Robotic-assisted surgery and the NOSE technique in the treatment of colorectal endometriosis

P.P. Nefedov, А.А. Popov, A.A. Fedorov, T.A. Glebov, Yu.I. Sopova
In: Medical Robotics · 2026 · vol. 1(1) , pp. 77–84 · doi:10.63769/3033-6392-2026-1-1-77-84 · W7155074496
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This study evaluated the safety and short-term outcomes of robotic-assisted colorectal resections with natural orifice specimen extraction (NOSE) in 66 patients with endometriosis, finding it technically feasible, safe, and effective.

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The paper retrospectively evaluated robotic-assisted colorectal resection using the NOSE (natural orifice specimen extraction) approach in 66 women with confirmed deep infiltrating colorectal endometriosis, focusing on safety and short-term clinical outcomes. Procedures were completed by extracting the resected specimen through the anal canal, with reported operative duration (about 145 minutes) and blood loss (about 125 mL), and fever on postoperative day 2 in 13 patients reaching 38°C. The authors conclude the technique is feasible, safe, and effective while offering better cosmetic results, faster rehabilitation, and reduced use of disposable instruments, but the study design is retrospective and single-moment without an explicit comparator group. This paper is centrally about endometriosis — it reports robotic-assisted NOSE colorectal resection outcomes specifically for deep infiltrating colorectal endometriosis.

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Abstract

Background. Natural orifice specimen extraction (NOSE) is an innovative technique of endoscopic surgery in which with specimen extraction through the natural orifice. The relevance of studying robot-assisted colorectal NOSE resection is driven by the need for an objective assessment of its advantages and safety. Aim. To evaluate the safety and short-term clinical outcomes of robotic-assisted bowel resections with specimen extraction through the anal canal in patients with colorectal endometriosis. Materials and methods. A retrospective cross-sectional study was conducted based on the analysis of data from 66 patients with confirmed deep infiltrative colorectal endometriosis. All patients underwent robot-assisted colorectal NOSE resection. Results . The mean age of the patients was 35.4 years (range 23 to 49 years). The mean body mass index was 23.36 kg/m2 (range 16.65 to 33.12 kg/m2). The mean operative time for robotic-assisted colorectal resection using the NOSE technique was 144.6 ± 50.1 min. The mean intraoperative blood loss was 124.6 ± 90.8 mL. On postoperative day 2, 13 patients presented with a body temperature elevation up to 38°C. Conclusion. Robotic-assisted laparoscopy combined with the NOSE technique is a technically feasible, safe, and effective approach in the comprehensive surgical management of colorectal endometriosis. The technique offers several advantages: reduction in the consumption of disposable instruments, absence of a laparotomic incision, accelerated postoperative rehabilitation.
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Робот-ассистированная колоректальная резекция по методу NOSE в лечении эндометриоза https://doi.org/10.63769/3033-6392-2026-1-1-77-84 Аннотация Введение. NOSE (natural orifice specimen extraction) – новый метод эндоскопической хирургии, при котором удаленный препарат извлекают через естественные отверстия тела. Актуальность изучения робот-ассистированной колоректальной NOSE-резекции обусловлена потребностью в объективной оценке ее преимуществ и безопасности. Цель исследования – оценить безопасность и краткосрочные клинические результаты робот-ассистированных резекций кишечника с извлечением резецированного препарата через анальный канал у пациенток с колоректальным эндометриозом. Материалы и методы. Проведено ретроспективное одномоментное исследование данных 66 пациенток с подтвержденным глубоким инфильтративным колоректальным эндометриозом. Всем больным выполнена робот-ассистированная колоректальная NOSE-резекция. Результаты. Средний возраст пациенток составил 35,4 года (от 23 до 49 лет). Средний индекс массы тела был равен 23,36 кг/м2 (от 16,65 до 33,12 кг/м2). Операция продолжалась в среднем 144,6 ± 50,1 мин. Средний объем кровопотери составил 124,6 ± 90,8 мл. У 13 пациенток на 2-е сутки после операции отмечено повышение температуры тела до 38°С. Заключение. Робот-ассистированная лапароскопия в сочетании с извлечением препарата через анальный канал является технически выполнимым, безопасным, эффективным подходом к комплексному хирургическому лечению колоректального эндометриоза. Метод имеет лучшие косметические результаты, ускоряет реабилитацию, снижает расход одноразовых инструментов. Об авторах П. П. НефедовРоссия Павел Петрович Нефедов 101000 Москва, ул. Покровка, 22а А. А. Попов Россия 101000 Москва, ул. Покровка, 22а А. А. Федоров Россия 101000 Москва, ул. Покровка, 22а Т. А. Глебов Россия 101000 Москва, ул. Покровка, 22а Ю. И. Сопова Россия 101000 Москва, ул. Покровка, 22а Список литературы 1. 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Clinical efficacy analysis of natural orifice specimen extraction surgery (NOSES) and conventional laparoscopic surgery (CLS) in the treatment of rectal cancer: a singlecenter retrospective analysis. Tech Coloproctol 2025;29(1):140. DOI: 10.1007/s10151025031864 14. Haas E.M., de Paula T.R., LunaSaracho R. et al. The success rate of robotic natural orifice intracorporeal anastomosis and transrectal extraction (NICE procedure) in a large cohort of consecutive unselected patients. Surg Endosc 2023;37(1):683–91. DOI: 10.1007/s00464022097176 15. Попов А.А., Федоров А.А., Сопова Ю.И. и др. Сравнение основных методов хирургического лечения пациенток с колоректальным эндометриозом. Российский вестник акушерагинеколога 2024;24(6):118–23. DOI: 10.17116/rosakush202424061118 16. Попов А.А., Федоров А.А., Хабибуллах Т. и др. Оптимизация хирургического лечения пациенток с колоректальным эндометриозом с применением транслюминальной технологии. Российский вестник акушерагинеколога 2023;23(6):173–8. 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Feasibility and safety of laparoscopicassisted bowel segmental resection for deep infiltrating endometriosis: a retrospective cohort study with description of technique. J Minim Invasive Gynecol 2016;23(4):512–25. DOI: 10.1016/j.jmig.2015.09.024 Рецензия Для цитирования: Нефедов П.П., Попов А.А., Федоров А.А., Глебов Т.А., Сопова Ю.И. Робот-ассистированная колоректальная резекция по методу NOSE в лечении эндометриоза. Медицинская робототехника. 2026;1(1):77-84. https://doi.org/10.63769/3033-6392-2026-1-1-77-84 For citation: Nefyodov P.P., Popov A.A., Fedorov A.A., Glebov T.A., Sopova Yu.I. Robotic-assisted surgery and the NOSE technique in the treatment of colorectal endometriosis. Medical Robotics. 2026;1(1):77-84. (In Russ.) https://doi.org/10.63769/3033-6392-2026-1-1-77-84 JATS XML

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