Laparoscopic Left Hemicolectomy with Transrectal Specimen Extraction (CRC-NOSES VIB)

Abstract

For patients with tumors located at the splenic flexure or left transverse colon, specimen extraction through the sigmoid colon is often difficult because the tumor is located far from the anus. For such patients, specimen extraction can be performed after opening the rectum. The main operating features of this procedure include complete dissection and resection of the left colon in the abdominal cavity, specimen extraction from a longitudinal incision in the upper rectum, totally laparoscopic side-to-side anastomosis between the transverse colon and sigmoid colon, and closing the incision of the upper rectum. The approach for specimen extraction from the rectum can avoid auxiliary incision in the abdominal wall and only leaves a few tiny trocar scars on the abdominal wall after the surgery. The operating difficulties of this procedure mainly involve laparoscopic technical difficulties and the challenges of NOSES. Specifically, the laparoscopic technical difficulties include the complete mesocolon resection of the left colon, dissection of lymph nodes at the root of the mesentery, and the mobilization of the splenic flexure. The NOSES technical difficulties include the specimen extraction after opening the rectum, totally laparoscopic digestive tract reconstruction, and application of aseptic and tumor-free operation. These are the challenges the surgeons need to face and overcome.