NOSES vs Laparoscopic Colorectal Resection

The modified lithotomy position was taken, and all patients adopted the five trocar position with a pneumoperitoneum of 15 mmHg. One trocar was placed supraumbilical for the camera, while two trocars were placed on the right and left quadrant, respectively. After careful exploration, the patient was placed in the Trendelenburg position. The standard surgical technique was performed both in NOSES group and LAP group including separation and high ligation of the inferior mesenteric vessel, mobilization of the bowel, and dissection of the lymph nodes and and division of the distal rectum. Then the specimen extraction approach was different in two group. After the operation, both groups of patients will have 2 drainage tubes in the pelvic cavity, which are usually removed 5–7 days after the operation.
For LAP group, an auxiliary abdominal incision 6–8 cm in length was made for specimen extraction. Then, the anastomosis was performed by a double-stapling technique under the direct visual observation.
For NOSES group, after mobilization of the rectum and left colon, the distal rectum was transected below the tumor with a linear stapler. An incision was generated below the staple line of the rectal stump and a sterile plastic sleeve was placed into the abdominal cavity through the anus and rectal stump. Next, a long Babcock grasper was brought through the anus, and the specimen was extracted through the plastic sleeve (Figure 2A). Then, an anvil head attached to circular stapling device was inserted into the abdominal cavity, and a longitudinal incision approximately 2 cm was made on proximal colon wall to insert the anvil head (Figure 2B). Subsequently, the proximal colon was transected in close proximity to the upper pole of the incision using a linear stapler. Next, the rectum stump was transected with a linear stapling device. Finally, end-to-end colorectal anastomosis was performed with the use of a circular stapling device (Figure 2C). After the procedure, there is no auxiliary incision in the abdomen (Figure 2D).