title: Natural Orifice Specimen Extraction With Single Stapling Colorectal Anastomosis for Laparoscopic Anterior Resection: Feasibility, Outcomes, and Technical Considerations.
abstract: BACKGROUND
  Double and triple stapling techniques to close the rectal stump in laparoscopic anterior resection are fraught with technical drawbacks that could possibly be avoided with the use of the single stapling technique. However, little is known of its safety in laparoscopic surgery or outcomes when combined with natural orifice specimen extraction.
  
  
  OBJECTIVE
  This study aims to analyze the feasibility and the operative and immediate postoperative outcomes of single-stapled anastomosis and natural orifice specimen extraction with conventional techniques. It intends to evaluate technical variations related to colon, mesentery, and pelvic anatomy characteristics.
  
  
  METHODS
  A consecutive series of 188 patients underwent elective surgery for benign or malignant lesions between 10 and 40 cm from the anal verge, 5 cm or less in diameter on radiological examination, stage T1 to T3, Nx, M0, with 2 different methods of rectal stump closure (pursestring vs linear-stapled closure) associated with single or double stapling and per anus vs conventional specimen extraction.
  
  
  METHODS
  This study was conducted at China Medical University Hospital, Taiwan, a tertiary referral center, between January 2012 and April 2015.
  
  
  METHODS
  The main outcomes measured are feasibility and operative and immediate postoperative outcomes.
  
  
  RESULTS
  Single-stapled resection with natural orifice specimen extraction was feasible in 94% patients with an 11% perioperative morbidity rate. The patients required statistically significantly less analgesia, had earlier return of bowel movements, and shorter hospital stay, whereas there was no statistically significant difference in the overall readmission rate and overall morbidity, including anastomotic leakage.
  
  
  CONCLUSIONS
  This was a single-center, retrospective case-matched study.
  
  
  CONCLUSIONS
  Anatomic variations (short colon and short mesentery) can be managed adequately with intracorporeal anvil head fixation. The single stapling technique is feasible and as safe as conventional double stapling techniques, although it is technically more demanding. The transanal endoscopic operation platform can be useful when the rectal stump is long.
authors.affiliation: Division of Colorectal Surgery, China Medical University Hospital, Taichung, Taiwan.
authors.forename: Bansal
authors.initials: B
authors.lastname: Saurabh
authors.forename: Sheng-Chi
authors.initials: SC
authors.lastname: Chang
authors.forename: Tao-Wei
authors.initials: TW
authors.lastname: Ke
authors.forename: Yu-Chun
authors.initials: YC
authors.lastname: Huang
authors.forename: Takashi
authors.initials: T
authors.lastname: Kato
authors.forename: Hwei-Ming
authors.initials: HM
authors.lastname: Wang
authors.forename: William
authors.initials: W
authors.lastname: Tzu-Liang Chen
authors.forename: Abe
authors.initials: A
authors.lastname: Fingerhut
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical / Q000379:methods*; D057868:Anastomotic Leak / Q000453:epidemiology*; D016022:Case-Control Studies; D002681:China; D013505:Digestive System Surgical Procedures / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D010535:Laparoscopy; D007902:Length of Stay; D008297:Male; D008643:Mesentery / Q000601:surgery; D008875:Middle Aged; D057605:Natural Orifice Endoscopic Surgery; D012004:Rectal Neoplasms / Q000601:surgery*; D012007:Rectum / Q000601:surgery; D012189:Retrospective Studies; D017792:Surgical Stapling / Q000379:methods*; D016896:Treatment Outcome