Safety and feasibility of single-operator-conducted natural orifice specimen extraction surgery (NOSES) for sigmoid colon and upper rectal cancer

Background Laparoscopic colectomy has become a standard minimally invasive approach for the treatment of colorectal cancer. Ongoing efforts aim to minimize the surgical trauma associated with the procedure and reduce the number of port sites. This study was conducted to develop and evaluate a novel technique of single-operator-conducted natural orifice specimen extraction surgery (NOSES) for sigmoid colon and upper rectal cancer resections. Methods A retrospective review was conducted on 12 consecutive patients with sigmoid colon or upper rectal cancer treated at the Sixth Affiliated Hospital of Sun Yat-sen University between June 2022 and June 2023. All procedures were performed by a single surgeon using a modified three-port laparoscopic approach with transanal specimen extraction. Perioperative parameters including blood loss, operation time, postoperative recovery, and oncological outcomes were analyzed. Results The cohort demonstrated favorable surgical outcomes with a mean operation time of 127.17 ± 20.59 minutes and the mean intraoperative blood loss of 16.83 ± 12.07 ml. All specimens were successfully retrieved through the natural orifice with a mean tumor diameter of 3.12 ± 1.07 cm. The mean postoperative hospital stay of 5.83 ± 1.64 days. Histopathological examination confirmed R0 resection in all cases. No procedure-related complications or mortality occurred during the 30-day postoperative period. Conclusions Single-operator-conducted NOSES represents a safe and technically feasible approach for selected patients with sigmoid colon or upper rectal cancer. This modified technique preserves the advantages of minimally invasive surgery while achieving satisfactory oncological outcomes. Further prospective studies with larger cohorts are warranted to validate these findings.