AP-NOSES: A Prospective Multicentre Registry of Natural Orifice Specimen Extraction in Minimally Invasive Colorectal Surgery

Summary

Natural orifice specimen extraction (NOSE) is a minimally invasive colorectal surgical technique in which the surgical specimen is removed through a natural orifice, including transanal or transvaginal routes, thereby avoiding an abdominal extraction incision. Observational studies suggest that NOSE may reduce wound-related morbidity and improve postoperative recovery, but prospective multicenter data evaluating long-term outcomes remain limited. AP-NOSES is a prospective, multicenter observational registry evaluating clinical, patient-reported, and long-term wound outcomes following minimally invasive colorectal surgery with NOSE or transabdominal specimen extraction. The primary objective is to compare time to incisional hernia within 24 months between NOSE-eligible patients undergoing planned NOSE extraction and NOSE-eligible patients undergoing planned transabdominal extraction. Secondary objectives include evaluation of postoperative complications, extraction-related morbidity, bowel function, urinary and sexual function, oncologic outcomes, and long-term patient-reported and clinical outcomes across participating centers. This study does not alter routine clinical care. Surgical technique, perioperative management, and follow-up are performed according to local institutional practice.

Eligibility

Inclusion Criteria:

* Age 21 years or older
* Elective minimally invasive colorectal resection (laparoscopic or robotic intent)
* Planned intact specimen extraction
* Eligible for natural orifice specimen extraction (NOSE) or transabdominal specimen extraction according to study protocol
* Ability to provide informed consent

Exclusion Criteria:

* Emergency colorectal surgery
* Planned transanal total mesorectal excision (TaTME)
* Planned ultralow anterior resection with planned anastomosis 3 cm or less from the anal verge
* Planned abdominoperineal resection (APR)
* Planned permanent end stoma without restoration of intestinal continuity
* Planned multivisceral resection
* Generalized peritonitis or uncontrolled intra-abdominal sepsis
* Pregnancy
* Pre-existing ventral or incisional hernia at the planned extraction site
* Planned specimen extraction through a prior laparotomy incision containing mesh
* Fixed distal obstruction, severe pelvic stenosis, or other anatomical constraint precluding intact specimen extraction

Conditions3

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