[A Case of Robot-Assisted Laparoscopic Lower Anterior Resection and Total Hysterectomy with Transvaginal NOSE].

Natural orifice specimen extraction(NOSE)can be considered a minimally invasive treatment method. We performed robotassisted laparoscopic lower anterior resection and total hysterectomy with transvaginal NOSE. The patient was a 44-year-old woman. When she underwent CS in the blood in 2017, the rectal Rs had a mass-like lesion. On pathological examination, sarcoma from the endometrial stroma was suspected, and an operation was planned. The surgical findings included the following: The camera port was inserted 4 cm from the navel, the first arm on the right side at the same height, the second arm on the left, the third arm in the lower left abdomen, and the 12mm port in the lower right abdomen. First, the uterus was removed, the vagina was opened, and the uterus was removed. Vacuum was maintained, and the operation for the anterior resection was performed without changing the arrangement of the arms. The IMAwas treated; the descending colon was also sufficiently peeled for NOSE surgery, and then the lower rectum was peeled until the levator muscle was exposed to secure the AW. The inter-rectal membrane was treated to secure the AW. The intestinal tract was induced from the vaginal stump, the anvil head of ILS 29 was inserted, and anal anastomosis was performed again by insufflation. The vaginal stump was closed with continuous sutures and covered with the bladder peritoneum.