<strong>Tóm tắt</strong> <em>Đặt vấn đề: </em>Phẫu thuật nội soi (PTNS) cắt đại - trực tràng cho thấy nhiều ưu điểm vượt trội hơn so với mổ mở, tuy nhiên vẫn còn hạn chế của đường mổ nhỏ lấy bệnh phẩm như đau vết mổ, nhiễm trùng, thoát vị... PTNS kết hợp lấy bệnh phẩm qua đường tự nhiên (NOSE) có nhiều ưu điểm hơn và đã được áp dụng ở nhiều trung tâm trên thế giới. Chúng tôi thông báo kết quả ban đầu 5 trường hợp được chúng tôi áp dụng kĩ thuật này. <em>Đối tượng và phương pháp nghiên cứu:</em> 5 người bệnh (NB) được PTNS cắt đoạn đại- trực tràng kết hợp lấy bệnh phẩm qua đường tự nhiên tại Bệnh viện Hữu nghị Việt Đức và bệnh viện Đa khoa Quốc tế Vinmec từ 5/2021 đến 7/2021 theo một mẫu Protocol chung. Nghiên cứu mô tả các case lâm sàng. <em>Kết quả:</em> Tuổi trung bình là 67,2 ± 10,2, trong đó 2 NB là nam, 3 NB là nữ. Hai NB ung thư đại tràng sigma, 1 NB ung thư trực tràng trên, 1 NB ung thư trực tràng giữa và 1NB viêm túi thừa đại tràng sigma.Thời gian phẫu thuật trung bình là 196 ± 49,3 phút (120 - 250 phút). Chúng tôi đều sử dụng 5 trocar, lấy bệnh phẩm qua đường trực tràng thực hiện đối với người bệnh nam; qua đường âm đạo đối với người bệnh nữ. Không có tai biến trong mổ. Thời gian nằm viện trung bình là 7,75 ± 1,5 ngày (6 - 10 ngày). Tất cả NB chỉ có biểu hiện đau vừa và nhẹ tại vị trí lỗ trocar, không có biến chứng nặng sau mổ và 1 trường hợp nhiễm trùng lỗ trocar rốn. <em>Kết luận:</em> PTNS cắt đại trực tràng lấy bệnh phẩm qua đường tự nhiên là một kĩ thuật khả thi, an toàn có hiệu quả rõ rệt với kết quả sớm. <strong><em>Từ khóa:</em></strong> Phẫu thuật nội soi cắt đại trực tràng, ung thư trực tràng, lấy bệnh phẩm đường tự nhiên. <strong> </strong> <strong>Laparoscopic natural orifice specimen extraction (NOSE) colectomy: Experience in 5 case</strong> Pham Duc Huan<sup>1</sup>, Quach Van Kien<sup>2</sup>, Dao Duc Dung<sup>1</sup>, Vu Duc Thinh<sup>2</sup>, Tran Minh Hieu<sup>2</sup>, Tong Quang Hieu<sup>2</sup>, Pham Quang Thai<sup>2</sup> <ol> <li>Vinmec International General Hospital, 2. Viet Duc University Hospital</li> </ol> <strong>Abstract</strong> <em>Introduction: </em>Laparoscopic surgery in the treatment of colorectal cancer or benign diseases of the colorectal has shown efficacy than open surgery and has been widely applied in many centers, but there are still limitations of the small incsision such as: wound pain, infection, hernia incision. Laparoscopy combined with natural orifice specimen extraction (NOSE) has more advantages and has been applied in many centers. We report the initial results of 5 cases where we applied this technique. <em>Patients and Methods: </em>5 patients were applied laparoscopic colorectal resection combined natural orifice specimen extraction (NOSE) at Viet Duc Hospital and Vinmec International Hospital from May. 2021 to July. 2021 according to a Protocol. <em>Results:</em> The mean age was 67.2 ± 10.2, in which 2 patients were male, 3 patient were female. Two case was sigmoid colon cancer, 1 case was upper rectal cancer, 1 case was middle rectal cancer and 1 case was sigmoid diverticulitis. The average surgical time was 196 ± 49.3 minutes, (120 - 250 minute). We both used 5 trocarts. Transanal specimen extraction was performed in male patient , and transvaginal specimen extraction was performed in female patient. There were no intraoperative complications such as bleeding, ureteral injury. The average hospital stay was 7.75 ± 1.5 days (6 - 10 days). All patients had only moderate pain after surgery at the trocart-site. 4/5 patients were assigned to eat by mouth after 48 hours, and there were no serious complications after surgery (bleeding, ansastomosis fistula ..), and only 1 case was infection of the umbilical trocart site. <em>Conclusion: </em>Laparoscopic natural orifice specimen extraction in rectal cancer appears to be feasible, safe, and show promising efficacy for selected patients. <strong><em>Keyword:</em></strong> Laparoscopic, NOSE, natural orifice specimen extraction. <strong>Tài liệu tham khảo</strong> <ol> <li>Stewert EA, L.A., Friedman AJ., <em>Operative laparoscopy followed by colpotomy for resecting a colonic leiomyosarcoma: a case report.</em> J Reprod Med., 1991. 36: p. 883–884.</li> <li>Nezhat F, <em>Laparoscopic segmental resection for infiltrating endometriosis of rectosigmoid colon: a preliminary report.</em> Surg Laparosc Endosc Percutan Tech., 2001. 11: p. 67–68.</li> <li>Franklin ME Jr, R.R., Rosenthal D, Schuessler W., <em>Laparoscopic colonic procedures.