Complications and management of natural orifice specimen extraction in colorectal cancer: a narrative review


ANNALS OF LAPAROSCOPIC AND ENDOSCOPIC SURGERY, vol.7, pp.1-7, 2022 (ESCI) identifier identifier

  • Publication Type: Article / Review
  • Volume: 7
  • Publication Date: 2022
  • Doi Number: 10.21037/ales-22-18
  • Journal Indexes: Emerging Sources Citation Index (ESCI), Scopus
  • Page Numbers: pp.1-7
  • Keywords: Natural orifice, leakage, haemorrhage, dyspareunia, incontinence, malignancy, RIGHT HEMICOLECTOMY, RESECTION, COLON
  • Eskisehir Osmangazi University Affiliated: Yes


Background and Objective: Surgery is the principal treatment for colorectal cancer today. As minimally invasive surgical approaches develop, the mini-laparotomy has been used for specimen extraction. To reduce the pain and incision-related complications associated with mini-laparotomy incisions, the technique of natural orifice specimen extraction (NOSE) has been developed and gained popularity over the years. In colorectal surgery, depending on the tumor location and gender of the patient, transanal, transrectal, transcolonic or transvaginal (TV) NOSE routes can be chosen as an addition to laparoscopic surgery. While the advantages of the NOSE technique are well documented, complications, the management of complications and postoperative outcomes can still be challenging. The purpose of this review article is to analyze complications of nose in colorectal cancer surgery and their treatment.Methods: A literature review of the last 11 years in English was researched using PubMed and Google Scholar databases to identify articles on NOSE complications in colorectal cancer surgery.Key Content and Findings: Perioperative complications of NOSE in colorectal cancer surgery include anastomotic leakage, fecal incontinence, intra-abdominal contamination, intraoperative iatrogenic organ injuries, dysperonia, rectovaginal fistula (RVF), and recurrence at the specimen extraction site.Conclusions: To minimize complications, an experienced surgical team is essential. Also, patient selection is of utmost importance. Other important steps to consider are the diameter of the tumor, depth of invasion, and physical characteristics of the patient, as well as strict compliance to the rules of intraoperative asepsis, irrigation of the tissue with the appropriate solution before opening the distal rectal/colonic stump, and the use of a protective specimen sheath before removing the specimen.