Video correspondence for laparoscopic anterior resection with natural orifice specimen extraction—a video vignette

Dear Editor, Over the past decades, minimally invasive surgery has evolved leading to constant improvements in functional recovery and aesthetic outcomes. Among new techniques, natural orifice specimen extraction surgery (NOSES) has demonstrated promising results. Here we present the case of a totally laparoscopic anterior resection with transanal specimen extraction for a tumour of the upper rectum. A 37- year-old man underwent colonoscopy for rectal bleeding. A pedunculated polyp 18 mm in main diameter at 15 cm from the anal verge was detected and completely removed. The histological ex-amination revealed a pT1, moderately differentiated (G2) adenocar-cinoma with lymphatic invasion. Considering the risk of lymph node metastases, laparoscopic anterior resection was proposed. NOSES was chosen due to the favourable habitus of the patient (body mass index 20.5 kg/m2) and tumour characteristics (absence of bulky neoplasia).Surgical dissection was conducted as per the standard technique. After bowel transection, the specimen was extracted through the anus using an endo-bag. The anvil of the stapling device was then inserted and secured through an intra-corporeal purse-string using a barbed suture. Rectal cuff was similarly closed around the circular stapler and a single-stapled anastomosis was created. Postoperative course was uneventful with discharge on day 4. Final histological examination demonstrated the presence of one metastatic node out of 33.NOSES may represent an excellent minimally invasive option in selected patients with thin mesentery and small tumours. Minimizing abdominal wall damage, NOSES allows excellent pain control, fast recovery and reduction in wound complications.