Laparoscopic-Assisted Natural Orifice Specimen Extraction Radical Descending Colectomy Using a Cai Tube.

Abstract

To overcome the technical difficulty of exteriorizing a specimen through the descending colon stump, we applied laparoscopic-assisted natural orifice specimen extraction (LA-NOSE) using a Cai tube. From April 2014 to February 2015, we successfully performed total laparoscopic radical surgery with LA-NOSE in six patients with descending colon lesions. The time of operation, blood loss amount, lymph nodes harvested, postoperative recovery, postoperative complications and follow-up were observed. Total laparoscopic dissection and anastomosis with natural orifice removal using a Cai tube was successful in all 6 patients; no deaths, anastomotic bleeding, fistulas, infections, or any other complications were recorded. The median operating time was 327.7 ± 73.4 min, and the estimated blood loss was 66.7 ± 69.2 mL. The mean number of lymph nodes harvested was 15.7 ± 4.4. Recovery of gastrointestinal function ranged from 2 to 4 days after the operation. The mean length of postoperative hospital stay was 12.3 ± 3.2 days. The six cases were followed up for 6-16 (12.5 ± 3.6) months, and all patients avoided auxiliary incision which demonstrated potential cosmetic advantages and uneventful recovery with no additional complications or cancer recurrence. In this pilot study of six patients, LA-NOSE radical descending colectomy using a Cai tube was feasible and safe.