Published online Sep 28, 2014. doi: 10.3748/wjg.v20.i36.12981
Revised: March 28, 2014
Accepted: April 27, 2014
Published online: September 28, 2014
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 NOSE-procedures 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.
Core tip: Natural orifice specimen extraction (NOSE) will be the way forward to avoid abdominal wall incisions and reduce access trauma during laparoscopic colorectal resection. This systematic review addresses all aspects of NOSE in laparoscopic colorectal surgery and discusses the advantages and disadvantages of this technique. Moreover, a detailed discussion of all available studies concerning NOSE-procedures is given. Although different surgical techniques are being used, it is clear that worldwide experience with this minimally invasive procedure is increasing and that the barriers to the use of natural orifice transluminal endoscopic surgery procedures are decreasing.