title: Complete laparoscopic resection of the rectum using natural orifice specimen extraction.
abstract: OBJECTIVE
  To investigate how complete laparoscopic anterior resection with natural orifice specimen extraction (NOSE), as a novel minimally invasive surgery, compares to conventional laparoscopic surgery.
  
  
  METHODS
  Twenty patients who underwent complete laparoscopic anterior resection with NOSE and 50 patients who underwent laparoscopic assisted anterior resection by the conventional method between 2011 and 2012 were studied. Selection for complete laparoscopic anterior resection with NOSE was decided on the basis of tumor size, localization of the tumor, and body mass index. Outcomes related to surgery, including operation time, postoperative wound pain, hospital stay after surgery, the number of totally dissected lymph nodes, postoperative complications (suture failure and wound infection), and anal function, were reviewed retrospectively. Anal function was assessed at 3 and 6 mo after surgery using the Wexner fecal incontinence scoring system.
  
  
  RESULTS
  Complete laparoscopic resection with NOSE was performed to completion in all 20 patients. There was no patient emergency that required conversion to conventional laparoscopic surgery or open surgery. The comparison between complete laparoscopic resection with NOSE and conventional laparoscopic surgery showed no significant differences in the maximal diameter of the tumor, number of totally dissected lymph nodes, bleeding volume, mean operation time, time to start of oral ingestion, postoperative hospital stay, and postoperative complications. On the other hand, with regard to pain after epidural anesthesia, the total usage of analgesia in this novel surgical technique was 1.85 ± 1.8 times, whereas it was 5.89 ± 2.86 in conventional laparoscopic surgery (P < 0.001). The postoperative pain period was 1.9 ± 1.9 d in this novel surgical technique, whereas it was 3.43 ± 1.41 d in conventional laparoscopic surgery (P < 0.004). In complete laparoscopic surgery with NOSE, the mean postoperative follow-up period was 20 mo (range: 12-30 mo). Neither local recurrence nor remote metastasis was observed during the follow-up period.
  
  
  CONCLUSIONS
  Complete laparoscopic anterior resection using NOSE does not require any incision and has excellent cosmetic properties, with mitigated postoperative pain.
authors.affiliation: Masayuki Hisada, Kenji Katsumata, Tetsuo Ishizaki, Masanobu Enomoto, Takaaki Matsudo, Kazuhiko Kasuya, Akihiko Tsuchida, Department of Digestive Surgery and Pediatric Surgery, Tokyo Medical University, Tokyo 160-0023, Japan.
authors.forename: Masayuki
authors.initials: M
authors.lastname: Hisada
authors.affiliation: Masayuki Hisada, Kenji Katsumata, Tetsuo Ishizaki, Masanobu Enomoto, Takaaki Matsudo, Kazuhiko Kasuya, Akihiko Tsuchida, Department of Digestive Surgery and Pediatric Surgery, Tokyo Medical University, Tokyo 160-0023, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Katsumata
authors.affiliation: Masayuki Hisada, Kenji Katsumata, Tetsuo Ishizaki, Masanobu Enomoto, Takaaki Matsudo, Kazuhiko Kasuya, Akihiko Tsuchida, Department of Digestive Surgery and Pediatric Surgery, Tokyo Medical University, Tokyo 160-0023, Japan.
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Ishizaki
authors.affiliation: Masayuki Hisada, Kenji Katsumata, Tetsuo Ishizaki, Masanobu Enomoto, Takaaki Matsudo, Kazuhiko Kasuya, Akihiko Tsuchida, Department of Digestive Surgery and Pediatric Surgery, Tokyo Medical University, Tokyo 160-0023, Japan.
authors.forename: Masanobu
authors.initials: M
authors.lastname: Enomoto
authors.affiliation: Masayuki Hisada, Kenji Katsumata, Tetsuo Ishizaki, Masanobu Enomoto, Takaaki Matsudo, Kazuhiko Kasuya, Akihiko Tsuchida, Department of Digestive Surgery and Pediatric Surgery, Tokyo Medical University, Tokyo 160-0023, Japan.
authors.forename: Takaaki
authors.initials: T
authors.lastname: Matsudo
authors.affiliation: Masayuki Hisada, Kenji Katsumata, Tetsuo Ishizaki, Masanobu Enomoto, Takaaki Matsudo, Kazuhiko Kasuya, Akihiko Tsuchida, Department of Digestive Surgery and Pediatric Surgery, Tokyo Medical University, Tokyo 160-0023, Japan.
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Kasuya
authors.affiliation: Masayuki Hisada, Kenji Katsumata, Tetsuo Ishizaki, Masanobu Enomoto, Takaaki Matsudo, Kazuhiko Kasuya, Akihiko Tsuchida, Department of Digestive Surgery and Pediatric Surgery, Tokyo Medical University, Tokyo 160-0023, Japan.
authors.forename: Akihiko
authors.initials: A
authors.lastname: Tsuchida
mesh_terms: D000328:Adult; D000368:Aged; D000700:Analgesics / Q000627:therapeutic use; D003672:Defecation; D005242:Fecal Incontinence / Q000209:etiology / Q000503:physiopathology; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D007902:Length of Stay; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D057605:Natural Orifice Endoscopic Surgery / Q000009:adverse effects / Q000379:methods*; D061646:Operative Time; D010149:Postoperative Pain / Q000209:etiology / Q000517:prevention & control; D012004:Rectal Neoplasms / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D047368:Tumor Burden
chemical_list: D000700:Analgesics
keywords: Complete laparoscopic surgery; Incisionless surgery; Less invasive surgery; Natural orifice specimen extraction; Transanal specimen extraction