The patient complained of minimal pain.There were no postoperative complications or surgery-associated death.The mean size of the lesion was 2.8 cm(range,1.8-6.0 cm),and the mean number of lymph nodes harvested was 18.7(range, 8-27).At a mean follow-up of 20.6 mo(range,10-37 mo),there were no functional disorders associated with the transvaginal and transanal specimen extraction. CONCLUSION:Transvaginal or transanal extraction in L-TME is a safe and effective procedure.Natural orifice specimen extraction can avoid the abdominal wall incision and its potential complications.展开更多
AIM: To describe the application of complete robotic gastrectomy with transvaginal specimen extraction(TVSE) for gastric cancer patients.METHODS: Between July and November 2014, eight female patients who were diagnose...AIM: To describe the application of complete robotic gastrectomy with transvaginal specimen extraction(TVSE) for gastric cancer patients.METHODS: Between July and November 2014, eight female patients who were diagnosed with gastric adenocarcinoma underwent a TVSE following a full robot-sewn gastrectomy. According to the tumor location, the patients were allocated to two different groups; two patients received robotic total gastrectomy with TVSE and the other six received robotic distal gastrectomy with TVSE.RESULTS: Surgical procedures were successfully performed in all eight cases without conversion. The mean age was 55.3(range, 42-69) years, and the mean body mass index was 23.2(range, 21.6-26.0) kg/m2. The mean total operative time and blood loss were 224(range, 200-298) min and 62.5(range, 50-150) m L, respectively. The mean postoperative hospital stay was 3.6(range, 3-5) d. The mean number of lymph nodes resected was 23.6(range, 17-27). None was readmitted within 30 d of postoperation. During the follow-up, no stricture developed nor was any anastomotic leakage detected.CONCLUSION: It is possible to perform a TVSE following a full robot-sewn gastrectomy with standard D2 lymph node resection for female gastric cancer patients.展开更多
AIM: To investigate how complete laparoscopic anterior resection with natural orifice specimen extraction (NOSE), as a novel minimally invasive surgery, compares to conventional laparoscopic surgery.
BACKGROUND This case-control study compared the short-term clinical efficacy of natural orifice specimen extraction surgery(NOSES) using a prolapsing technique and the conventional laparoscopic-assisted approach for l...BACKGROUND This case-control study compared the short-term clinical efficacy of natural orifice specimen extraction surgery(NOSES) using a prolapsing technique and the conventional laparoscopic-assisted approach for low rectal cancer.AIM To further explore the application value of the transanal placement of the anvil and to evaluate the short-term efficacy of NOSES for resecting specimens of low rectal cancer, as well as to provide a theoretical basis for its extensive clinical application.METHODS From June 2015 to June 2018, 108 consecutive laparoscopic-assisted low rectal cancer resections were performed at our center. Among them, 26 specimens were resected transanally using a prolapsing technique(NOSES), and 82 specimens were resected through a conventional abdominal wall small incision(LAP). A propensity score matching method was used to select 26 pairs of matched patients, and their perioperative data were analyzed.RESULTS The baseline data were comparable between the two matched groups. All 52 patients underwent the surgery successfully. The operative time, blood loss,number of harvested lymph nodes, postoperative complication rate,circumferential margin involvement, postoperative follow-up data, and postoperative anal function were not statistically significant. The NOSES group had shorter time to gastrointestinal function recovery(2.6 ± 1.0 d vs 3.4 ± 0.9 d, P= 0.006), shorter postoperative hospital stay(7.1 ± 1.7 d vs 8.3 ± 1.1 d, P = 0.003),lower pain score(day 1: 2.7 ± 1.8 vs 4.6 ± 1.9, day 3: 2.0 ± 1.1 vs 4.1 ± 1.2, day 5: 1.7± 0.9 vs 3.3 ± 1.0, P < 0.001), a lower rate of additional analgesic use(11.5% vs61.5%, P = 0.001), and a higher satisfaction rate in terms of the aesthetic appearance of the abdominal wall after surgery(100% vs 23.1%, P < 0.001).CONCLUSION NOSES for low rectal cancer can achieve satisfactory short-term efficacy and has advantages in reducing postoperative pain, shortening the length of postoperative hospital stay, and improving patients' satisfaction in terms of a more aesthetic appearance of the abdominal wall.展开更多
