Experience Sharing in NOSES for Colorectal Cancer

Abstract

NOSES II is mainly applicable to patients with the long sigmoid colon and small tumors located in the middle rectum. As with conventional laparoscopic radical resection of rectal cancer, NOSES II should strictly follow the principles of total mesorectal excision (TME). Anatomy and dissection should be performed at the correct operating plane, which is a prerequisite for rapid and safe operation. The operating procedures of conventional NOSES II include transanal extraction of the rectal lesion under the protection of self-made protective sleeve, extracorporeal resection of tumor, purse-string suture, and insertion of anvil, as well as totally laparoscopic end-to-end anastomosis between the sigmoid colon and rectum. In the conventional NOSES II, attention has been paid to the aseptic and tumor-free operation, but this is an approach still has some drawbacks. The surgical procedure of a modified NOSES II, which is more in line with the aseptic and tumor-free principle, is presented as follows: