Laparoscopic Middle Rectal Cancer Resection with Transvaginal Natural Orifice Specimen Extraction (NOSES IIIB)

Abstract

NOSES IIIB， slightly different from NOSES III，is mainly applicable to female patients with relatively large middle rectal tumors that cannot be dragged out through the anus. The main operative steps include dissection of rectum, specimen resection, opening vaginal posterior fornix, specimen extraction through vagina, digestive tract reconstruction, and suturing of vaginal incision. In contrast to NOSES II, NOSES IIIB avoids intracorporeal bowel incision, aligning more effectively with the principles of aseptic operation. Another advantage is that the strong extensibility of the vagina allows the tumor with relatively large circumferential diameters to be extracted. Besides, digestive tract reconstruction is almost performed extracorporeally like conventional laparoscopic surgery and it is easy to be mastered. The aseptic and tumor-free principles are important, and they should be followed in the whole course. The safety and sexual function influence of the vaginal incision is hotly debated. According to the latest research, extracting specimen via vaginal incision would not increase short-term complications and decrease long-term survival. In addition, the vaginal incision has limited effect on women’s postoperative sexual life.