Hemorrhage ; Humans ; Natural Orifice Endoscopic Surgery ; Oropharyngeal Neoplasms/surgery* ; Robotic Surgical Procedures

In recent years, natural orifice specimen extraction surgery (NOSES) has been widely used in surgery of colorectal cancer. The rapid development of NOSES is mainly attributed to its own great advantages and values, including the reduction of surgical trauma, the acceleration of postoperative recovery and the reduction of adverse psychological reactions for patients. These advantages of NOSES are also important embodiment and perfect interpretation of the organ functional protection. Organ functional preservation is a hot topic in surgery today, and it is also an inevitable requirement for minimally invasive surgery. Essentially, NOSES and organ functional preservation are proposed in the same background, and the goals are highly compatible. NOSES is an important practitioner of organ functional preservation, and organ functional preservation is also the vane of the development of the theoretical system of NOSES. These two items complement each other and together constitute the important element in the development of modern minimally invasive surgery. In order to comprehensively discuss the relationship between NOSES and organ functional protection, we elaborate the important role and value of functional protection in NOSES from five key procedures of colorectal surgery, namely surgical approach, extent of resection, lymph node dissection, digestive tract reconstruction and specimen extraction.
Colorectal Neoplasms/surgery* ; Digestive System Surgical Procedures ; Humans ; Laparoscopy/methods* ; Natural Orifice Endoscopic Surgery/methods* ; Specimen Handling ; Treatment Outcome

Female ; Humans ; Hysterectomy ; Laparoscopy ; Natural Orifice Endoscopic Surgery ; Singapore ; Vagina/surgery*

Thanks to endoscopic assistance and the pressure effect of pelvic pneumoperitoneum, transanal total mesorectal excision (taTME) can better expose the surgical field of distal mesorectal space, and may have a prospect for the preservation of pelvic nerves and organ function. The transanal minimally invasive surgery (TAMIS) platform may decrease the injury of internal anal sphincter and protect anal function. Current data show that taTME procedure has similar results on postoperative anal function, urinary function and sexual function compared to transabdominal TME procedure. The early impaired anal function after taTME may be related to the transanal approach itself, implement of single port and the learning curve, but the anal function can improve with time. Regarding the protection of urinary and sexual function, the beginners should be familiar with the course of pelvic nerves, the anatomical landmarks and the technical points during the dissection upward, and try to avoid the injury of the pelvic plex trunk and pelvic splanchnic nerves. TaTME is different from natural orifice transluminal endoscopic surgery (NOTES), while the latter focuses on the minimally invasive principle, the former focuses on the oncological safety and nerve protection. We should combine the advantages of transanal and transabdominal approaches to achieve the final goal of surgical quality improvement and organ function preservation.
Humans ; Learning Curve ; Natural Orifice Endoscopic Surgery ; Rectal Neoplasms ; Rectum ; surgery ; Transanal Endoscopic Surgery

The surgical treatment of low rectal diseases has gradually changed from open radical operation to endoscopic minimally invasive operation. Transanal total mesorectal excision (taTME) combines endoscopic technique with transanal approach, and solves the problem of surgery exposure in lower rectal cancer. It has become an option for colorectal surgeons in lower rectal cancer. We named this operation as transanal endoscopic surgery, for the appropriateness when it is applied for other colorectal diseases. Transanal endoscopic surgery belongs to the category of natural orifice transluminal endoscopic surgery, which achieves the same pathological outcomes with less invasiveness and better organ functions compared with traditional surgery. It represents the tendency of low rectal surgery.
Digestive System Surgical Procedures ; Humans ; Minimally Invasive Surgical Procedures ; Natural Orifice Endoscopic Surgery ; Rectal Neoplasms ; Transanal Endoscopic Surgery

