Laparoscopic Upper Rectal Cancer Resection with Transvaginal Specimen Extraction (NOSES V)
NOSES V is mainly applied to patients with larger tumor in high rectum and distal sigmoid colon. The main operating procedures of NOSES V are as follows: dissecting specimen in the abdominal cavity, extracting specimen from vagina, and totally laparoscopic anastomosis between the sigmoid colon and rectum. Compared to NOSES IV, the main difference of NOSES V includes (1) broader indications of NOSES V due to anatomic ease of the vagina but only limited to female patients. (2) Only open a small cut on sigmoid colon above the tumor to insert the anvil, which minimizes abdominal contamination. As long as surgeons follow aseptic technique and non-touch principle, NOSES V is not only oncologically sound but also preserves organ function.