Over the last 20 years, laparoscopic colorectal surgery has shown equal efficacy for benign and malignant colorectal diseases when compared to open surgery. However, a laparoscopic approach reduces postoperative morbi...Over the last 20 years, laparoscopic colorectal surgery has shown equal efficacy for benign and malignant colorectal diseases when compared to open surgery. However, a laparoscopic approach reduces postoperative morbidity and shortens hospital stay. In the quest to optimize outcomes after laparoscopic colorectal surgery, reduction of access trauma could be a way to improve recovery. To date, one method to reduce access trauma is natural orifice specimen extraction(NOSE). NOSE aims to reduce access trauma in laparoscopic colorectal surgery. The specimen is delivered via a natural orifice and the anastomosis is created intracorporeally. Different methods are used to extract the specimen and to create a bowel anastomosis. Currently, specimens are delivered transcolonically, transrectally, transanally, or transvaginally. Each of these NOSEprocedures raises specific issues with regard to operative technique and application. The presumed benefits of NOSE-procedures are less pain, lower analgesia requirements, faster recovery, shorter hospital stay, better cosmetic results, and lower incisional hernia rates. Avoidance of extraction site laparotomy is the most important characteristic of NOSE. Concerns associated with the NOSE-technique include bacterial contamination of the peritoneal cavity, inflammatory response, and postoperative outcomes, including postoperative pain and the functional and oncologic outcomes. These issues need to be studied in prospective randomized controlled trials. The aim of this systematic review is to describe the role of NOSE in minimally invasive colorectal surgery.展开更多
Objective:The transanal approach to specimen collection,combined with the prolapsing technique,is a wellestablished and minimally invasive surgery for treating rectal cancer.However,reports on outcomes for this approa...Objective:The transanal approach to specimen collection,combined with the prolapsing technique,is a wellestablished and minimally invasive surgery for treating rectal cancer.However,reports on outcomes for this approach are sparse.We compared short-and long-term outcomes of conventional laparoscopic surgery(CLS)vs.transanal natural orifice specimen extraction(NOSE)using the prolapsing technique for patients with middle-to low-rectal cancer.Methods:From January 2013 to December 2017,we enrolled consecutive patients with middle-to low-rectal cancer undergoing laparoscopic anterior resection.Totally,50 patients who underwent transanal NOSE using the prolapsing technique were matched with 50 patients who received CLS.Clinical parameters and survival outcomes between the two groups were compared.Results:Estimated blood loss(29.70±29.28 vs.52.80±45.09 mL,P=0.003),time to first flatus(2.50±0.79 vs.2.86±0.76,P=0.022),time to liquid diet(3.62±0.64 vs.4.20±0.76 d,P<0.001),and the need for analgesics(22%vs.48%,P=0.006)were significantly lower for the NOSE group compared to the CLS group.The incidences of overall complications and fecal incontinence were comparable in both groups.After a median follow-up of 44.52 months,the overall local recurrence rate(6%vs.5%,P=0.670),3-year disease-free survival(86.7%vs.88.0%,P=0.945)and 3-year overall survival(95.6%vs.96.0%,P=0.708),were not significantly different.Conclusions:For total laparoscopic rectal resection,transanal NOSE using the prolapsing technique is effective and safe,and associated with less trauma and pain,a faster recovery,and similar survival outcomes compared to CLS.展开更多
BACKGROUND This article introduces the surgical method and early experience in performing totally laparoscopic radical gastrectomy with transrectal specimen extraction for gastric cancer, and we evaluate the short-ter...BACKGROUND This article introduces the surgical method and early experience in performing totally laparoscopic radical gastrectomy with transrectal specimen extraction for gastric cancer, and we evaluate the short-term effects and feasibility of this new procedure for gastric cancer in a 64-year-old male patient. This approach may provide new possibilities for gastric natural orifice specimen extraction(NOSE)surgery. In addition, we believe that this new procedure may further relieve pain,speed up recovery, and cause minimal physiological and psychological impact.CASE SUMMARY We performed NOSE gastrectomy in a male patient. Tumor resection, digestive tract reconstruction, and lymph node dissection were performed totally laparoscopically;the specimen was extracted from the natural orifice of the rectum-anus. This procedure reduced damage to the abdominal wall and decreased postoperative pain. We successfully performed radical gastrectomy without conversion and complications. Total operative time and blood loss were 176 min and 50 m L, respectively. The patient resumed normal activities of daily living on day 1 without pain, and passed flatus within 48 h. Postoperative hospital stay was 10 d. The number of resected lymph nodes was 0/43. During the follow-up, no stricture or anastomotic leakage was detected. Three months postoperatively, colonoscopy showed full recovery of the rectum without stricture or scar contracture. Computed tomography and laboratory test results showed no signs of tumor recurrence. There was no visible scar on the abdominal wall.CONCLUSION It is safe and reliable to perform totally laparoscopic radical gastrectomy with transrectal specimen extraction for distal gastric cancer patients.展开更多
BACKGROUND Natural orifice specimen extraction(NOSE)via the anus or vagina replaces conventional transabdominal specimen retrieval via the transabdominal route through a limited mid-line laparotomy or Pfannenstiel inc...BACKGROUND Natural orifice specimen extraction(NOSE)via the anus or vagina replaces conventional transabdominal specimen retrieval via the transabdominal route through a limited mid-line laparotomy or Pfannenstiel incision.Reducing the number of laparoscopic ports further decreases operative abdominal wall trauma.These techniques reduce the surgical wound size as well as the risk of incisionrelated morbidity.AIM To compare short-term outcomes following 3-port NOSE surgery with a matched cohort of conventional non-NOSE colorectal cancer surgery.METHODS Patients who underwent elective 3-port laparoscopic colorectal NOSE surgery between February to October 2021 were identified.Selection criteria for NOSE surgery was adapted from the 2019 International Consensus on Natural Orifice Specimen Extraction Surgery for colorectal cancer.Patients with clinical T4 or N2 tumors on staging computed tomography were also excluded.The propensity score-matched cohort was identified amongst patients who underwent conventional laparoscopic colorectal surgery from January 2019 to December 2020.Matching was performed in the ratio of 1:4 based on age,gender,type of resection,and p-tumor node metastasis staging.RESULTS Over the eight-month study duration,14 consecutive cases(nine female,five male)of elective 3-port laparoscopic surgery with NOSE were performed for colorectal cancer.Median age and body mass index were 70(range 43-82)years and 24.1(range 20.0-31.7)kg/m2 respectively.Six patients underwent transanal NOSE and eight had transvaginal NOSE.Median operative time,intraoperative blood loss and postoperative length of stay were 208(range 165-365)min,30(range 10-150)mL and 3(range 2-6)d respectively.Two(14%)suffered minor postoperative compilations not attributable to the NOSE procedure.Median follow-up duration was 12(range 8-15)mo.No instances of mortality,local or distant disease recurrence were recorded in this cohort.Compared to the conventional surgery cohort of 56 patients,the 3-port NOSE cohort had significantly quicker mean return of bowel function(2.6 vs 1.2 d,P<0.001),reduced postoperative pain and patientcontrolled analgesia use,and decreased length of hospital stay(6.4 vs 3.4 d,P<0.001).There were no statistical differences in surgical duration and perioperative complication rates between the NOSE and non-NOSE cohorts.CONCLUSION 3-port laparoscopic colorectal surgery with NOSE is a feasible technique,augmenting the minimally invasive nature of surgery and producing good outcomes.Appropriate patient selection and expertise in conventional laparoscopy are required.展开更多
In recent years,natural orifice specimen extraction surgery(NOSES),a novel minimally invasive surgical technique,has become a focus in the surgical field,and has been initially applied in gastric surgery in many natio...In recent years,natural orifice specimen extraction surgery(NOSES),a novel minimally invasive surgical technique,has become a focus in the surgical field,and has been initially applied in gastric surgery in many national medical centers worldwide.In addition,this new surgical technique was launched in major hospitals in China.With an increasing number of patients who have accepted this new surgical technique,NOSES has provided new prospects for the treatment of gastric cancer(GC),which may achieve a better outcome for both patients and surgeons.More and more experts and scholars from different countries and regions are currently paying close attention to NOSES for the treatment of GC.However,there are only a few reports of its use in GC.This review focuses on the research progress in NOSES for radical gastrectomy in recent years.We also discuss the challenges and prospects of NOSES in clinical practice.展开更多