PURPOSE: The aim of this study was to compare the long-term outcomes of total laparoscopic surgery with Natural Orifice Specimen Extraction (NOSE) with those for conventional laparoscopy (CL)-assisted surgery for treating rectal cancers. METHODS: We reviewed the prospectively collected records of 844 patients (163 NOSE and 681 CL) who underwent curative surgery for mid- or upper rectal cancers from January 2006 to November 2012. We applied propensity score analyses and compared oncological outcomes for the NOSE and CL groups in a 1:1 matched cohort. RESULTS: After propensity score matching, each group included 138 patients; the NOSE and CL groups did not differ significantly in terms of baseline clinical characteristics. The median follow-up was 57.7 months (interquartile range, 42.4–82.5 months). The combined 5-year local recurrence rate for all tumor stages was 4.1% (95% confidence interval [CI], 0.9%–7.4%) in the NOSE group and 3.0% (95% CI, 0%–6.3%) in the CL group (P = 0.355). The combined 5-year disease-free survival rates for all stages were 89.3% (95% CI, 84.3%–94.3%) in the NOSE group and 87.3% (95% CI, 81.8%–92.9%) in the CL group (P = 0.639). The postoperative mean fecal incontinence scores at 6, 12, and 24 months were similar between the 2 groups. CONCLUSION: In our experience, NOSE for mid- and upper rectal cancer had acceptable long-term oncologic outcomes comparable to those of conventional minimal invasive surgery and seems to be a safe alternative to reduce access trauma.
Case-Control Studies ; Cohort Studies ; Disease-Free Survival ; Fecal Incontinence ; Follow-Up Studies ; Humans ; Laparoscopy ; Natural Orifice Endoscopic Surgery ; Nose ; Propensity Score ; Prospective Studies ; Rectal Neoplasms ; Recurrence

Gastric outlet obstruction, afferent or efferent limb obstruction, and biliary obstruction among patients with altered anatomy often require surgical intervention which is associated with significant morbidity and mortality. Endoscopic dilation for benign etiologies requires multiple sessions, whereas self-expandable metal stents used for malignant etiologies often fail due to tumor in-growth. Lumen apposing metal stents, placed endoscopically with the intent of creating a de-novo gastrointestinal anastomosis bypassing the site of obstruction, can potentially achieve similar efficacy, with a much lower complication rate. In our study cohort (n=79), the composite technical success rate and clinical success rate was 91.1% (72/79) and 97.2% (70/72), respectively. Five different techniques were used: 43% (34/79) underwent the balloon-assisted method, 27.9% (22/79) underwent endoscopic ultrasound-guided balloon occluded gastro-jejunostomy bypass, 20.3% (16/79) underwent the direct technique, 6.3% (5/79) underwent the hybrid rendezvous technique, and 2.5% (2/79) underwent natural orifice transluminal endoscopic surgery (NOTES)-assisted procedure. All techniques required an echoendoscope except NOTES. In all, 53.2% (42/79) had non-cautery enhanced Axios stent, 44.3% (35/79) had hot Axios stent, and 2.5% (2/79) had Niti-S spaxus stent. Symptom-recurrence was seen in 2.8%, and 6.3% had a complication (bleeding, abdominal pain or peritonitis). All procedures were performed by experts at centers of excellence with adequate surgical back up.
Abdominal Pain ; Cohort Studies ; Endosonography ; Extremities ; Gastric Outlet Obstruction ; Humans ; Methods ; Mortality ; Natural Orifice Endoscopic Surgery ; Stents*

OBJECTIVE: The present study aimed to determine the differences in outcomes between natural orifice transluminal endoscopic surgery-assisted vaginal hysterectomy (NAVH) and conventional laparoscopy-assisted vaginal hysterectomy (LAVH). METHODS: We retrospectively reviewed the charts of patients who between July 2012 and September 2015, were diagnosed as having benign uterine disease such as uterine myoma, endometriosis, or adenomyosis and managed via NAVH or LAVH in a single-center (Eulji University Hospital). Data such as age, body weight, height, parity, operation time, intra/post-operative complications, and uterus weight were obtained from the clinical charts. NAVH and LAVH recipients were matched 1:3 in terms of baseline characteristics, and the 2 groups were compared regarding surgical outcomes. RESULTS: Of the 160 patients with benign uterine disease included in the present study. Forty received NAVH and remaining 120 received LAVH. There were significant differences between the groups regarding operation time and hemoglobin change. Notably, although the operation time was shorter for LAVH, hemoglobin change was lower for NAVH. Additionally, although maximum hospitalization duration was shorter for LAVH, the average length of hospitalization was similar between NAVH and LAVH. There were no significant differences between the groups in terms of other variables. CONCLUSION: NAVH may become a new alternative surgical method of choice for hysterectomy, as it represents a clinically feasible and safe approach; moreover is superior to LAVH in terms of bleeding loss.
Adenomyosis ; Body Weight ; Endometriosis ; Female ; Hemorrhage ; Hospitalization ; Humans ; Hysterectomy ; Hysterectomy, Vaginal* ; Laparoscopy ; Leiomyoma ; Methods ; Natural Orifice Endoscopic Surgery ; Parity ; Postoperative Complications ; Retrospective Studies ; Uterine Diseases ; Uterus

