Laparoscopic Ultralow Rectal Cancer Resection with Transanal Specimen Extraction: Bacon Method (CRC-NOSES IE)

NOSES IE is mainly applicable to patients with lower rectal cancer who have a large circumference of invasion. As with conventional laparoscopic radical resection of rectal cancer, this method should also strictly follow the principles of total mesorectal excision (TME). There is no difference in extent of resection and lymph node dissection between the two methods. The main differences between conventional laparoscopic surgery and NOSES IE are digestive tract reconstruction and specimen extraction. The operation characteristics of NOSES IE are to prolapse the rectum from the anus, remove the rectum specimen extracorporeally, suture and fix the excess rectum to the perianal, remove the redundant rectum and finally complete anoplasty after the perianal is healed at 2–3 weeks. The operation characteristics of NOSES IE are as follows: 1. the rectum is dissected into the internal and external space of the sphincter according to the TME principles; 2. the anus is annularly sutured from 1–2 cm below the tumor and above the intersphincteric sulcus; 3. the rectal wall is circularly incised and then dissected upward into the abdominal plane; 4. the rectum is extracted from the anus and the normal rectum is retained at 3–5 cm, then cutting off the rectum at 5–7 cm above the upper edge of tumor; 5. the anoplasty is conducted after 2–3 weeks. This technique requires excellent skills and tacit cooperation between the surgeon and assistant. In addition, the aseptic principle and non-touch technique must be strictly practiced. The NOSES IE can not only ensure the R0 resection but also achieve anal function preservation in lower rectal cancer, which is an ideal operation in line with the requirements of functional surgery.