Transanal extraction of two specimens after laparoscopic anterior resection with extended D3 lymph node dissection and unilateral salpingo-oophorectomy (NOSES) - a video vignette.

Laparoscopic surgery for colorectal cancer has survival outcomes similar to open surgery but is associated with shorter hospital stay and better quality of life (1,2). However, the surgical specimen still has to be extracted at mini-laparotomy. Natural orifice specimen extraction surgery ( NOSES) provides an opportunity to avoid this step (3). This technique's feasibility and long-term survival rate for colorectal surgery is unproven and there are limitations to it's usefulness (4). For instance, NOSES 2 with transanal specimen extraction, is only possible for patients with BMI < 30 kg/m2 and it does not allow a risk free specimen extraction (3,5).