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.
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
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)
Adult patients undergoing elective minimally invasive colorectal resection with planned intact specimen extraction at participating tertiary colorectal centers in the Asia-Pacific region.
Cohort
Prospective
Natural Orifice Specimen Extraction
Procedure/SurgerySpecimen extraction through a natural orifice, including transanal or transvaginal extraction, during minimally invasive colorectal surgery.
Transabdominal Specimen Extraction
Procedure/SurgerySpecimen extraction through an abdominal incision during minimally invasive colorectal surgery.
Time to Incisional Hernia Within 24 Months
Time from index colorectal surgery to first clinical or radiologic diagnosis of incisional hernia at or adjacent to the specimen extraction site.
Overall Postoperative Complications
Postoperative complications within 30 days classified according to the Clavien-Dindo grading system.
Surgical Site Infection
Incidence of postoperative surgical site infection following minimally invasive colorectal surgery.
Extraction-Site Complications
Extraction-related morbidity including specimen rupture, contamination, bleeding, fistula, or extraction-site injury.
Length of Hospital Stay
Length of postoperative inpatient hospital stay following index colorectal surgery.
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