title: Natural orifice specimen extraction versus conventional laparoscopically assisted right hemicolectomy.
abstract: BACKGROUND
  This case-control study compared the clinical outcomes of totally laparoscopic hemicolectomy with natural orifice specimen extraction (NOSE) and the conventional laparoscopically assisted approach for right-sided colonic cancer.
  
  
  METHODS
  Consecutive patients who underwent totally laparoscopic mobilization of the right colon with transvaginal resection, anastomosis and specimen extraction between April 2007 and December 2009 were matched by various clinicopathological characteristics with patients who had conventional laparoscopically assisted procedures.
  
  
  RESULTS
  Thirty-four patients in each group were studied. The number of lymph nodes harvested and the resection margin status were similar in the two groups. After NOSE, patients experienced less pain (mean(s.e.m.) pain score on day 1: 4·2(0·3) versus 5·7(0·3), P = 0·001; on day 3: 2·6(0·2) versus 3·5(0·2), P = 0·010) and had a shorter hospital stay (mean(s.d.) 7·9(0·8) versus 8·8(1·5) days; P = 0·003). The NOSE group had less surgical morbidity than the laparoscopically assisted group, but the difference was not significant (4 of 34 versus 9 of 34; P = 0·119). After a median follow-up of 23 (range 5-40) months, there was no transvaginal access-site recurrence or posterior colpotomy-related complications. NOSE was associated with significantly better cosmetic results (mean(s.d.) score 7·5(1·7) versus 6·6(1·8); P = 0·037).
  
  
  CONCLUSIONS
  The NOSE approach is feasible with favourable short-term surgical outcomes.
authors.affiliation: Department of Surgery, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Korea.
authors.forename: J S
authors.initials: JS
authors.lastname: Park
authors.forename: G-S
authors.initials: GS
authors.lastname: Choi
authors.forename: H J
authors.initials: HJ
authors.lastname: Kim
authors.forename: S Y
authors.initials: SY
authors.lastname: Park
authors.forename: S H
authors.initials: SH
authors.lastname: Jun
mesh_terms: D000700:Analgesics / Q000627:therapeutic use; D000704:Analysis of Variance; D016022:Case-Control Studies; D002430:Cecal Neoplasms / Q000601:surgery*; D003082:Colectomy / Q000379:methods*; D005260:Female; D006801:Humans; D007902:Length of Stay; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000209:etiology; D010149:Postoperative Pain / Q000209:etiology / Q000517:prevention & control
chemical_list: D000700:Analgesics