Laparoscopic-Assisted Natural Orifice Specimen Extraction Gastrectomy Using an Auxiliary Incision-Free Tube for Gastric Cancer

• Published in: The Journal of surgical research 2022-02, Vol.270, p.31-38
• Main Authors: Xu, Shu-Zhen, Cai, Jian-Chun
• Format: Article
• Language: English
• Subjects: Auxiliary Incision-free tube; Natural orifice specimen extraction surgery; Stomach neoplasm; Transrectal; Transvaginal
• ISSN: 0022-4804; 1095-8673
• DOI: 10.1016/j.jss.2021.08.026

•A total of 9 patients with gastric cancer underwent successful LA-NOSE gastrectomy using an auxiliary incision-free tube and standard D2 lymph node resection.•LA-NOSE gastrectomy using the auxiliary incision-free tube to transferred the original abdominal wall incision to the natural orifice incision may reduce visible scarring, pain and faster recovery.•After a mean follow-up of 14.7±9.6 months, no transrectal or transvaginal access-site recurrence, anterior rectectomy or posterior fornix colpotomy related complications, and local recurrence or distant metastasis occurred.•Transrectal or transvaginal specimen extraction following totally laparoscopic subtotal or total gastrectomy using the auxiliary incision-free tube is a feasible procedure for patients with gastric cancer. Laparoscopic-assisted natural orifice specimen extraction (LA-NOSE) gastrectomy effectively avoids the need for an abdominal incision, unlike conventional laparoscopic gastrectomy. In this study, we documented our experience with LA-NOSE gastrectomy using an auxiliary incision-free tube (Cai tube, a homemade invention: ZL201410168748.2) in 9 gastric cancer patients and summarized the clinical results. From July 2018 to June 2020, a total of 9 patients with gastric cancer were recruited for this study. LA-NOSE gastrectomy (subtotal or total) using the auxiliary incision-free tube and D2 lymph node dissection were performed. Specimens were extracted through the anterior wall of the upper rectum in 4 male patients and the posterior fornix of the vagina in 5 female patients using the auxiliary incision-free tube. All 9 patients underwent successful laparoscopic gastrectomy with NOSE using the auxiliary incision-free tube. No perioperative death, re-admission within 60 days post operation, natural orifice wound infection or tumor implantation was observed. The mean operating time was 365.3±41.7 min, and the mean estimated blood loss was 87.8±39.3 ml. The mean duration of hospital stay was 11.3±1.2 days, while the mean maximum pain score (visual analogue score, VAS) was 2.3±0.9 on postoperative day (POD) 1, and the mean time to ambulation was 1.3±0.5 days. The 60-day postoperative morbidity rate was 11.1% (1/9). After a mean follow-up of 14.7±9.6 months, there was no transrectal or transvaginal access-site recurrence, no anterior rectectomy or posterior fornix colpotomy-related complications, and no local recurrence or distant metastasis. Our preliminary experience indicates that this new