Natural Orifice Specimen Extraction Colorectal Resection for Deep Endometriosis: A 50 Case Series

Abstract

Study objective: To describe our experience with the use of natural orifice specimen extraction (NOSE) technique for segmental bowel resection in patients with colorectal endometriosis.

Design: A retrospective, observational study.

Setting: A single tertiary referral center.

Patients: A total of 50 consecutive patients undergoing NOSE colectomy for colorectal endometriosis in our center, between March 2021 and November 2021.

Interventions: NOSE colectomy for colorectal endometriosis with removal of the excised colorectal specimen through the vagina or the anus.

Measurement and main results: A total of 45 procedures were performed laparoscopically and 5 procedures were performed robotically. All interventions were performed by 3 endometriosis surgeons in a multidisciplinary fashion, with involvement of a colorectal surgeon. There were no cases of conversion to laparotomy. Concomitant surgical procedures were performed in all cases. Eleven patients had concomitant interventions on the digestive tract. Five patients had concomitant interventions on the sacral plexus or sciatic nerve. All anastomoses were lateroterminal. The mean height of colorectal anastomosis was 12 cm (standard deviation [SD] ± 4), and the mean length of the excised colorectal specimen was 9 cm (SD ± 4). In 29 cases, the specimen was extracted through the vagina and in 21 cases through the anus. A total of 5 patients required a reoperation in the early postoperative period: We identified 1 case of anastomotic leak, 1 case of postoperative bowel obstruction, 1 case of hemorrhage and 2 cases of pelvic collection (no macroscopic evidence of pus). No patient received blood transfusion. The mean operative time was 158 minutes (SD ± 70) and mean hospital stay was 4 days (SD ± 1).

Conclusion: NOSE colectomy is a reproducible surgical technique for the management of colorectal endometriosis. The complication rate appears comparable with the conventional (minilaparotomy) surgical approach. In experienced hands, this technique has a short learning curve, both in laparoscopy and in robotic surgery.

Keywords: Colectomy; Deep endometriosis; Natural orifice; Rectovaginal endometriosis; Robotic surgery.