Laparoscopic Middle Rectal Cancer Resection with Transvaginal Specimen Extraction (NOSES III)

NOSES III is mainly applied to female patients with slightly larger rectal tumors. The main steps in NOSES III include extracting specimen from vagina, removal of rectal specimens outside of body, and total laparoscopic anastomosis between the sigmoid colon and rectum. Compared with NOSES II, the main difference of NOSES III is as follows: (1) There is no need to open the bowel wall in the abdominal cavity, which better meets the requirements of aseptic principle; (2) more stringent vaginal preparation is needed before operation; and (3) because of strong extension of vagina, the indication of NOSES III is wider than NOSES II but only limited to female patients. Although there is difference between NOSES III and conventional laparoscopic rectal resection, this technology is entirely reasonable, safe, and feasible as long as surgeons have clear anatomic understanding and solid operating skills.