Laparoscopic Left Colon Cancer Resection with Transvaginal Specimen Extraction (NOSES VII)

Abstract

NOSES VII is mainly applied to female patients with a slightly larger lesion in the left colon. The main procedures of NOSES VII include totally laparoscopic left hemicolectomy, extracting specimen from vagina, and performing anastomosis between transverse colon and rectum in the abdominal cavity. Compared with NOSES VI, NOSES VII has a broader indication because the specimen extraction from vagina is easier, albeit limited to women only. The main difficulties of NOSES VII involve two aspects: laparoscopic technique and NOSES technique. Laparoscopic technical difficulties include the complete mesocolic excision of left-sided colon, the extended lymph node dissection, and the separation of splenic colon. From the NOSES technical point of view, the difficulties include the removal of specimens, total laparoscopic reconstruction of the digestive tract, the suture of vaginal incision, and maintenance of aseptic principle and non-touch technique.