Total Intracorporeal Colon Surgery Using the N.o.s.e. (natural Orifice Specimen Extraction) Technique.

Introduction: Laparoscopic surgery for colonic disease has experienced an increased utilization by surgeons owing to decreased morbidity, less pain, earlier ambulation, earlier bowel function, fewer complications, decreased narcotic use, and improved cosmesis compared with open colon surgery. The ability to perform a totally intracorporeal anastomosis will be an initial step to allow surgeons to perform natural orifice colon surgery in the future. Natural orifice specimen extraction eliminates the need for any enlargement of extraction abdominal incisions. The transvaginal site for specimen extraction is a safe alternative to transabdominal specimen extraction where enlargement of incisions are needed during laparoscopic colorectal surgery.

Methods: The objective of this study was to report our experience with patients requiring a laparoscopic right hemicolectomy using a totally intracorporeal technique. We designed a nonrandomized prospective study of all consecutive female patients requiring a right hemicolectomy for both benign and malignant disease.

Results: Forty-nine patients were entered into the study from December 2007 to August 2009; 24 patients in the transvaginal (NOSE) group, and 25 patients in the counter incision group. Mean age was 69.9 +/- 14.8. Operative time 159 +/- 27.1 min NOSE group vs 133.5 +/- 29 min counter incision group. Estimated blood loss was 83.3 +/- 14.4 mL NOSE group vs.133 +/- 65.5 mL. Length of hospital stay was similar at 5.5 +/- 2.5 days NOSE group vs. 5.9 +/- 2.2 days. There was one intraoperative complication in the NOSE group (4.1%) and two minor postoperative complications (6.6%). There was one incisional hernia, one wound infection and two minor postoperative complications in the counter incisional group (13%). The overall complication rate was 8.3% for the NOSE group vs. 13% for the counter incision group.

Conclusion: We consider the Natural orifice extraction approach after a laparoscopic right hemicolectomy to be feasible and safe.

Session: Podium Presentation

Program Number: S086