Comparison of Natural Orifice Versus Transabdominal Specimen Extraction Following Laparoscopic Minor Hepatectomy

Abstract

Natural orifice specimen extraction (NOSE) is an emerging technique usually preferred for colorectal resections or cholecystectomy. NOSE following laparoscopic liver resections is limited to case reports, and there is no previous study comparing the outcomes of NOSE and transabdominal (TA) specimen extraction. Our aim was to compare NOSE and TA specimen extraction methods following laparoscopic minor hepatectomy. Thirty-one patients undergoing laparoscopic minor hepatectomy between 2014 and 2020 were evaluated. The patients were divided into two groups as NOSE (n: 12) and TA (n: 19). The patients’ demographics, preoperative and postoperative findings, pain, and cosmetic scores were compared. Female ratio was higher in the NOSE group (83.3% vs 31.6%, p=0.005); other demographics were similar. The median length of incision was 6 cm in the TA group but only trocar incisions in the NOSE group. There was no difference between intraoperative and postoperative findings except pain and cosmetic scores. Pain scores on postoperative days 1, 2, and 3 and in total were lower in the NOSE group (4.1±0.6 vs. 5.6±1.1, p=0.001; 2.2±04 vs. 4.1±0.9, p<0.001; 1.7±0.6 vs. 2.4±0.8, p=0.025; 8.1±1.4 vs. 12.2±2.5, p<0.001). In addition, patients in NOSE group had better cosmetic scores (9.2±0.6 versus 7.0±0.6, p<0.01). Laparoscopic minor hepatectomy combined with NOSE is a safe and effective procedure in selected patients with the advantages of less postoperative pain and better cosmesis. NOSE is ideal for female patients with high cosmetic expectancy.