title: Transanal natural orifice specimen extraction in colorectal surgery: bacteriological and oncological concerns.
abstract: BACKGROUND
  Natural orifice techniques have been developed to reduce incision-related morbidity in laparoscopic colorectal surgery. We describe our method of performing transanal specimen extraction in laparoscopic colorectal surgery, addressing bacteriological and oncological concerns in its implementation.
  
  
  METHODS
  Data of consecutive patients undergoing natural orifice specimen extraction (NOSE) laparoscopic colorectal surgery in our institution were retrospectively analysed. All specimens were extracted transanally via a wound protector, followed by intracorporeal end-to-end colorectal anastomosis. Perioperative details, microbiological and oncological findings were reviewed.
  
  
  RESULTS
  Between November 2014 and February 2015, five patients underwent NOSE laparoscopic colorectal procedures in our institution. All cases were completed laparoscopically and specimens were extracted transanally via a wound protector. There were no cases of post-operative anastomotic leaks, wound infections, intra-abdominal sepsis or faecal incontinence. Oncological margins and lymph node harvest were adequate for malignant cases. Transanal specimen extraction did not result in a malignant yield on peritoneal fluid cytology.
  
  
  CONCLUSIONS
  Early bacteriological, oncological and functional results show that NOSE is safe and feasible. Follow-up is required to establish that long-term oncological outcome is not compromised.
authors.affiliation: Department of General Surgery, Changi General Hospital, Singapore.
authors.forename: James
authors.identifier: http://orcid.org/0000-0001-5233-457X
authors.initials: J
authors.lastname: Ngu
authors.affiliation: Department of General Surgery, Changi General Hospital, Singapore.
authors.forename: Andrew Siang Yih
authors.initials: AS
authors.lastname: Wong
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical; D015179:Colorectal Neoplasms / Q000601:surgery*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000382:microbiology; D000067368:Transanal Endoscopic Surgery / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome
keywords: colorectal; laparoscopic; natural orifice; surgery