Robotic Radical Resection for Lower Rectal Carcinoma with Transanal Pullout of Rectum Eversion and Extracorporeal Resection Technique

With the rapid development of surgical technology, the minimally invasive surgery has obtained a widespread application in colorectal carcinoma resection. In recent years, natural orifice specimen extraction surgery (NOSES) has been applied in colorectal surgery. NOSES not only obtains radical oncological resection but also minimizes the postoperative pain. Laparoscopic radical resection with transanal specimen eversion and extracorporeal resection (NOSES I) is well suitable for lower rectal carcinoma. The advantage of this method is that the specimen is transected after being averted transanally, which helps to evaluate the definite distance of distal resection margin and reduce the possibility of positive resection margin. Six different methods of NOSES I have been reported. The key procedure of this method is the introduction of anvil into the bowel lumen of the sigmoid colon. However, how to complete this step aseptically is still the focus. Based on the clinical experience of colorectal resection with da Vinci robotic surgery system, we developed a modified NOSES I as robotic radical resection for lower rectal carcinoma with transanal pullout of rectum eversion and extracorporeal resection technique. The procedures of operation are as follows: