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A new technique of totally laparoscopic resection with natural orifice specimen extraction (NOSE) for large rectal adenoma

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Abstract

There is no consensus about the best technique to use for the surgical treatment for large rectal adenomas. The advent of laparoscopic surgery has led to the development of several new methods for the treatment of gastrointestinal tumors. This study was designed to introduce an innovative technique of totally laparoscopic resection with natural orifice specimen extraction (NOSE) for large rectal adenomas and to assess the feasibility and safety of the technique. Between February 2011 and January 2014, we performed totally laparoscopic resection with NOSE on 18 patients with a large rectal adenoma. This new technique was successful in all 18 patients. The average size of the adenoma was 4.2 cm. Mean operation time was 108.4 min, and mean intraoperative blood loss was 36.6 ml. The mean time to passing of the first flatus was 2.3 days, and the mean postoperative hospital stay was 7.2 days. Only one patient needed analgesics after the operation. All patients were able to walk within the first 2 days. There were no cases of morbidity and recurrence. Totally laparoscopic resection with NOSE appears to be suitable for selected patients with a large adenoma located in mid- or low rectum.

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References

  1. Risio M (2010) The natural history of adenomas. Best Pract Res Clin Gastroenterol 24:271–280

    Article  PubMed  Google Scholar 

  2. Amann M, Modabber A, Burghardt J et al (2012) Transanal endoscopic microsurgery in treatment of rectal adenomas and T1 low-risk carcinomas. World J Surg Oncol 10:255

    Article  PubMed Central  PubMed  Google Scholar 

  3. Vatn MH, Stalsberg H (1982) The prevalence of polyps of the large intestine in Oslo: an autopsy study. Cancer 49:819–825

    Article  CAS  PubMed  Google Scholar 

  4. Williams AR, Balasooriya BA, Day DW (1982) Polyps and cancer of the large bowel: a necropsy study in Liverpool. Gut 23:835–842

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  5. Morino M, Allaix ME (2013) Transanal endoscopic microsurgery: what indications in 2013? Gastroenterol Rep 1:75–84

    Article  Google Scholar 

  6. Hussein Q, Artinyan A (2014) Pushing the limits of local excision for rectal cancer: transanal minimally invasive surgery for an upper rectal/rectosigmoid lesion. Ann Surg Oncol 21:1631

    Article  PubMed  Google Scholar 

  7. Sallinen V, Santti H, Liukkonen T et al (2013) Safety and long-term results of endoscopic transanal resection in treating rectal adenomas: 15 years’ experience. Surg Endosc 27:3431–3436

    Article  PubMed  Google Scholar 

  8. Allaix ME, Arezzo A, Cassoni P, Famiglietti F, Morino M (2012) Recurrence after transanal endoscopic microsurgery for large rectal adenomas. Surg Endosc 26:2594–2600

    Article  PubMed  Google Scholar 

  9. Barendse RM, van den Broek FJ, van Schooten J et al (2012) Endoscopic mucosal resection versus transanal endoscopic microsurgery for the treatment of large rectal adenomas. Colorectal Dis 14:e191–e196

    Article  CAS  PubMed  Google Scholar 

  10. Barendse RM, van den Broek FJ, Dekker E et al (2011) Systematic review of endoscopic mucosal resection versus transanal endoscopic microsurgery for large rectal adenomas. Endoscopy 43:941–949

    Article  CAS  PubMed  Google Scholar 

  11. Puli SR, Kakugawa Y, Gotoda T, Antillon D, Saito Y, Antillon MR (2009) Meta-analysis and systematic review of colorectal endoscopic mucosal resection. World J Gastroenterol 15:4273–4277

    Article  PubMed Central  PubMed  Google Scholar 

  12. Iishi H, Tatsuta M, Iseki K et al (2000) Endoscopic piecemeal resection with submucosal saline injection of large sessile colorectal polyps. Gastrointest Endosc 51:697–700

    Article  CAS  PubMed  Google Scholar 

  13. Yamamoto H, Kawata H, Sunada K et al (2003) Successful en-bloc resection of large superficial tumors in the stomach and colon using sodium hyaluronate and small-caliber-tip transparent hood. Endoscopy 35:690–694

    Article  CAS  PubMed  Google Scholar 

  14. Probst A, Golger D, Arnholdt H, Messmann H (2009) Endoscopic submucosal dissection of early cancers, flat adenomas, and submucosal tumors in the gastrointestinal tract. Clin Gastreoenterol Hepatol 7:149–155

    Article  Google Scholar 

  15. Fujishiro M, Yahagi N, Nakamura M et al (2006) Endoscopic submucosal dissection for rectal epithelial neoplasia. Endoscopy 38:493–497

    Article  CAS  PubMed  Google Scholar 

  16. Onozato Y, Kakizaki S, Ishihara H et al (2007) Endoscopic submucosal dissection for rectal tumors. Endoscopy 39:423–427

    Article  CAS  PubMed  Google Scholar 

  17. Kakushima N, Fujishiro M, Kodashima S, Muraki Y, Tateishi A, Omata M (2006) A learning curve for endoscopic submucosal dissection of gastric epithelial neoplasms. Endoscopy 38:991–995

    Article  CAS  PubMed  Google Scholar 

  18. McKenzie S, Baek JH, Wakabayashi M, Garcia-Aguilar J, Pigazzi A (2010) Totally laparoscopic right colectomy with transvaginal specimen extraction: the authors’ initial institutional experience. Surg Endosc 24:2048–2052