Objective:To investigate the effect of 3D laparoscopic natural orifice specimen extraction surgery as rectal cancer treatment.Methods:The study was carried out in Shaanxi Provincial People’s Hospital from July 2021 t...Objective:To investigate the effect of 3D laparoscopic natural orifice specimen extraction surgery as rectal cancer treatment.Methods:The study was carried out in Shaanxi Provincial People’s Hospital from July 2021 to July 2022.80 rectal cancer patients were selected and divided into two groups which are the experimental group and control group.The experimental group was given 3D laparoscopic surgery while the control group was given 2D laparoscopic surgery.The results were compared and analysed.Results:The patients in the experimental group had shorter operative and evacuation times,less intraoperative bleeding,and a lower rate of complications.Conclusion:The clinical application of 3D laparoscopic radical surgery for rectal cancer via natural lumen extraction is more effective,which can promote patients'recovery and reduce the incidence of adverse events.展开更多
Objective To investigate the appropriate incision for intact specimen extraction during retroperitoneoscopic radical nephrectomy. Methods One hundred and nineteen patients in need of retroperitoneoscopic radical nephr...Objective To investigate the appropriate incision for intact specimen extraction during retroperitoneoscopic radical nephrectomy. Methods One hundred and nineteen patients in need of retroperitoneoscopic radical nephrectomy were randomized into two groups. One group of 60 patients received intact specimen extraction展开更多
[Objective]The aim was to find out the optimal methods for extracting DNA from dried butterfly specimen.[Method]A total of five methods including SDS method,SDS-mercaptoethanol-phenol method,CTAB method,saturated NaCl...[Objective]The aim was to find out the optimal methods for extracting DNA from dried butterfly specimen.[Method]A total of five methods including SDS method,SDS-mercaptoethanol-phenol method,CTAB method,saturated NaCl method,SDS-mercaptoethanol-chloroform methods were employed to extract DNA from dried butterfly specimen.[Result]SDS-mercaptoethanol-phenol method,saturated NaCl method and SDS-mercaptoethanol-chloroform method were suitable for genomic DNA extraction from dried butterfly samples,and the DNA extracted can be successfully applied to the PCR amplification of butterfly mitochondrial COI,EF-1α and CytB genes.[Conclusion]SDS-mercaptoethanol-phenol method,saturated NaCl method and SDS-mercaptoethanol-chloroform method can be used to study the extraction of DNA from dried butterfly samples,which laid foundation for study on molecular phylogenetics of butterfly.展开更多
文摘BACKGROUND Natural orifice specimen extraction surgery(NOSES)has emerged as a promising alternative compared to conventional laparoscopic-assisted total gastrectomy(LATG)for treating gastric cancer(GC).However,evidence regarding the efficacy and safety of NOSES for GC surgery is limited.This study aimed to compare the safety and feasibility,in addition to postoperative complications of NOSES and LATG.METHODS Dual circular staplers were used in Roux-en-Y digestive tract reconstruction for transvaginal specimen extraction LATG,and its outcomes were compared with LATG in a cohort of 51 GC patients with tumor size≤5 cm.The study was conducted from May 2018 to September 2020,and patients were categorized into the NOSES group(n=22)and LATG group(n=29).Perioperative parameters were compared and analyzed,including patient and tumor characteristics,postoperative outcomes,and anastomosis-related complications,postoperative hospital stay,the length of abdominal incision,difference in tumor type,postoperative complications,and postoperative survival.RESULTS Postoperative exhaust time,operation duration,mean postoperative hospital stay,length of abdominal incision,number of specific staplers used,and Brief Illness Perception Questionnaire score were significant in both groups(P<0.01).In the NOSES group,the postoperative time to first flatus,mean postoperative hospital stay,and length of abdominal incision were significantly shorter than those in the LATG group.Patients in the NOSES group had faster postoperative recovery,and achieved abdominal minimally invasive incision that met aesthetic requirements.There were no significant differences in gender,age,tumor type,postoperative complications,and postoperative survival between the two groups.CONCLUSION The application of dual circular staplers in Roux-en-Y digestive tract reconstruction combined with NOSES gastrectomy is safe and convenient.This approach offers better short-term outcomes compared to LATG,while long-term survival rates are comparable to those of conventional laparoscopic surgery.
基金National Natural Science Foundation of China,No.81860519.
