An EEA-assisted transanal specimen extraction and colorectal reconstruction technique during laparoscopic left colectomy: technical note and 22-patient experience

Natural orifice specimen extraction surgery (NOSES) aims to eliminate abdominal extraction incisions while preserving the benefits of minimally invasive colorectal surgery. We describe an institution-developed EEA-assisted transanal specimen extraction and colorectal reconstruction technique developed at our institution and report its technical feasibility, supported by our clinical experience in patients undergoing laparoscopic left colectomy for benign colorectal disease. This was a retrospective consecutive case series of 22 attempted EEA-assisted extraction cases. Following laparoscopic mobilization and resection, the proximal colon is divided using a linear stapler while the distal rectal margin is left open. The EEA anvil is introduced transanally through the rectal stump and secured to the open end of the completely transected specimen using a purse-string suture placed around the anvil shaft. The specimen is subsequently extracted transanally by withdrawing the unfired EEA assembly, which provides the principal traction, while a laparoscopic grasper guides specimen alignment. Following specimen extraction, the rectal stump is stapled closed and a standard end-to-end colorectal anastomosis is completed using the EEA device. Between 2014 and 2018, the technique was attempted in 22 consecutive patients undergoing laparoscopic left colectomy for benign colorectal pathology, including diverticular disease, endoscopically unresectable benign polyps, and chronic constipation associated with dolichocolon and/or volvulus. Successful transanal specimen extraction without an abdominal extraction incision was achieved in 21 of 22 attempted cases (95.5%). One patient required abdominal extraction because of a markedly thick mesosigmoid. Median hospital stay was 2 days. Operative duration ranged from 2.5 to 3.5 h (median, 3 h), and estimated blood loss was recorded qualitatively as minimal. No early clinically documented mortality, readmission, reoperation, or postoperative complication was identified through the planned postoperative day-10 assessment. This EEA-assisted technique enables transanal specimen extraction and subsequent colorectal reconstruction through a single integrated approach while avoiding an abdominal extraction incision in most patients in this selected cohort. Our experience suggests that the technique was technically feasible in selected patients undergoing laparoscopic left colectomy for benign colorectal disease; however, the small series, day-10 follow-up, and absence of a comparison group do not establish comparative safety, superiority, or long-term outcomes.