Laparoscopic Mid-Rectal Cancer Resection with Transanal Specimen Extraction (NOSES II)

NOSES II is mainly applied to patients with small tumors in the mid-rectum. As with conventional laparoscopic radical resection of rectal cancer, NOSES II should strictly follow the principles of total mesorectal excision (TME). The main operating procedures of NOSES II include transanal specimen extraction, removal of rectal specimen extraabdominally, and totally laparoscopic anastomosis between the sigmoid colon and rectum. The extraction portion featuring NOSES II include (1) opening bowel lumen under laparoscopy and (2) extracting the rectal specimen from the anus. This technique requires extensive cooperation between the surgeon and assistant during the operation. In addition, the aseptic principle and non-touch technique must be strictly practiced.