    Article  PubMed  Google Scholar 

  19. Choi GS, Park IJ, Kang BM, Lim KH, Jun SH (2009) A novel approach of robotic-assisted anterior resection with transanal or transvaginal retrieval of the specimen for colorectal cancer. Surg Endosc 23:2831–2835

    Article  PubMed  Google Scholar 

  20. Ooi BS, Quah HM, Fu CW, Eu KW (2009) Laparoscopic high anterior resection with natural orifice specimen extraction (NOSE) for early rectal cancer. Tech Coloproctol 13:61–64

    Article  CAS  PubMed  Google Scholar 

  21. Jorge JM, Wexner SD (1993) Etiology and management of fecal incontinence. Dis Colon Rectum 36:77–97

    Article  CAS  PubMed  Google Scholar 

  22. Darwood RJ, Wheeler JM, Borley NR (2008) Transanal endoscopic microsurgery is a safe and reliable technique even for complex rectal lesions. Br J Surg 95:915–918

    Article  CAS  PubMed  Google Scholar 

  23. Cho SD, Herzig DO, Douthit MA, Deveney KE (2008) Treatment strategies and outcomes for rectal villous adenoma from a single-center experience. Arch Surg 143:866–870; discussion 871–862

  24. Platell C (2010) Malignant recurrence following TEM excision of a large rectal adenoma. ANZ J Surg 80:468–469

    Article  PubMed  Google Scholar 

  25. Nusko G, Mansmann U, Altendorf-Hofmann A, Groitl H, Wittekind C, Hahn EG (1997) Risk of invasive carcinoma in colorectal adenomas assessed by size and site. Int J Colorectal Dis 12:267–271

    Article  CAS  PubMed  Google Scholar 

  26. Jang JH, Balik E, Kirchoff D et al (2012) Oncologic colorectal resection, not advanced endoscopic polypectomy, is the best treatment for large dysplastic adenomas. J Gastrointest Surg 16:165–171; discussion 171–162

  27. Morino M, Verra M, Famiglietti F, Arezzo A (2011) Natural orifice transluminal endoscopic surgery (NOTES) and colorectal cancer? Colorectal Dis 13(Suppl 7):47–50

    Article  PubMed  Google Scholar 

  28. de Lacy AM, Rattner DW, Adelsdorfer C et al (2013) Transanal natural orifice transluminal endoscopic surgery (NOTES) rectal resection: “down-to-up” total mesorectal excision (TME)-short-term outcomes in the first 20 cases. Surg Endosc 27:3165–3172

    Article  PubMed  Google Scholar 

  29. Kwag SJ, Kim JG, Oh ST, Kang WK (2013) Single incision versus conventional laparoscopic anterior resection for sigmoid colon cancer: a case-matched study. Am J Surg 206:320–325

    Article  PubMed  Google Scholar 

  30. Mufty H, Hillewaere S, Appeltans B, Houben B (2012) Single-incision right hemicolectomy for malignancy: a feasible technique with standard laparoscopic instrumentation. Colorectal Dis 14:e764–e770

    Article  CAS  PubMed  Google Scholar 

  31. Zhang X, Zhou H, Hou H, Hu J, Wang H, Zhou Z (2014) Totally laparoscopic resection with natural orifice specimen extraction for carcinoma of sigmoid colon and rectum: a feasible and innovative technique. J Clin Gastroenterol 48:e57–e61

    Article  PubMed  Google Scholar 

  32. Wang Q, Wang C, Sun DH, Kharbuja P, Cao XY (2013) Laparoscopic total mesorectal excision with natural orifice specimen extraction. World J Gastroenterol 19:750–754

    Article  PubMed Central  PubMed  Google Scholar 

  33. Akamatsu H, Omori T, Oyama T et al (2009) Totally laparoscopic sigmoid colectomy: a simple and safe technique for intracorporeal anastomosis. Surg Endosc 23:2605–2609

    Article  PubMed  Google Scholar 

  34. D’Hoore A, Wolthuis AM (2011) Laparoscopic low anterior resection and transanal pull-through for low rectal cancer: a Natural Orifice Specimen Extraction (NOSE) technique. Colorectal Dis 7:28–31

    Article  Google Scholar 

  35. Arezzo A, Arolfo S, Cravero F, Migliore M, Allaix ME, Morino M (2014) Which treatment for large rectal adenoma? Preoperative assessment and therapeutic strategy. Minim Invasive Ther Allied Technol 23:21–27

    Article  PubMed  Google Scholar 

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Acknowledgments

The authors thank Bi Jian-jun, Zeng Wei-gen and Hu Jun-jie for collecting the patient data. Their support was essential for completing this paper.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical standard

The National Cancer Center ethics committee, the ethics committee of Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.

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A waiver of consent was obtained from the ethics committee of Cancer Hospital.

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Authors and Affiliations

  1. Department of Gastrointestinal Surgery, Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China

    X.-M. Zhang, Z. Wang & Z.-X. Zhou

  2. The Overall Planning Office, Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China

    H.-R. Hou

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  1. X.-M. Zhang
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  2. Z. Wang
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  3. H.-R. Hou
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  4. Z.-X. Zhou
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Correspondence to Z.-X. Zhou.

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Zhang, XM., Wang, Z., Hou, HR. et al. A new technique of totally laparoscopic resection with natural orifice specimen extraction (NOSE) for large rectal adenoma. Tech Coloproctol 19, 355–360 (2015). https://doi.org/10.1007/s10151-015-1300-y

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  • DOI: https://doi.org/10.1007/s10151-015-1300-y

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