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. 2022 Aug 10;22(1):308.
doi: 10.1186/s12893-022-01719-4.

The feasibility, safety and short-term clinical efficacy of laparoscopic anterior resection of rectal cancer with left colonic artery (LCA) preservation and natural orifice specimen extraction (NOSE)

Zhang Ke  1 , Deng Zijian  1 , Hu Hai  1 , Yan Jin  1 , Rui Yuanyi  1 , Yi Bo  1 , Zheng Yangchun  2
Affiliations

The feasibility, safety and short-term clinical efficacy of laparoscopic anterior resection of rectal cancer with left colonic artery (LCA) preservation and natural orifice specimen extraction (NOSE)

Zhang Ke et al. BMC Surg. .

Abstract

Background: Natural orifice specimen extraction surgery (NOSES) has the advantages of less postoperative pain, fast bowel function recovery, reduced hospital stay and better cosmetic effects. In our centre, anterior resection of rectal cancer with preservation of the left colonic artery (LCA) was performed using NOSES. The feasibility, safety and short-term clinical efficacy of the technique were discussed.

Methods: A retrospective analysis was performed on 19 patients who underwent laparoscopic anterior resection of rectal cancer with left colonic artery preservation and natural orifice specimen extraction in the Gastrointestinal Surgery Center of Sichuan Cancer Hospital from September 2018 to December 2019. General information about the patients, perioperative data and short-term postoperative results were analysed.

Results: All operations were completed smoothly, with an average operation duration of 304.36 ± 45.04 min, intraoperative bleeding of 76.31 ± 61.12 ml, first time off bed of 14.42 ± 3.56 h, first time to anus exhaust of 15.26 ± 8.92 h, first time to liquid diet of 2.94 ± 1.12 days, and average postoperative stay of 10.21 ± 3.13 days. Two patients developed temporary intestinal obstruction, and one patient developed pulmonary infection. All of them recovered well after active supportive treatment and were successfully discharged.

Conclusion: Laparoscopic NOSES for rectal cancer with left colon artery preservation is safe and feasible, with satisfactory short-term results, and is worthy of further clinical investigation.

Keywords: Laparoscopic surgery; Left colon artery; Natural orifice specimen extraction (NOSE); Rectal cancer.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
A D3 lymph node dissection at the root of the inferior mesenteric artery, B preservation of the left colonic artery; LCA left colonic artery; IMA inferior mesenteric artery; SHP superior hypogastric plexus
Fig. 2
Fig. 2
A Everted rectum with toothed ring forceps; B Rectal specimens pulled out of the body; C rectum and tumour were cut off under direct observation; D specimen after resection, check the cutting edge
Fig. 3
Fig. 3
A Opening the distal rectum; B expansion of distal bowel with TEM instrument; C insert protective sleeve; D pulling out the specimen through the protective sleeve
Fig. 4
Fig. 4
A Proximal purse string suture, iodophor gauze protection, proximal clipping; B complete reconstruction, pelvic floor reconstruction)
See this image and copyright information in PMC

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