Laparoscopic Resection of Tumors of Left Colon, Sigmoid Colon, and Upper Rectum with Transanal Specimen Extraction (NOSES IV and VI): Portuguese Experience

The technical variations in transanal NOSE colon surgery exist to overcome the restrictions caused by the absence of minilaparotomy and the transanal extraction itself. Without the minilaparotomy there is a need for intra-abdominal anvil delivery and its positioning in the proximal colon by laparoscopy. The way to position the anvil in the proximal colon defines the type of anastomosis created (end-to-end or side-to-end). Because the specimen is extracted through the rectum and anus, the rectum is opened and must be closed before the anastomosis. In low rectal cancer, the rectal stump might be difficult to close, but in tumors of the sigmoid or upper rectum, it is easily achieved.