This is the Scientific Surgery Archive, which contains all randomized clinical trials in surgery that have been identified by searching the top 50 English language medical journal issues since January 1998. Compiled by Jonothan J. Earnshaw, former Editor-in-Chief, BJS

Natural orifice specimen extraction versus conventional laparoscopically assisted right hemicolectomy. BJS 2011; 98: 710-715.

Published: 8th February 2011

Authors: J. S. Park, G.‐S. Choi, H. J. Kim, S. Y. Park, S. H. Jun

Background

This case–control study compared the clinical outcomes of totally laparoscopic hemicolectomy with natural orifice specimen extraction (NOSE) and the conventional laparoscopically assisted approach for right‐sided colonic cancer.

Method

Consecutive patients who underwent totally laparoscopic mobilization of the right colon with transvaginal resection, anastomosis and specimen extraction between April 2007 and December 2009 were matched by various clinicopathological characteristics with patients who had conventional laparoscopically assisted procedures.

Results

Thirty‐four patients in each group were studied. The number of lymph nodes harvested and the resection margin status were similar in the two groups. After NOSE, patients experienced less pain (mean(s.e.m.) pain score on day 1: 4·2(0·3) versus 5·7(0·3), P = 0·001; on day 3: 2·6(0·2) versus 3·5(0·2), P = 0·010) and had a shorter hospital stay (mean(s.d.) 7·9(0·8) versus 8·8(1·5) days; P = 0·003). The NOSE group had less surgical morbidity than the laparoscopically assisted group, but the difference was not significant (4 of 34 versus 9 of 34; P = 0·119). After a median follow‐up of 23 (range 5–40) months, there was no transvaginal access‐site recurrence or posterior colpotomy‐related complications. NOSE was associated with significantly better cosmetic results (mean(s.d.) score 7·5(1·7) versus 6·6(1·8); P = 0·037).

Conclusion

Full text