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China-developed minimally invasive surgical technique - Natural Orifice Specimen Extraction Surgery (NOSES) promoted to the world

May 30, 2022


Abstract : Natural Orifice Specimen Extraction Surgery (NOSES), a new minimally invasive surgical technique developed by a team with the Cancer Hospital of Chinese Academy of Medical Sciences to extract specimen through natural orifice, has been rapidly accepted and utilized around the world.

BEIJING, May 30 (Xinhua) -- Natural Orifice Specimen Extraction Surgery (NOSES), a new minimally invasive surgical technique developed by a team with the Cancer Hospital of Chinese Academy of Medical Sciences to extract specimen through natural orifice (such as rectum, vagina, and oral cavity), has been rapidly accepted and utilized around the world.

Wang Xishan, director of the colorectal department of Cancer Hospital and his team took the lead in developing the NOSES, which boasts advantages including absence of auxiliary incision, less surgical trauma, alleviation of postoperative pain, better abdominal wall function, faster recovery and better cosmetic outcome.

Wang developed NOSES from a few surgical procedures to a complete theoretical system, expanded the surgery targets from a single organ to multiple organs and promoted the application scale of the new technique from several centers to the whole country and even the world. By far, four editions of NOSES academic monographs in Chinese have been published by Wang and he also cooperated with Springer, one of the largest scientific and technological publishers in the world, to publish the second edition of "Natural Orifice Specimen Extraction Surgery - Gastrointestinal Tumor". The electronic edition of this book has been downloaded more than 20,000 times and the book has been translated into Russian, Japanese, Korean, French and Vietnamese by foreign experts for publication worldwide, greatly promoting the Chinese original technique to the world.

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Photo shows the series of NOSES monographs.

On August 31, 2018, Wang initiated under the unanimous advocacy of experts in the field establishment of the International Alliance of NOSES and was elected as the chairman of the first International Alliance of NOSES on the first international NOSES academic conference held in Beijing. By convening successively four international NOSES conferences afterwards, hundreds of experts from dozens of countries were invited to conduct in-depth communications and discussions on NOSES theory, technical operation, clinical research and other academic issues, all of which indicated the bright prospects of NOSES being widely applied around the world.

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Photo shows the inauguration ceremony of the International Alliance of NOSES.  

In 2018, Wang led a Chinese delegation to attend the 11th annual conference of the Russian Society of Colorectal Surgery, and demonstrated an operation on live - the NOSES IV, which took only one and a half hours and attracted experts from Sweden, Japan and Russia to witness this new technique for the first time. Thanks to his contributions to exchanges between Chinese and Russian colorectal experts and his achievements in the field of colorectal surgery, Wang was awarded as honorary member of the Russian Society of Colorectal Surgery.

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Photo shows that Wang Xishan was awarded as the honorary member of the Russian Society of Colorectal Surgery.

At the beginning of 2019, Wang gave demonstrations of NOSES operation to introduce steps and operation skills of NOSES on the two consecutive China-Republic of Korea (ROK) NOSES symposiums held by China's National Cancer Center. Experts of both sides exchanged in-depth views on the NOSES and other academic issues such as NOSES, en-bloc resection of rectal cancer, lateral lymph node dissection, robotic surgery, hand-assisted laparoscopy, and ICG imaging.

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Group photo of Chinese and ROK experts after the symposium.

In June of 2019, Wang demonstrated a case of laparoscopic abdominoperineal resection with lateral lymph nodes dissection on the international NOSES multi-center symposium held also by the National Cancer Center. The symposium, which invited seven foreign specialists from Japan, Russia and Turkey to participate in and included both the surgical demonstration and experience sharing as well, was well received by all the participants which had real-time communications with the operating surgeon by means of real-time voice link.

In December 2019, Wang and his team organized an advanced workshop on NOSES, inviting 19 surgical experts from nine countries to share NOSES experience. The conference demonstrated the China-developed minimally invasive surgical level through various activities such as academic reports, surgical demonstrations and MDT discussion, which won acclaim among international colleagues.

In December of the same year, Wang was invited to join the international symposium on colorectal surgery held by King's College London. Wang and his team members presented several academic reports and surgical videos to show the latest achievements in field of NOSES in China recent years.

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Photo shows that Wang Xishan gave academic reports on the international symposium on colorectal surgery held by King's College London.

Under the leadership of Wang, members of the International Alliance of NOSES drafted on basis of clinical evidences the "International Consensus on Natural Orifice Specimen Extraction Surgery (NOSES) for Colorectal Cancer", which provided important reference and guidelines for the standardized development of NOSES.

Apart from these, a domestic multi-center database of NOSES was established by Wang. In total, 5,055 cases were included to analyze the short-term and long-term outcomes of NOSES. The findings have been published in a top medical journal, Science Bulletin. (Contributed by Zhang Mingguang & Hu Xiyue; edited by Duan Jing with Xinhua Silk Road, duanjing@xinhua.org)

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Keyword: NOSES minimally invasive surgical technique China-developed Natural Orifice Specimen Extraction Surgery

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