Observational studyBMJ open2026
Prospective multicentre observational study of natural orifice specimen extraction in minimally invasive colorectal surgery in the Asia-Pacific: protocol for the AP-NOSES registry.
Observational study in BMJ open, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT07615036 (AP-NOSES), which is not on this map. Not yet cited in PubMed.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
AP-NOSES: A Prospective, Multicentre Registry of Natural Orifice Specimen Extraction in Minimally Invasive Colorectal Surgery Across the Asia-Pacific Region
Who cites it
0 citing papers in PubMed.
No citing paper in PubMed yet.
Corrections and comments
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Authors and funding
14 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionNatural orifice specimen extraction (NOSE) enables removal of colorectal surgical specimens through transanal or transvaginal routes while avoiding an abdominal extraction incision. Existing studies suggest potential benefits, including reduced wound morbidity and faster postoperative recovery. However, current evidence remains limited by retrospective designs, heterogeneous patient selection, variable extraction strategies and inconsistent assessment of long-term abdominal wall and patient-reported outcomes. The Asia-Pacific Natural Orifice Specimen Extraction Surgery (AP-NOSES) registry was established to prospectively evaluate clinical, abdominal wall and patient-reported outcomes following minimally invasive colorectal surgery involving natural orifice specimen extraction. METHODS AND ANALYSIS: AP-NOSES is a prospective multicentre observational registry coordinated by Singapore General Hospital. Consecutive adult patients undergoing elective minimally invasive colorectal resection with planned intact specimen extraction will be enrolled. The primary comparative analysis will be conducted within a predefined NOSE-eligible cohort comparing planned natural orifice specimen extraction with planned transabdominal specimen extraction. The registry aims to recruit approximately 800 patients across participating centres.The primary outcome is time to incisional hernia within 24 months following index surgery, with extraction-site incision type recorded and accounted for in the analysis. Secondary outcomes include postoperative morbidity, surgical site infection, extraction-site morbidity, length of hospital stay, patient-reported quality-of-life and functional outcomes, local recurrence, distant recurrence and disease-free survival.Patient-reported outcomes will be assessed using validated instruments including the EuroQol 5-Dimension 5-Level questionnaire, Body Image Scale and Low Anterior Resection Syndrome score. Data will be prospectively collected using a secure centralised REDCap database. ETHICS AND DISSEMINATION: Ethics approval has been obtained from the SingHealth Centralised Institutional Review Board (2026-0237). Findings from the registry will be disseminated through peer-reviewed publications and scientific conference presentations. TRIAL REGISTRATION NUMBER: NCT07615036.
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