title: A new technique of totally laparoscopic resection with natural orifice specimen extraction (NOSE) for large rectal adenoma.
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.
authors.affiliation: Department of Gastrointestinal Surgery, Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China.
authors.forename: X-M
authors.initials: XM
authors.lastname: Zhang
authors.forename: Z
authors.initials: Z
authors.lastname: Wang
authors.forename: H-R
authors.initials: HR
authors.lastname: Hou
authors.forename: Z-X
authors.initials: ZX
authors.lastname: Zhou
mesh_terms: D000236:Adenoma / Q000473:pathology / Q000601:surgery*; D000368:Aged; D016063:Blood Loss, Surgical; 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*; D009364:Neoplasm Recurrence, Local; D061646:Operative Time; D056888:Patient Positioning; D012004:Rectal Neoplasms / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome; D047368:Tumor Burden
references.citation: Endoscopy. 2006 Oct;38(10):991-5
references.pmid: 17058163
references.citation: Ann Surg Oncol. 2014 May;21(5):1631
references.pmid: 24407315
references.citation: Colorectal Dis. 2011 Nov;13 Suppl 7:28-31
references.pmid: 22098514
references.citation: J Gastrointest Surg. 2012 Jan;16(1):165-71; discussion 171-2
references.pmid: 22058042
references.citation: Best Pract Res Clin Gastroenterol. 2010 Jun;24(3):271-80
references.pmid: 20510828
references.citation: Minim Invasive Ther Allied Technol. 2014 Jan;23(1):21-7
references.pmid: 23992387
references.citation: World J Gastroenterol. 2009 Sep 14;15(34):4273-7
references.pmid: 19750569
references.citation: Endoscopy. 2003 Aug;35(8):690-4
references.pmid: 12929067
references.citation: Surg Endosc. 2012 Sep;26(9):2594-600
references.pmid: 22476837
references.citation: Dis Colon Rectum. 1993 Jan;36(1):77-97
references.pmid: 8416784
references.citation: Surg Endosc. 2013 Sep;27(9):3431-6
references.pmid: 23494510
references.citation: Endoscopy. 2006 May;38(5):493-7
references.pmid: 16767585
references.citation: Gut. 1982 Oct;23(10):835-42
references.pmid: 7117903
references.citation: Surg Endosc. 2009 Nov;23(11):2605-9
references.pmid: 19266229
references.citation: World J Gastroenterol. 2013 Feb 7;19(5):750-4
references.pmid: 23430965
references.citation: Colorectal Dis. 2012 Nov;14(11):e764-70
references.pmid: 22776288
references.citation: Br J Surg. 2008 Jul;95(7):915-8
references.pmid: 18496889
references.citation: Surg Endosc. 2010 Aug;24(8):2048-52
references.pmid: 20108143
references.citation: World J Surg Oncol. 2012 Nov 26;10:255
references.pmid: 23181563
references.citation: ANZ J Surg. 2010 Jun;80(6):468-9
references.pmid: 20618210
references.citation: Am J Surg. 2013 Sep;206(3):320-5
references.pmid: 23570738
references.citation: Clin Gastroenterol Hepatol. 2009 Feb;7(2):149-55
references.pmid: 19032991
references.citation: Surg Endosc. 2009 Dec;23(12):2831-5
references.pmid: 19440794
references.citation: Gastroenterol Rep (Oxf). 2013 Sep;1(2):75-84
references.pmid: 24759812
references.citation: Arch Surg. 2008 Sep;143(9):866-70; discussion 871-2
references.pmid: 18794424
references.citation: Colorectal Dis. 2011 Nov;13 Suppl 7:47-50
references.pmid: 22098518
references.citation: Gastrointest Endosc. 2000 Jun;51(6):697-700
references.pmid: 10840302
references.citation: Cancer. 1982 Feb 15;49(4):819-25
references.pmid: 7055790
references.citation: Endoscopy. 2007 May;39(5):423-7
references.pmid: 17354181
references.citation: Tech Coloproctol. 2009 Mar;13(1):61-4
references.pmid: 19288243
references.citation: Colorectal Dis. 2012 Apr;14(4):e191-6
references.pmid: 22023493
references.citation: Int J Colorectal Dis. 1997;12(5):267-71
references.pmid: 9401839
references.citation: Endoscopy. 2011 Nov;43(11):941-9
references.pmid: 21971923
references.citation: Surg Endosc. 2013 Sep;27(9):3165-72
references.pmid: 23519489
references.citation: J Clin Gastroenterol. 2014 Aug;48(7):e57-61
references.pmid: 24440933