文摘BACKGROUND Robotic resection using the natural orifice specimen extraction surgery I-type F method(R-NOSES I-F)is a novel minimally invasive surgical strategy for the treatment of lower rectal cancer.However,the current literature on this method is limited to case reports,and further investigation into its safety and feasibility is warranted.AIM To evaluate the safety and feasibility of R-NOSES I-F for the treatment of low rectal cancer.METHODS From September 2018 to February 2022,206 patients diagnosed with low rectal cancer at First Affiliated Hospital of Nanchang University were included in this retrospective analysis.Of these patients,22 underwent R-NOSES I-F surgery(RNOSES I-F group)and 76 underwent conventional robotic-assisted low rectal cancer resection(RLRC group).Clinicopathological data of all patients were collected and analyzed.Postoperative outcomes and prognoses were compared between the two groups.Statistical analysis was performed using SPSS software.RESULTS Patients in the R-NOSES I-F group had a significantly lower visual analog score for pain on postoperative day 1(1.7±0.7 vs 2.2±0.6,P=0.003)and shorter postoperative anal venting time(2.7±0.6 vs 3.5±0.7,P<0.001)than those in the RLRC group.There were no significant differences between the two groups in terms of sex,age,body mass index,tumor size,TNM stage,operative time,intrao-perative bleeding,postoperative complications,or inflammatory response(P>0.05).Postoperative anal and urinary functions,as assessed by Wexner,low anterior resection syndrome,and International Prostate Symptom Scale scores,were similar in both groups(P>0.05).Long-term follow-up revealed no significant differences in the rates of local recurrence and distant metastasis between the two groups(P>0.05).CONCLUSION R-NOSES I-F is a safe and effective minimally invasive procedure for the treatment of lower rectal cancer.It improves pain relief,promotes gastrointestinal function recovery,and helps avoid incision-related complications.
文摘AIM: To investigate whether transanal natural orifice specimen extraction (NOSE) is a better technique for rectal cancer resection.METHODS: A prospectively designed database of a consecutive series of patients undergoing laparoscopic low anterior resection for rectal cancer with various tumor-node-metastasis classi?cations from March 2011 to February 2012 at the First Affiliated Hospital of Sun Yat-Sen University was analyzed. Patient selection for transanal specimen extraction and intracorporeal anastomosis was made on the basis of tumor size and distance of rectal lesions from the anal verge. Demographic data, operative parameters, and postoperative outcomes were assessed.RESULTS: None of the patients was converted to laparotomy. Respectively, there were 16 cases in the low anastomosis and five in the ultralow anastomosis groups. Mean age of the patients was 45.4 years, and mean body mass index was 23.1 kg/m2. Mean distance of the lower edge of the lesion from the anal verge was 8.3 cm. Mean operating time was 132 min, and mean intraoperative blood loss was 84 mL. According to the principle of rectal cancer surgery, we performed D2 lymph node dissection in 13 cases and D3 in eight. Mean lymph nodes harvest was 17.8, and the number of positive lymph nodes was 3.4. Median hospital stay was 6.7 d. No serious postoperative complication occurred except for one anastomotic leakage. All patients remained disease free. Mean Wexner score was 3.7 at 11 mo after the operation.CONCLUSION: Transanal NOSE for total laparoscopic low/ultralow anterior resection is feasible, safe and oncologically sound. Further studies with long-term outcomes are needed to explore its potential advantages.
基金Supported by Jilin University,China,No.3R211P163428
文摘AIM:To introduce transvaginal or transanal specimen extraction in laparoscopic total mesorectal excision surgery to avoid an abdominal incision. METHODS:Between January 2009 and December 2011,21 patients with rectal cancer underwent laparoscopic radical resection and the specimen was retrieved by two different ways:transvaginal or transanal rectal removal.Transvaginal specimen extraction approach was strictly limited to elderly post-menopausal women who need hysterectomy.Patients aged between 30 and 80 years,with a body mass index of less than 30 kg/m2, underwent elective surgery.The surgical technique and the outcomes related to the specimen extraction,such as duration of surgery,length of hospital stay,and the complications were retrospectively reviewed. RESULTS:Laparoscopic resection using a natural orifice removal approach was successful in all of the 21 patients.Median operating time was 185 min(range,122-260 min)and the estimated blood loss was 48 mL. The mean length of hospital stay was 7.5 d(range,2-11 d).One patient developed postoperative ileus and had an extended hospital stay.The patient complained of minimal pain.There were no postoperative complications or surgery-associated death.The mean size of the lesion was 2.8 cm(range,1.8-6.0 cm),and the mean number of lymph nodes harvested was 18.7(range, 8-27).At a mean follow-up of 20.6 mo(range,10-37 mo),there were no functional disorders associated with the transvaginal and transanal specimen extraction. CONCLUSION:Transvaginal or transanal extraction in L-TME is a safe and effective procedure.Natural orifice specimen extraction can avoid the abdominal wall incision and its potential complications.