Natural orifice transluminal endoscopic surgery (NOTES) is the latest surgical technique for inserting an endoscope through the mouth, anus, vagina etc., and for performing surgery with mucosal incision only, i.e., without skin incision. Recently, a number of researchers have applied NOTES to thyroid surgery in several trials, with the aim of removing the thyroid gland through oral cavity. The transoral endoscopic thyroid surgery became widely known after Anuwong et al. reported successful results for their first 60 patients and it has become increasingly recognized as a feasible novel surgical procedure. The purpose of this article is to review and summarize the existing literature, and describe in detail the preoperative considerations, rationale for patient selection, surgical method and postoperative management for transoral thyroid surgery.
Anal Canal ; Endoscopes ; Humans ; Methods ; Mouth ; Natural Orifice Endoscopic Surgery ; Patient Selection ; Skin ; Thyroid Gland* ; Thyroidectomy ; Vagina

ObjectiveTo explore the practicability and safety of the F4.8 visual miniature nephroscope in the diagnosis and treatment of hematospermia.

METHODSThis study included 12 cases of refractory hematospermia accompanied by perineal or lower abdominal pain and discomfort. All the patients failed to respond to two months of systemic anti-inflammatory medication and local physiotherapy. Seminal vesicle tumor and tuberculosis were excluded preoperatively by rectal seminal vesicle ultrasonography, MRI or CT. Under epidural anesthesia, microscopic examination was performed with the F4.8 miniature nephroscope through the urethra and ejaculatory duct orifice into the seminal vesicle cavity, the blood clots washed out with normal saline, the seminal vesicle stones extracted by holmium laser lithotripsy and with the reticular basket, the seminal vesicle polyps removed by holmium laser ablation and vaporization, and the seminal vesicle cavity rinsed with diluted iodophor after operation.

RESULTSOf the 10 patients subjected to bilateral seminal vesiculoscopy, 3 with unilateral and 2 with bilateral seminal vesicle stones were treated by holmium laser lithotripsy, saline flushing and reticular-basket removal, 2 with seminal vesicle polyps by holmium laser ablation and vaporization, and the other 3 with blood clots in the seminal vesicle cavity by saline flushing for complete clearance. The 2 patients subjected to unilateral seminal vesiculoscopy both received flushing of the seminal vesicle cavity for clearance of the blood clots. The operations lasted 10－55 (25 ± 6) minutes. There were no such intra- or post-operative complications as rectal injury, peripheral organ injury, and external urethral sphincter injury. The urethral catheter was removed at 24 hours, anti-infection medication withdrawn at 72 hours, and regular sex achieved at 2 weeks postoperatively. The patients were followed up for 6－20 (7 ± 2.3) months, during which hematospermia and related symptoms disappeared in 10 cases at 3 months and recurrence was observed in the other 2 at 4 months after surgery but improved after antibiotic medication.

CONCLUSIONSThe F4.8 visual miniature nephroscope can be applied to the examination of the seminal vesicle cavity and treatment of seminal vesicle stones and polyps, with the advantages of minimal invasiveness, safety and reliability.

Calculi ; diagnostic imaging ; surgery ; Ejaculatory Ducts ; Endoscopes ; Endoscopy ; instrumentation ; Genital Neoplasms, Male ; Hemospermia ; diagnosis ; therapy ; Holmium ; Humans ; Lasers, Solid-State ; Lithotripsy ; Magnetic Resonance Imaging ; Male ; Natural Orifice Endoscopic Surgery ; instrumentation ; Neoplasm Recurrence, Local ; Postoperative Complications ; Reproducibility of Results ; Seminal Vesicles ; diagnostic imaging ; Urethra