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CC BY 4.0 · Journal of Coloproctology 2024; 44(S 01): S1-S138
DOI: 10.1055/s-0045-1808835
Temas Gerais Dentro da Especialidade
General Topics Within the Specialty
ID – 141649
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REMOVAL OF SURGICAL SPECIMEN VIA NATURAL ORIFICE (NOSES) VERSUS MINI-ABDOMINAL INCISION IN THE LAPAROSCOPIC SURGICAL TREATMENT OF INTESTINAL ENDOMETRIOSIS

Authors

  • Rogerio Serafim Parra

    1   Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, Ribeirão Preto, Brasil

  • José Vitor Cabral Zanardi

    1   Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, Ribeirão Preto, Brasil

  • Fernando Passador Valério

    1   Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, Ribeirão Preto, Brasil

  • Marley Ribeiro Feitosa

    1   Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, Ribeirão Preto, Brasil

  • José Joaquim Ribeiro da Rocha

    1   Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, Ribeirão Preto, Brasil

  • Omar Féres

    1   Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, Ribeirão Preto, Brasil

  • Matheus Couto Furtado Albuquerque

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Introduction and Objective Natural Orifice Specimen Extraction (NOSES) emerged as an alternative to mini-abdominal incision (MIA) for segmental resection (RES) in patients with intestinal endometriosis. This study aims to compare the surgical outcomes of the two techniques.

Methods Patients who underwent RES of the rectum and/or sigmoid for endometriosis between January 2021 and May 2024 were assessed. Data regarding operative time, hospitalization duration, early discharge (within 24 hours after surgery), major postoperative complications (Clavien Dindo II or III), and mortality were collected and compared.

Results A total of 88 RES procedures were performed, with 76 (86.4%) involving specimen removal via mini-abdominal incision (MIA) and 12 (13.6%) via NOSES. The average age at the time of surgery was lower in the MIA group compared to the NOSES group (36.5 vs. 40.1 years), as was the operative time (155.1 vs. 187.5 minutes). In the NOSES group, laparoscopic hysterectomy was performed in 5 cases (41.7%), vaginal dome lesions requiring intentional vaginal opening occurred in 6 cases (50%), and specimen removal via vaginal opening was done in 1 case (8.3%). In the MIA group, 9 out of 76 cases (11.8%) required concomitant laparoscopic hysterectomy. The hospitalization duration was similar in both groups (1.97 vs. 2.00 days), as was the rate of early discharge (n=24, 31.6% vs. n=4, 33.3%). The frequency of major postoperative complications within 30 days of discharge was significantly higher in the NOSES group compared to the MIA group (n=4, 33.3% vs. n=8, 10.5%). However, 3 of the 4 patients with complications (75%) had vaginal nodules, and only 1 (25%) required vaginal opening due to hysterectomy. There were no deaths.

Conclusion NOSES was associated with a higher rate of major postoperative complications and longer surgical time compared to MIA. However, the majority of vaginal openings in the NOSES group were due to infiltrative lesions in the vaginal dome. Hospitalization duration and early discharge rates were similar. Randomized clinical trials are needed to further evaluate NOSES as an alternative to MIA in minimally invasive colectomy for the treatment of intestinal endometriosis.


No conflict of interest has been declared by the author(s).

Publication History

Article published online:
25 April 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/)

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