</em> World J Surg., 1993. 17: p. 51–56.</li> <li>Stewart, E.A., A.S. Liau, and A.J. Friedman, <em>Operative laparoscopy followed by colpotomy for resecting a colonic leiomyosarcoma. A case report.</em> J Reprod Med, 1991. 36(12): p. 883-4.</li> <li>Nezhat, F., et al., <em>Laparoscopic segmental resection for infiltrating endometriosis of the rectosigmoid colon: a preliminary report.</em> Surg Laparosc Endosc, 1992. 2(3): p. 212-6.</li> <li>Franklin, M.E., Jr., et al., <em>Laparoscopic colonic procedures.</em> World J Surg, 1993. 17(1): p. 51-6.</li> <li>Kvasha, A., et al., <em>Unlimited-Length Proctocolectomy Utilizing Sequential Intussusception and Pull-Through: Novel Clean Endolumenal NOTE-Assisted Technique With Transanal Natural Orifice Specimen Extraction Without Rectal Stump Opening in a Porcine Model.</em> Surg Innov, 2016. 23(5): p. 456-62.</li> <li>Andres, G., et al., <em>The best option: Umbilical LESS radical nephrectomy with vaginal extraction.</em> Actas Urol Esp, 2015. 39(3): p. 188-94.</li> <li>Ouyang, Q., et al., <em>Comparison of NOSES and Conventional Laparoscopic Surgery in Colorectal Cancer: Bacteriological and Oncological Concerns. </em>Front Oncol, 2020. 10: p. 946.</li> <li>Izquierdo, K.M., E. Unal, and J.H. Marks, <em>Natural orifice specimen extraction in colorectal surgery: patient selection and perspectives. </em>Clin Exp Gastroenterol, 2018. 11: p. 265-279.</li> <li>Sehgal, R. and R.A. Cahill, <em>Advanced laparoscopic surgery for colorectal disease: NOTES/NOSE or single port?</em> Best Pract Res Clin Gastroenterol, 2014. 28(1): p. 81-96.</li> <li>Kim, H.J., et al., <em>Transvaginal specimen extraction versus conventional minilaparotomy after laparoscopic anterior resection for colorectal cancer: mid-term results of a case-matched study.</em> Surg Endosc, 2014. 28(8): p. 2342-8.</li> <li>Palanivelu, C., et al., <em>An innovative technique for colorectal specimen retrieval: a new era of “natural orifice specimen extraction”</em> (N.O.S.E). Dis Colon Rectum, 2008. 51(7): p. 1120-4.</li> <li>Hoi-Ioi Ng, M., Wu-qing Sun, MD, Xiao-mu Zhao, MD, Lan Jin, MD, Xi-xi Shen, MD, and M. Zhong-tao Zhang, Jin Wang, MD, <em>Outcomes of trans-anal natural orifice specimen extraction combined with laparoscopic anterior resection for sigmoid and rectal carcinoma. An observational study. </em>Medicine, 2018. 97.</li> <li>Wolthuis, A.M., et al., <em>Randomized clinical trial of laparoscopic colectomy with or without natural-orifice specimen extraction.</em> Br J Surg, 2015. 102(6): p. 630-7.</li> <li>Hackert, T., W. Uhl, and M.W. Buchler, <em>Specimen retrieval in laparoscopic colon surgery.</em> Dig Surg, 2002. 19(6): p. 502-6.</li> <li>Kuhry, E., et al., <em>Long-term results of laparoscopic colorectal cancer resection.</em> Cochrane Database Syst Rev, 2008(2): p. CD003432.</li> <li>Bu, J., et al., <em>Effect of laparoscopic surgery for colorectal cancer with N. O. S. E. on recovery and prognosis of patients.</em> Minim Invasive Ther Allied Technol, 2020: p. 1-8.</li> <li>Park, J.S., et al., <em>Long-term outcomes after Natural Orifice Specimen Extraction versus conventional laparoscopy-assisted surgery for rectal cancer: a matched case-control study.</em> Ann Surg Treat Res, 2018. 94(1): p. 26-35.</li> <li>Kevin M Izquierdo, E.U., John H Marks, <em>Natural orifice specimen extraction in colorectal surgery: patient selection and perspectives.</em> Clinical and Experimental Gastroenterology 2018. 11: p. 265–279.</li> <li>Cheng, C.C., et al., <em>Minimally invasive right colectomy with transrectal natural orifice extraction: could this be the next step forward?</em> Tech Coloproctol, 2020. 24(11): p. 1197-1205.</li> <li>Shinsuke Masubuchia, J.O., Masashi Yamamotoa, Yoshihiro Inouea,Keitaro Tanakaa, Kazuhisa Uchiyama, <em>Natural orifice specimen extraction in laparoscopic colorectal cancersurgery: A case series study.</em> International Journal of Surgery Case Reports, 2021. 78: p. 204-209.</li> <li>Jun He, H.-B.Y., Chang-Jian Wang, Qin-Yan Yang, Jian-Ming Qiu, Jin-Ming Chen, Zhong Shen and and G.-G. Yang, <em>Meta-analysis of laparoscopic anterior resection with natural orifice specimen extraction (NOSE-LAR) versus abdominal incision specimen extraction (AISE-LAR) for sigmoid or rectal tumors. </em>World Journal of Surgical Oncology, 2020. 18.</li> </ol> <!--more--> <a href="https://vjsel.com/wp-content/uploads/2022/05/BAI-4-TCNS-SO-4-TAP-11-2021.pdf">Download PDF File</a>