文摘AIM: To describe the application of complete robotic gastrectomy with transvaginal specimen extraction(TVSE) for gastric cancer patients.METHODS: Between July and November 2014, eight female patients who were diagnosed with gastric adenocarcinoma underwent a TVSE following a full robot-sewn gastrectomy. According to the tumor location, the patients were allocated to two different groups; two patients received robotic total gastrectomy with TVSE and the other six received robotic distal gastrectomy with TVSE.RESULTS: Surgical procedures were successfully performed in all eight cases without conversion. The mean age was 55.3(range, 42-69) years, and the mean body mass index was 23.2(range, 21.6-26.0) kg/m2. The mean total operative time and blood loss were 224(range, 200-298) min and 62.5(range, 50-150) m L, respectively. The mean postoperative hospital stay was 3.6(range, 3-5) d. The mean number of lymph nodes resected was 23.6(range, 17-27). None was readmitted within 30 d of postoperation. During the follow-up, no stricture developed nor was any anastomotic leakage detected.CONCLUSION: It is possible to perform a TVSE following a full robot-sewn gastrectomy with standard D2 lymph node resection for female gastric cancer patients.
文摘AIM: To investigate how complete laparoscopic anterior resection with natural orifice specimen extraction (NOSE), as a novel minimally invasive surgery, compares to conventional laparoscopic surgery.
基金Supported by National Natural Science Foundation of China,No.81500430 and No.U1304802(to Lin XH)Basic and Frontier Technology Research Program of Henan Province,No.162300410101(to Hu JH)+1 种基金Wu Jieping Medical Foundation of Clinical Research Special Fund,No.320.2710.1836(to Hu JH)The Henan Science and Technology Planning Project,No.182102310544(to Lin XH)
文摘BACKGROUND This case-control study compared the short-term clinical efficacy of natural orifice specimen extraction surgery(NOSES) using a prolapsing technique and the conventional laparoscopic-assisted approach for low rectal cancer.AIM To further explore the application value of the transanal placement of the anvil and to evaluate the short-term efficacy of NOSES for resecting specimens of low rectal cancer, as well as to provide a theoretical basis for its extensive clinical application.METHODS From June 2015 to June 2018, 108 consecutive laparoscopic-assisted low rectal cancer resections were performed at our center. Among them, 26 specimens were resected transanally using a prolapsing technique(NOSES), and 82 specimens were resected through a conventional abdominal wall small incision(LAP). A propensity score matching method was used to select 26 pairs of matched patients, and their perioperative data were analyzed.RESULTS The baseline data were comparable between the two matched groups. All 52 patients underwent the surgery successfully. The operative time, blood loss,number of harvested lymph nodes, postoperative complication rate,circumferential margin involvement, postoperative follow-up data, and postoperative anal function were not statistically significant. The NOSES group had shorter time to gastrointestinal function recovery(2.6 ± 1.0 d vs 3.4 ± 0.9 d, P= 0.006), shorter postoperative hospital stay(7.1 ± 1.7 d vs 8.3 ± 1.1 d, P = 0.003),lower pain score(day 1: 2.7 ± 1.8 vs 4.6 ± 1.9, day 3: 2.0 ± 1.1 vs 4.1 ± 1.2, day 5: 1.7± 0.9 vs 3.3 ± 1.0, P < 0.001), a lower rate of additional analgesic use(11.5% vs61.5%, P = 0.001), and a higher satisfaction rate in terms of the aesthetic appearance of the abdominal wall after surgery(100% vs 23.1%, P < 0.001).CONCLUSION NOSES for low rectal cancer can achieve satisfactory short-term efficacy and has advantages in reducing postoperative pain, shortening the length of postoperative hospital stay, and improving patients' satisfaction in terms of a more aesthetic appearance of the abdominal wall.
文摘Over the last 20 years, laparoscopic colorectal surgery has shown equal efficacy for benign and malignant colorectal diseases when compared to open surgery. However, a laparoscopic approach reduces postoperative morbidity and shortens hospital stay. In the quest to optimize outcomes after laparoscopic colorectal surgery, reduction of access trauma could be a way to improve recovery. To date, one method to reduce access trauma is natural orifice specimen extraction(NOSE). NOSE aims to reduce access trauma in laparoscopic colorectal surgery. The specimen is delivered via a natural orifice and the anastomosis is created intracorporeally. Different methods are used to extract the specimen and to create a bowel anastomosis. Currently, specimens are delivered transcolonically, transrectally, transanally, or transvaginally. Each of these NOSEprocedures raises specific issues with regard to operative technique and application. The presumed benefits of NOSE-procedures are less pain, lower analgesia requirements, faster recovery, shorter hospital stay, better cosmetic results, and lower incisional hernia rates. Avoidance of extraction site laparotomy is the most important characteristic of NOSE. Concerns associated with the NOSE-technique include bacterial contamination of the peritoneal cavity, inflammatory response, and postoperative outcomes, including postoperative pain and the functional and oncologic outcomes. These issues need to be studied in prospective randomized controlled trials. The aim of this systematic review is to describe the role of NOSE in minimally invasive colorectal surgery.
