Natural Orifice Specimen Extraction (NOSE) during Laparoscopic Bowel Resection for Colorectal Endometriosis: Technique and Outcome

STUDY OBJECTIVE We first present a detailed description of a modified NOSE-colectomy technique. Secondly, we report the postoperative outcomes of our prospective case series when compared to conventional laparoscopic bowel resection in a relatively large series of patients. DESIGN Canadian Task Force Classification II-1. SETTING University tertiary referral center. PATIENTS Patient selection The last 90 consecutive patients in our care with DIE of the bowel are presented in this study. Patients were diagnosed at the 1Department of OB/GYN Semmelweis Universtiy Budapest, Hungary. INTERVENTIONS We performed laparoscopic bowel resection using the transrectal NOSE-technique and compared the results of the new operative method (n=30) to traditional laparoscopic bowel resection (n=60). MEASUREMENTS AND MAIN RESULTS Duration of operations The median duration of surgery was 121 minutes in the control group and 96 minutes in the NOSE-group (p=.005). Postoperative complications According to Clavien-Dindo classification, we observed a severe, grade IIIb or higher, overall complication rate of 3.3% among all 90 patients. In the control group anastomosis insufficiency occurred in 3.3% of patients (2/60 cases) and in one patient with anastomotic leakage a rectovaginal fistula was observed (1.7%). There was no significant difference in rates of severe postoperative complications (p=0.55). Hospital stay The length of hospital stay in the control group was a median of 7 (5-13) days whereas in the NOSE-group this was 6 (3-11) days (p