Laparoscopic Right Hemicolectomy and Rectal Cancer Resection with Transrectal Specimen Extraction

At present, with the increasing incidence of colorectal cancer, the incidence and diagnosis rates of multiple primary colorectal cancer (MPCRC) are also increasing. Patients with right colon cancer complicated with rectal cancer need radical resection of both right colon cancer and rectal cancer, which involve many organs. In addition, since the right colon has many adjacent organs, complicated vasculature, and high incidence of anatomical variations, this procedure is a very difficult technique in NOSES. When NOSES is performed in the right colon alone, the vagina is the only applicable route of specimen extraction. When the patient is complicated with rectal cancer, the right colon specimen and the rectal specimen can be extracted through the anus. The main operating features of right colon cancer resection include complete dissection and transection of the right colon in abdominal cavity, totally laparoscopic functional end-to-end anastomosis between terminal ileum and transverse colon, and right colon specimen extraction from the rectum or vagina. The specimen extraction methods for rectal resection vary based on the different tumor locations, but the principles of TME should be strictly followed. Anatomy and dissection should be performed at the correct operating plane, which is a prerequisite for the rapid and safe operation. The operating difficulties of this procedure mainly involve three aspects. Firstly, the laparoscopic technical difficulties include the correct identification of anatomical landmarks, reasonable surgical approach and complete mesentery resection, ligation of vessels at the root of mesentery and dissection of lymph nodes, and exposure and protection of important tissues and organs. Secondly, the technical difficulty of NOSES in the right colon cancer and rectal cancer is totally laparoscopic digestive tract reconstruction for twice, which is more difficult than other procedures. Thirdly, this procedure requires surgeons and assistants to have better cooperation. In the process of specimen extraction, the precise application of aseptic and tumor-free techniques is crucial.