YUNUS EMRE ALTUNTAŞ, İSMAİL ERTUĞRUL, OSMAN AKDOĞAN
Southern Clinics of Istanbul Eurasia - 2024;35(4):393-399
Objective: Natural orifice specimen extraction surgery (NOSES) is defined as the removal of the specimen through natural orifices following laparoscopic colorectal surgery, and it is an important component of minimally invasive surgery. This study aims to compare the extraction of resected malignant and benign lesions through natural orifices after laparoscopic colorectal surgery. Methods: Among 45 patients undergoing laparoscopic colorectal resection with planned NOSES between January 2019 and March 2020, 36 patients underwent NOSES. Transanal and transvaginal routes were utilized for extraction following laparoscopic resection. The transvaginal route was used in gynecologic cases and if there was a hysterectomy. Patients were divided into two groups based on the diagnosis of malignant or benign lesions. Demographic characteristics, perioperative and postoperative findings, as well as pathology and specimen sizes, were examined. Results: Lesion localization was predominantly in the rectosigmoid region in the malignant group and in the rectum in the benign group. There was a statistically significant difference between the groups (p<0.05). The maximum specimen size was higher in the malignant group (p>0.05), whereas the maximum lesion size was larger in the benign group (p<0.05). Mesenteric dissection distribution was higher in the malignant group (p<0.05). There were significant differences between the patient groups in terms of specimen extraction site distribution and anvil localization (p<0.05). Transanal extraction and extracorporeal anastomosis were more common in the malignant group, whereas transvaginal extraction and intracorporeal anastomosis were more common in the benign group. Conclusion: NOSES can be safely performed for both malignant and benign colorectal lesions. Despite larger lesion sizes in benign lesions in comparison to malignant ones, specimen sizes are smaller. Therefore, they are easier to extract through natural orifices after laparoscopic resection. Moreover, benign lesions can be dismembered into smaller sizes for extraction, in contrast with the case for malignant lesions.