基金supported by National Key R&D Program of China(No.2017YFC0908203)Chinese Academy of Medical Sciences Initiative for Innovative Medicine(No.2017-I2M-2-003 and 2016-I2M-1-001)+2 种基金Science and Technology Project of Chaoyang District,Beijing(No.CYSF-1931)Beijing Science and Technology Program(No.D17110002617004)Beijing Gold-Bridge Funds(No.ZZ19055)。
文摘Objective:The transanal approach to specimen collection,combined with the prolapsing technique,is a wellestablished and minimally invasive surgery for treating rectal cancer.However,reports on outcomes for this approach are sparse.We compared short-and long-term outcomes of conventional laparoscopic surgery(CLS)vs.transanal natural orifice specimen extraction(NOSE)using the prolapsing technique for patients with middle-to low-rectal cancer.Methods:From January 2013 to December 2017,we enrolled consecutive patients with middle-to low-rectal cancer undergoing laparoscopic anterior resection.Totally,50 patients who underwent transanal NOSE using the prolapsing technique were matched with 50 patients who received CLS.Clinical parameters and survival outcomes between the two groups were compared.Results:Estimated blood loss(29.70±29.28 vs.52.80±45.09 mL,P=0.003),time to first flatus(2.50±0.79 vs.2.86±0.76,P=0.022),time to liquid diet(3.62±0.64 vs.4.20±0.76 d,P<0.001),and the need for analgesics(22%vs.48%,P=0.006)were significantly lower for the NOSE group compared to the CLS group.The incidences of overall complications and fecal incontinence were comparable in both groups.After a median follow-up of 44.52 months,the overall local recurrence rate(6%vs.5%,P=0.670),3-year disease-free survival(86.7%vs.88.0%,P=0.945)and 3-year overall survival(95.6%vs.96.0%,P=0.708),were not significantly different.Conclusions:For total laparoscopic rectal resection,transanal NOSE using the prolapsing technique is effective and safe,and associated with less trauma and pain,a faster recovery,and similar survival outcomes compared to CLS.
基金Supported by National Natural Science Foundation of China,No.81772642Beijing science and technology plan,No.D171100002617004
文摘BACKGROUND This article introduces the surgical method and early experience in performing totally laparoscopic radical gastrectomy with transrectal specimen extraction for gastric cancer, and we evaluate the short-term effects and feasibility of this new procedure for gastric cancer in a 64-year-old male patient. This approach may provide new possibilities for gastric natural orifice specimen extraction(NOSE)surgery. In addition, we believe that this new procedure may further relieve pain,speed up recovery, and cause minimal physiological and psychological impact.CASE SUMMARY We performed NOSE gastrectomy in a male patient. Tumor resection, digestive tract reconstruction, and lymph node dissection were performed totally laparoscopically;the specimen was extracted from the natural orifice of the rectum-anus. This procedure reduced damage to the abdominal wall and decreased postoperative pain. We successfully performed radical gastrectomy without conversion and complications. Total operative time and blood loss were 176 min and 50 m L, respectively. The patient resumed normal activities of daily living on day 1 without pain, and passed flatus within 48 h. Postoperative hospital stay was 10 d. The number of resected lymph nodes was 0/43. During the follow-up, no stricture or anastomotic leakage was detected. Three months postoperatively, colonoscopy showed full recovery of the rectum without stricture or scar contracture. Computed tomography and laboratory test results showed no signs of tumor recurrence. There was no visible scar on the abdominal wall.CONCLUSION It is safe and reliable to perform totally laparoscopic radical gastrectomy with transrectal specimen extraction for distal gastric cancer patients.
