An investigation report on the current situation of natural orifice specimen extraction surgery in China

doi:10.3877/cma.j.issn.2095-3224.2021.02.003

Chinese Journal of Colorectal Diseases(Electronic Edition) ›› 2021, Vol. 10 ›› Issue (02): 122-131. doi: 10.3877/cma.j.issn.2095-3224.2021.02.003

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An investigation report on the current situation of natural orifice specimen extraction surgery in China

Xu Guan¹, Shuai Jiao², Haiyang Huang¹, Haitao Zhou¹, Chuangang Fu³, Ye Wei⁴, Zhiguo Xiong⁵, Donghui Sun⁶, Luchuan Chen⁷, Jianchun Cai⁸, Qingsi He⁹, Dan Ma¹⁰, Yangchun Zheng¹¹, Kefeng Ding¹², Junhong Hu¹³, Jian Peng¹⁴, Hongliang Yao¹⁵, Guiyu Wang¹⁶, Yong Wang¹⁷, Xuejun Sun¹⁸, Taiyuan Li¹⁹, Bo Jiang²⁰, Liang Kang²¹, Xishan Wang¹^,^†()

^1. Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Bejing 100021, China
^2. Department of Colorectal Surgery, the Second Affiliated Hospital of Harbin Medical University, Harbin 150006, China
^3. Endoscopy Center of Dongfang Hospital Affiliated to Tongji University, Shanghai 200120, China
^4. Department of General Surgery, Zhongshan Hospital Affiliated to Fudan University, Shanghai 200032, China
^5. Department of Gastrointestinal Surgery, Hubei Cancer Hospital, Wuhan 430070, China
^6. Department of Gastrocolorectal and Anal Surgery, the First Hospital of Jilin University, Changchun 130000, China
^7. Department of Gastrointestinal Surgery, Fujian Cancer Hospital, Fuzhou 350011, China
^8. Department of Gastrointestinal Surgery, Zhongshan Hospital affiliated to Xiamen University, Xiamen, 361000 China
^9. Department of Gastrointestinal Surgery, Qilu Hospital, Shandong University, Jinan 250000, China
^10. Department of General Surgery, Xinqiao Hospital, Army Military Medical University, Chongqing 400000, China
^11. Department of Colorectal Cancer, Sichuan Cancer Hospital, Chengdu 610000, China
^12. Department of Oncology, the Second Affiliated Hospital of Medical College of Zhejiang University, Hangzhou 310000, China
^13. Department of Colorectal and Anal Surgery, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, China
^14. Department of Hepatobiliary Surgery, Xiangya Hospital, Central South University, Changsha 410000, China
^15. Department of Gastrointestinal Surgery, Xiangya Second Hospital, Central South University, Changsha 410000, China
^16. Department of Colorectal Surgery, Zhejiang Cancer Hospital, Hangzhou 310000, China
^17. Department of General Surgery, the Second Affiliated Hospital of Anhui Medical University, Hefei 230000, China
^18. Department of General Surgery, the First Affiliated Hospital of Medical College of Xi'an Jiaotong University, Xi'an 710000, China
^19. Department of General Surgery, the First Affiliated Hospital of Nanchang University, Nanchang 330000, China
^20. Department of Colorectal and Anal Surgery, Shanxi Cancer Hospital, Taiyuan 030000, China
^21. Department of Colorectal and Anal Surgery, the Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou 510000, China

Received:2021-02-09 Online:2021-04-25 Published:2021-05-07
Contact: Xishan Wang

Abstract

Abstract:

Objective

To understand the current situation of natural orifice specimen extraction surgery (NOSES) in China, and to analyze its main advantages and challenges, so as to provide a powerful basis for future development.

Methods

From November to December 2020, doctors engaged in gastrointestinal surgery, general surgery and gynecology were selected as the main subjects. This survey was conducted from four aspects: the basic information of doctors, the current situation of NOSES, the advantages and challenges of NOSES, the teaching and training of NOSES and the current situation of scientific research.

Results

In this study, a total of 830 doctors filled out questionnaires, 18 invalid questionnaires were excluded, and a total of 812 valid questionnaires were investigated. the proportion of valid questionnaires was 97.8%, of which the number of people carrying out NOSES accounted for 69.3%. This survey covers 30 provinces and municipalities directly under the Central Government in China, of which 29 regions have doctors who have carried out NOSES, and carried out NOSES in a total of 373 hospitals. With the passage of time, the development of NOSES in China shows a significant upward trend, but there are great differences among provinces and municipalities directly under the Central Government. The results of this survey show that the total number of NOSES cases in China is 20,799, of which colorectal tumors account for 85.8%. NOSES analysis of colorectal tumors showed that transanal sampling accounted for 85.7% and transvaginal sampling accounted for 14.3%. The results of this survey showed that 85.3%(480/563) of the physicians thought that improving the psychological mood during the postoperative recovery period was the greatest advantage of NOSES, and 52.8% (297/563) believed that aseptic and tumor-free control was still the main challenge for NOSES surgery. According to the survey results of NOSES training and learning, attending academic conferences, live demonstrations of experts in surgery and online surgery video learning accounted for 89.9% (506/563), 78.9% (444/564) and 77.8% (438/563), respectively. 40.0% (225/563) of physicians said that the best way to learn NOSES was to participate in the training course. The results of the scientific research survey on NOSES show that 15.1% (85/563) of doctors have published NOSES-related papers, and 65.7% (370/563) and 27.9% (157/563) of NOSES data have not been uploaded or partially uploaded to China's NOSES database.

