Standardized laparoscopic NOSE-colectomy is feasible with low morbidity

Albert M Wolthuis, Wolthuis AM, de Buck van Overstraeten A, Anthony de Buck van Overstraeten, Fieuws S, Steffen Fieuws, Boon K, Katrien Boon, André D'Hoore, D'Hoore A
Surgical endoscopy · 2015 · doi:10.1007/s00464-014-3784-3 · PMID:25149636
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⚙ AI-generated summary by claude@2026-07, 2026-07-09 ⓘ

This prospective cohort study of 110 patients found that standardized laparoscopic NOSE-colectomy is safe and feasible, exhibiting good short-term outcomes with low overall morbidity and a median hospital stay of 5 days.

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This prospective cohort study analyzed prospectively collected data (retrospectively analyzed) from 110 elective patients undergoing laparoscopic left-sided NOSE-colectomy between July 2009 and December 2013, with short-term morbidity as the primary endpoint. Most patients were female (88%) with a median age of 38 years, and indications included endometriosis (57%), diverticular disease (26%), and tumor (15%). Postoperative complications occurred in 13% of patients, with 8% classified as Clavien-Dindo grade 1–2; intraluminal bleeding from the anastomosis occurred in 3.6% (managed endoscopically) and there was one anastomotic leak (1%) requiring emergency laparotomy (grade 3b), with a median hospital stay of 5 days. The study explicitly emphasizes its standardized operative technique and reports low morbidity, while being limited to short-term outcomes. This paper relates to endometriosis because 63 of 110 (57%) NOSE-colectomies were performed for endometriosis, providing procedure outcome data for that patient group.

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Abstract

BACKGROUND: In laparoscopic colorectal surgery, extraction site laparotomy can be avoided by natural orifice specimen extraction (NOSE) resulting in less postoperative pain, shorter length of stay, and less morbidity such as wound complications. To date, short-term outcome of a large prospective cohort of patients has not been studied. The aim of this prospective cohort study was to assess short-term outcome of laparoscopic left-sided NOSE-colectomy. METHODS: Prospectively collected data of patients who had undergone elective laparoscopic NOSE-colectomy between July 2009 and December 2013 were analyzed retrospectively. Primary endpoint was short-term morbidity. RESULTS: A total of 110 patients were included in this study. Median age was 38 years (IQR: 32-56), median BMI was 23 kg/m(2) (IQR: 21-25), and 88% of the patients were female. Sixty-three patients (57%) underwent resection for endometriosis, 29 patients (26%) for diverticular disease, 16 patients (15%) for a tumor, and 2 patients for other indications. Median operating time was 85 min (IQR: 70-100) and median length of the extracted specimen was 20 cm (IQR: 16-25). Overall, 14 patients had a postoperative complication (13%), of which 9 were Clavien-Dindo grade 1 or 2 (8%). Four patients (3.6%) had an intraluminal bleeding from the anastomosis, which was treated endoscopically. There was 1 anastomotic leak (1%), treated by emergency laparotomy and creation of a new colorectal anastomosis (grade 3b). The median hospital stay was 5 days (IQR: 4-6). CONCLUSION: Laparoscopic NOSE-colectomy is safe and feasible with good short-term outcome. This study concerning a standardized operative technique is the first in literature reporting on a large group of patients.
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Abstract

Background In laparoscopic colorectal surgery, extraction site laparotomy can be avoided by natural orifice specimen extraction (NOSE) resulting in less postoperative pain, shorter length of stay, and less morbidity such as wound complications. To date, short-term outcome of a large prospective cohort of patients has not been studied. The aim of this prospective cohort study was to assess short-term outcome of laparoscopic left-sided NOSE-colectomy.

Methods

Prospectively collected data of patients who had undergone elective laparoscopic NOSE-colectomy between July 2009 and December 2013 were analyzed retrospectively. Primary endpoint was short-term morbidity.

Results

A total of 110 patients were included in this study. Median age was 38 years (IQR: 32–56), median BMI was 23 kg/m2 (IQR: 21–25), and 88 % of the patients were female. Sixty-three patients (57 %) underwent resection for endometriosis, 29 patients (26 %) for diverticular disease, 16 patients (15 %) for a tumor, and 2 patients for other indications. Median operating time was 85 min (IQR: 70–100) and median length of the extracted specimen was 20 cm (IQR: 16–25). Overall, 14 patients had a postoperative complication (13 %), of which 9 were Clavien-Dindo grade 1 or 2 (8 %). Four patients (3.6 %) had an intraluminal bleeding from the anastomosis, which was treated endoscopically. There was 1 anastomotic leak (1 %), treated by emergency laparotomy and creation of a new colorectal anastomosis (grade 3b). The median hospital stay was 5 days (IQR: 4–6).

Conclusion

Laparoscopic NOSE-colectomy is safe and feasible with good short-term outcome. This study concerning a standardized operative technique is the first in literature reporting on a large group of patients. Similar content being viewed by others

References

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endometriosis

MeSH descriptors

Colectomy Laparoscopy Natural Orifice Endoscopic Surgery Adult Anastomotic Leak Anastomotic Leak Colectomy Colectomy Colon Colon Colonic Diseases Colonic Diseases Female Humans Laparoscopy Laparoscopy Length of Stay Male Middle Aged Natural Orifice Endoscopic Surgery

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