文摘BACKGROUND Natural orifice specimen extraction(NOSE)via the anus or vagina replaces conventional transabdominal specimen retrieval via the transabdominal route through a limited mid-line laparotomy or Pfannenstiel incision.Reducing the number of laparoscopic ports further decreases operative abdominal wall trauma.These techniques reduce the surgical wound size as well as the risk of incisionrelated morbidity.AIM To compare short-term outcomes following 3-port NOSE surgery with a matched cohort of conventional non-NOSE colorectal cancer surgery.METHODS Patients who underwent elective 3-port laparoscopic colorectal NOSE surgery between February to October 2021 were identified.Selection criteria for NOSE surgery was adapted from the 2019 International Consensus on Natural Orifice Specimen Extraction Surgery for colorectal cancer.Patients with clinical T4 or N2 tumors on staging computed tomography were also excluded.The propensity score-matched cohort was identified amongst patients who underwent conventional laparoscopic colorectal surgery from January 2019 to December 2020.Matching was performed in the ratio of 1:4 based on age,gender,type of resection,and p-tumor node metastasis staging.RESULTS Over the eight-month study duration,14 consecutive cases(nine female,five male)of elective 3-port laparoscopic surgery with NOSE were performed for colorectal cancer.Median age and body mass index were 70(range 43-82)years and 24.1(range 20.0-31.7)kg/m2 respectively.Six patients underwent transanal NOSE and eight had transvaginal NOSE.Median operative time,intraoperative blood loss and postoperative length of stay were 208(range 165-365)min,30(range 10-150)mL and 3(range 2-6)d respectively.Two(14%)suffered minor postoperative compilations not attributable to the NOSE procedure.Median follow-up duration was 12(range 8-15)mo.No instances of mortality,local or distant disease recurrence were recorded in this cohort.Compared to the conventional surgery cohort of 56 patients,the 3-port NOSE cohort had significantly quicker mean return of bowel function(2.6 vs 1.2 d,P<0.001),reduced postoperative pain and patientcontrolled analgesia use,and decreased length of hospital stay(6.4 vs 3.4 d,P<0.001).There were no statistical differences in surgical duration and perioperative complication rates between the NOSE and non-NOSE cohorts.CONCLUSION 3-port laparoscopic colorectal surgery with NOSE is a feasible technique,augmenting the minimally invasive nature of surgery and producing good outcomes.Appropriate patient selection and expertise in conventional laparoscopy are required.
基金Supported by Chongqing Medical Scientific Research Project(Joint Project of Chongqing Health Commission and Science and Technology Bureau),No.2022ZDXM016.
文摘In recent years,natural orifice specimen extraction surgery(NOSES),a novel minimally invasive surgical technique,has become a focus in the surgical field,and has been initially applied in gastric surgery in many national medical centers worldwide.In addition,this new surgical technique was launched in major hospitals in China.With an increasing number of patients who have accepted this new surgical technique,NOSES has provided new prospects for the treatment of gastric cancer(GC),which may achieve a better outcome for both patients and surgeons.More and more experts and scholars from different countries and regions are currently paying close attention to NOSES for the treatment of GC.However,there are only a few reports of its use in GC.This review focuses on the research progress in NOSES for radical gastrectomy in recent years.We also discuss the challenges and prospects of NOSES in clinical practice.
文摘Objective:To investigate the effect of 3D laparoscopic natural orifice specimen extraction surgery as rectal cancer treatment.Methods:The study was carried out in Shaanxi Provincial People’s Hospital from July 2021 to July 2022.80 rectal cancer patients were selected and divided into two groups which are the experimental group and control group.The experimental group was given 3D laparoscopic surgery while the control group was given 2D laparoscopic surgery.The results were compared and analysed.Results:The patients in the experimental group had shorter operative and evacuation times,less intraoperative bleeding,and a lower rate of complications.Conclusion:The clinical application of 3D laparoscopic radical surgery for rectal cancer via natural lumen extraction is more effective,which can promote patients'recovery and reduce the incidence of adverse events.
文摘Objective To investigate the appropriate incision for intact specimen extraction during retroperitoneoscopic radical nephrectomy. Methods One hundred and nineteen patients in need of retroperitoneoscopic radical nephrectomy were randomized into two groups. One group of 60 patients received intact specimen extraction
基金Supported by Scientific Research Foundation for Doctors in Qinghai Normal University~~
文摘[Objective]The aim was to find out the optimal methods for extracting DNA from dried butterfly specimen.[Method]A total of five methods including SDS method,SDS-mercaptoethanol-phenol method,CTAB method,saturated NaCl method,SDS-mercaptoethanol-chloroform methods were employed to extract DNA from dried butterfly specimen.[Result]SDS-mercaptoethanol-phenol method,saturated NaCl method and SDS-mercaptoethanol-chloroform method were suitable for genomic DNA extraction from dried butterfly samples,and the DNA extracted can be successfully applied to the PCR amplification of butterfly mitochondrial COI,EF-1α and CytB genes.[Conclusion]SDS-mercaptoethanol-phenol method,saturated NaCl method and SDS-mercaptoethanol-chloroform method can be used to study the extraction of DNA from dried butterfly samples,which laid foundation for study on molecular phylogenetics of butterfly.