Conclusions

The present situation of NOSES development in China shows a significant development trend, wide regional distribution and great potential for popularization. However, standardized surgical training and clinical scientific research output still need to be further improved. In the next step, more targeted measures are needed to improve the NOSES development system and promote its more scientific, standardized, healthy and orderly development.

Key words: Colorectal neoplasms, Questionnaire survey, Natural orifice specimen extraction surgery(NOSES), Surgeon, Current situation

Xu Guan, Shuai Jiao, Haiyang Huang, Haitao Zhou, Chuangang Fu, Ye Wei, Zhiguo Xiong, Donghui Sun, Luchuan Chen, Jianchun Cai, Qingsi He, Dan Ma, Yangchun Zheng, Kefeng Ding, Junhong Hu, Jian Peng, Hongliang Yao, Guiyu Wang, Yong Wang, Xuejun Sun, Taiyuan Li, Bo Jiang, Liang Kang, Xishan Wang. An investigation report on the current situation of natural orifice specimen extraction surgery in China[J]. Chinese Journal of Colorectal Diseases(Electronic Edition), 2021, 10(02): 122-131.

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Figures/Tables 8

References 23

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调查条目	总人数（%）（n=812）
年龄
40岁以下	278（34.2）
40~50岁	374（46.1）
50岁以上	160（19.7）
性别
男	784（96.6）
女	28（3.4）
最高学历
本科以下	7（0.9）
本科	331（40.8）
硕士	263（32.4）
博士	211（26.0）
职称
住院医师	37（4.6）
主治医师	169（20.8）
副主任医师	323（39.8）
主任医师	283（34.9）
最高级别学术任职
无	90（11.1）
地市级	115（14.2）
省级	304（37.4）
国家级	303（37.3）
外科执业年限
5年以下	44（5.4）
6~10年	117（14.4）
11~20年	302（37.2）
20年以上	349（43.0）
所在医院级别
三甲	558（68.7）
非三甲	254（31.3）
掌握NOSES理论体系情况
完全掌握	230（28.3%）
部分掌握	562（69.2）
完全不了解	20（2.5）
是否开展过NOSES手术
开展	563（69.3）
没有开展	249（30.7）

调查条目	总人数（%）（n=812）
年龄
40岁以下	278（34.2）
40~50岁	374（46.1）
50岁以上	160（19.7）
性别
男	784（96.6）
女	28（3.4）
最高学历
本科以下	7（0.9）
本科	331（40.8）
硕士	263（32.4）
博士	211（26.0）
职称
住院医师	37（4.6）
主治医师	169（20.8）
副主任医师	323（39.8）
主任医师	283（34.9）
最高级别学术任职
无	90（11.1）
地市级	115（14.2）
省级	304（37.4）
国家级	303（37.3）
外科执业年限
5年以下	44（5.4）
6~10年	117（14.4）
11~20年	302（37.2）
20年以上	349（43.0）
所在医院级别
三甲	558（68.7）
非三甲	254（31.3）
掌握NOSES理论体系情况
完全掌握	230（28.3%）
部分掌握	562（69.2）
完全不了解	20（2.5）
是否开展过NOSES手术
开展	563（69.3）
没有开展	249（30.7）

调查条目	人数（%）
未开展NOSES手术的原因？（多选）
技术经验不足	184（73.9）
缺少专业培训	174（69.9）
器械设备不到位	85（34.1）
其他原因	47（18.9）
主观无法接受	3（1.2）
将来是否愿意开展NOSES手术？
愿意开展	245（98.4）
不愿意开展	4（1.6）

调查条目	人数（%）
未开展NOSES手术的原因？（多选）
技术经验不足	184（73.9）
缺少专业培训	174（69.9）
器械设备不到位	85（34.1）
其他原因	47（18.9）
主观无法接受	3（1.2）
将来是否愿意开展NOSES手术？
愿意开展	245（98.4）
不愿意开展	4（1.6）

调查条目	人数（%）
NOSES手术最大的价值是？（多选）
术后恢复期心理情绪改变小	480（85.3）
消除切口瘢痕产生的心理暗示	473（84.0）
手术创伤小	432（76.7）
美容	379（67.3）
其他	30（5.3）
开展NOSES手术面临的困难与挑战？（多选）
无菌无瘤把控	297（52.8）
完全腹腔镜下消化道重建	214（38.0）
操作步骤复杂	209（37.1）
经自然腔道取标本	142（25.2）
技术难度高	129（22.9）
无	75（13.3）
理论体系复杂不易掌握	35（6.2）
其他	32（5.7）
开展NOSES最常用的器械平台？
2D腹腔镜	419（74.4）
3D腹腔镜	128（22.7）
机器人	12（2.1）
其他	4（0.7）
是否开展经阴道取标本NOSES手术？
开展	304（54.0）
没有开展	259（46.0）
^*没有开展经阴道取标本NOSES的主要原因？（多选）
医生操作经验不足	152（58.7）
对阴道损伤大	69（26.6）
伦理未通过	62（23.9）
其他	53（20.5）
影响术后性功能	43（16.6）

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