Conventional Laparoscopy Versus Laparoscopic Natural Orifice Specimen Extraction with Rectal Eversion for Rectal Cancer

Background: Colorectal carcinoma (CRC) ranks as the third most prevalent cancer worldwide, with surgical resection remaining the primary treatment approach. Laparoscopic surgery has largely replaced conventional open surgery due to its safety and enhanced postoperative recovery. However, there are additional expenses, wound-related morbidity, and postoperative pain associated with conventional laparoscopic anterior resection, which involves a 4-8 cm abdominal incision. As an alternative that minimizes postoperative complications and does away with abdominal incisions, natural orifice specimen extraction surgery (NOSES) is a viable option. Aim: This study aimed to compare Laparoscopic NOSES with rectal eversion to traditional laparoscopic anterior resection to assess its feasibility, safety, and effectiveness in treating rectal cancer. Patients and methods: A prospective, randomized, controlled clinical trial was conducted at Zagazig University Hospitals from June 2021 to December 2024. A total of 24 patients with rectal carcinoma were divided into two groups: Group A (n=12) underwent conventional laparoscopic anterior resection, and group B (n=12) underwent laparoscopic rectal resection with rectal eversion and NOSES. Patients were assessed for operative duration, postoperative recovery, complications, and functional outcomes. Results: NOSES was associated with significantly longer operative duration (281.67 ± 24.8 min vs. 213.75 ± 18.84 min, p < 0.001) but resulted in shorter hospital stays (5.17 ± 1.03 vs. 7.42 ± 1.56 days, p < 0.001). NOSES had fewer postoperative complications (33.3% vs. 58.3%, p < 0.05) and reduced urological complications (33.3% vs. 66.6%, p < 0.05). Bowel recovery and pain management were superior in the NOSES group. Conclusion: Laparoscopic NOSES with rectal eversion was a feasible and safe alternative to conventional laparoscopic resection, particularly for lower rectal cancer. It offered faster recovery, fewer complications, and improved postoperative outcomes while eliminating the need for abdominal incisions.