Natural Orifice Specimen Extraction Surgery: Gastrointestinal Tumor

Foreword by Jie He
Foreword by Tracy L. Hull
Foreword by Antonio Longo
Foreword by Ho-Kyung Chun
Introduction of Chief Editor
	The Main Academic Title
	Scientific Research and Clinical Achievements
	Novel Techniques
	Student Training
Introduction of Associate Editor
Preface
Contents
Contributors
Part I: General Statement
	1: Overview of NOSES
		1 Minimally Invasive Surgery and Surgical Incisions
		2 Nomenclature and Definition of NOSES
		3 Classification and Surgical Procedures of NOSES
			3.1	 Classification According to the Routes for Specimen Extraction
			3.2	 Classification According to the Procedures for Specimen Extraction
			3.3	 NOSES for Colorectal Neoplasms
			3.4	 NOSES for Gastric Neoplasms
			3.5	 NOSES for Gynecological Neoplasms
		4 Indications of NOSES
		5 Selecting Routes for Specimen Extraction in NOSES
		6 Aseptic and Tumor-Free Technique of NOSES
		7 Advantages and Limitations of NOSES
		8 Current Status and Achievements of NOSES in China
		9 The International NOSES Alliance
		10 Outlook on Future of NOSES
		References
	2: Perioperative Preparation of NOSES
		1 Bowel Preparation
		2 Vaginal Preparation
		3 Treatment Principles of Concomitant Diseases
			3.1 Hypertension
			3.2 Diabetes
			3.3 Pulmonary Insufficiency
			3.4 Chronic Kidney Disease
			3.5 Liver Insufficiency
			3.6 Coronary Heart Disease
			3.7 Conclusion
		4 Psychological Preparation
		5 Surgical Team and Instrument Preparation
	3: Laparoscopic Abdominal Pelvic Anatomical Landmarks and Essentials of Surgical Exploration
		1 Hepatobiliary and Gastric Landmarks
		2 Landmarks of the Greater Omentum, Spleen, and Pancreas
		3 Landmarks of the Jejunum, Ileum, and Colon
		4 Landmarks of the Pelvic Cavity
Part II: NOSES for Colorectal Cancer
	4: Laparoscopic Lower Rectal Cancer Resection with Transanal Specimen Extraction (CRC-NOSES IA, IB, and IB+, Eversion Method)
		1	 Indications and Contraindications of NOSES
			1.1	 Indications (Figs. 4.1, 4.2, and 4.3)
			1.2	 Contraindications
		2	 Anesthesia, Patient Positioning, Trocar Placement, and Surgical Team Position
			2.1	 Anesthesia Method
			2.2	 Patient Positioning
			2.3	 Trocar Placement
			2.4	 Surgical Team Position
			2.5	 Special Surgical Instruments
		3	 Surgical Procedures, Techniques, and Key Points
			3.1	 Exploration and Surgical Planning
				3.1.1	 General Exploration
				3.1.2	 Tumor Exploration
				3.1.3	 Evaluation of Anatomical Structures
			3.2	 Dissection and Separation
				3.2.1	 The First Point of the Incision
				3.2.2	 Isolation and Ligation of Inferior Mesenteric Artery and Vein
				3.2.3	 Dissection of the Mesorectum
				3.2.4	 Dissection of the Right Side of the Rectum
				3.2.5	 Dissection of the Sigmoid Colon and the Left Rectal Wall
				3.2.6	 Isolation of the Bowel Below the Tumor
				3.2.7	 Dividing the Sigmoid Mesocolon
			3.3	 Specimen Resection and Digestive Tract Reconstruction
				3.3.1	 Specimen Resection
				3.3.2	 Digestive Tract Reconstruction
				3.3.3	 Specimen Extraction
				3.3.4	 Digestive Tract Reconstruction
				3.3.5	 Specimen Resection and Digestive Tract Reconstruction
				3.3.6	 Postoperative Abdominal Wall and Specimen Display (Figs. 4.73 and 4.74)
		4	 Key Points, Difficulties, and Hotspots Related to Surgery
			4.1	 Standard of Rectal Segmentation and Concept of Low and Ultralow Anastomosis in Anus-Preserving Surgery
			4.2	 Technique Application of Artery “Vascular Bridging” on the Rectum in Low and Ultralow Anastomosis Anus-Preserving Surgeries for Rectal Cancer
			4.3	 Pros and Cons of Diverting Stoma During Ultralow Anus-Preserving Surgery
	5: Laparoscopic Ultralow Rectal Cancer Resection with Transanal Specimen Extraction: Park Method (CRC-NOSES IC)
		1 Indications and Contraindications of NOSES
			1.1 Indications (Figs. 5.1, 5.2 and 5.3)
			1.2 Contraindications
		2 Anesthesia, Patient Positioning, Trocar Placement, and Surgical Team Position
			2.1 Anesthesia Method
			2.2 Patient Positioning
			2.3 Trocar Placement
			2.4 Surgical Team Position
			2.5 Special Surgical Instruments
		3 Surgical Procedures, Techniques, and Key Points
			3.1 Exploration and Surgical Planning
				3.1.1	 General Exploration
				3.1.2	 Tumor Exploration
				3.1.3	 Evaluation of Anatomical Structures
			3.2 Dissection and Separation
				3.2.1	 The First Point of the Incision
				3.2.2	 Isolation and Ligation of the Root of Inferior Mesenteric Artery and Vein
				3.2.3	 Dissection of the Sigmoid Mesocolon
				3.2.4	 Dissection of the Right Rectal Wall and the Posterior Rectal Wall
				3.2.5	 Dissection of the Sigmoid Colon, the Left and the Anterior Rectal Wall
				3.2.6	 Dividing the Sigmoid Mesocolon
			3.3 Specimen Resection and Digestive Tract Reconstruction
				3.3.1	 Specimen Resection
				3.3.2	 Digestive Tract Reconstruction
			3.4 Postoperative Abdominal Wall and Specimen Pictures (Figs. 5.48 and 5.49)
		4 Key Points, Difficulties, and Hotspots Related to Surgery
			4.1 Indications and Precautions
			4.2 Four-Point Suture Fixation Technique for Anastomosis
			4.3 The Role of Peritoneal Reflection Line
	6: Laparoscopic Ultralow Rectal Cancer Resection with Transanal Specimen Extraction: Intersphincteric Resection Method (CRC-NOSES ID)
		1 Indications and Contraindications of NOSES
			1.1 Indications (Figs. 6.1, 6.2 and 6.3)
			1.2 Contraindications
		2 Anesthesia, Patient Positioning, