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J.Jpn. Surg. Soc.. 121(3): 309-314, 2020

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Department of Surgery, Institute of Gastroenterology, Nagaoka Chuo General Hospital, Nagaoka, Japan

Atsushi Nishimura, Mikako Kawahara, Yasuyuki Kawachi, Shigeto Makino, Chie Kitami, Keiya Nikkuni

The natural orifice specimen extraction (NOSE) technique, which does not involve extraction minilaparotomy, has been developed as a means of decreasing the destruction of the abdominal wall during surgery. NOSE has been performed in the treatment of many cases of colorectal cancer. Reported systematic reviews and meta-analysis concluded that NOSE is feasible and safe. Randomized controlled studies revealed its benefits in reducing postoperative pain, wound-related complications, and length of hospital stay and improving cosmetic outcomes. However, as the NOSE procedure necessitates intracorporeal bowel opening, there is a potential risk of tumor cell dissemination. This must be avoided through the use of specimen retrieval bags and protective barriers, adequate rectal washing and peritoneal lavage, etc. Although evidence on long-term outcomes after NOSE procedures is still being accumulated, it currently appears that the optimal indications for NOSE are in patients requiring additional resection after endoscopic mucosal/submucosal resection. In addition, the risks related to anal sphincter function, sexual function, and pregnancy rate have not been fully investigated. High-quality randomized controlled trials will be necessary to establish the raison d’être and risks of this procedure.

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