Application Of Reverse Puncture Technique In Laparoscopic NOSES For Rectal Cancer

Background:Laparoscopy is widely used for radical resection of colorectal cancer.However,the traditional approach needs to make an abdominal incision with 5-10 cm for removal of specimen and placing stapler anvil bottom.NOSES is a technique that all procedures are performed without abdominal incision.The applications of NOSES in laparoscopic radical rectal cancer resection have been preliminarily investigated.But the feasibility and safely are still unknown.Whether it increases the incidences of infection and tumor dissemination is unclear.The technique of placing stapler anvil bottom is not mature.In the current study,we reported our experience that application of reverse puncture technique in laparoscopic NOSES for rectal cancer.Objective:To discuss the feasibility,safety and short-term outcomes of that application of reverse puncture technique in laparoscopic NOSES for rectal cancer.Methods:Patients underwent laparoscopic radical rectal cancer resection in Qilu Hospital of Shandong University from January 2017 to July 2018 were collected,including 65 cases who underwent reverse puncture technique of laparoscopic NOSES(NOSES-group)and 68 cases underwent traditional approaches(Control group).The harvest of lymph nodes,blood loss,operative time,postoperative complications were evaluated and analyzed by SPSS v22.Results:Compared with control group,NOSES-group had lower incidence of incision-related complications(x 2= 7.063,P<0.05),and shorter postoperative exhaust time and postoperative hospitalization time(t = 7.503,2.530;P<0.05).However,NOSES-group had a longer operation time(195.11±17.17 min)than that of control group(161.18±47.21 min,t=-5.459,P<0.05).There were no significant difference in the number of blood loss,number of lymph node harvest,abdominal infection and postoperative anastomotic leakage.Conclusion:The reverse puncture technique of laparoscopic NOSES is safe and feasible for selected patients with rectal cancer,which displays obvious advantages over traditional approaches.