title: Standardized laparoscopic NOSE-colectomy is feasible with low morbidity.
abstract: BACKGROUND
  In laparoscopic colorectal surgery, extraction site laparotomy can be avoided by natural orifice specimen extraction (NOSE) resulting in less postoperative pain, shorter length of stay, and less morbidity such as wound complications. To date, short-term outcome of a large prospective cohort of patients has not been studied. The aim of this prospective cohort study was to assess short-term outcome of laparoscopic left-sided NOSE-colectomy.
  
  
  METHODS
  Prospectively collected data of patients who had undergone elective laparoscopic NOSE-colectomy between July 2009 and December 2013 were analyzed retrospectively. Primary endpoint was short-term morbidity.
  
  
  RESULTS
  A total of 110 patients were included in this study. Median age was 38 years (IQR: 32-56), median BMI was 23 kg/m(2) (IQR: 21-25), and 88% of the patients were female. Sixty-three patients (57%) underwent resection for endometriosis, 29 patients (26%) for diverticular disease, 16 patients (15%) for a tumor, and 2 patients for other indications. Median operating time was 85 min (IQR: 70-100) and median length of the extracted specimen was 20 cm (IQR: 16-25). Overall, 14 patients had a postoperative complication (13%), of which 9 were Clavien-Dindo grade 1 or 2 (8%). Four patients (3.6%) had an intraluminal bleeding from the anastomosis, which was treated endoscopically. There was 1 anastomotic leak (1%), treated by emergency laparotomy and creation of a new colorectal anastomosis (grade 3b). The median hospital stay was 5 days (IQR: 4-6).
  
  
  CONCLUSIONS
  Laparoscopic NOSE-colectomy is safe and feasible with good short-term outcome. This study concerning a standardized operative technique is the first in literature reporting on a large group of patients.
authors.affiliation: Department of Abdominal Surgery, University Hospital Gasthuisberg Leuven, Herestraat 49, 3000, Louvain, Belgium, amwolthuis@hotmail.com.
authors.forename: Albert M
authors.initials: AM
authors.lastname: Wolthuis
authors.forename: Anthony
authors.initials: A
authors.lastname: de Buck van Overstraeten
authors.forename: Steffen
authors.initials: S
authors.lastname: Fieuws
authors.forename: Katrien
authors.initials: K
authors.lastname: Boon
authors.forename: André
authors.initials: A
authors.lastname: D'Hoore
mesh_terms: D000328:Adult; D057868:Anastomotic Leak / Q000601:surgery; D003082:Colectomy / Q000009:adverse effects / Q000379:methods*; D003106:Colon / Q000601:surgery; D003108:Colonic Diseases / Q000601:surgery; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D057605:Natural Orifice Endoscopic Surgery / Q000009:adverse effects / Q000379:methods*; D061646:Operative Time; D010149:Postoperative Pain / Q000209:etiology; D011183:Postoperative Complications / Q000209:etiology; D011446:Prospective Studies; D012007:Rectum / Q000601:surgery; D012189:Retrospective Studies; D016896:Treatment Outcome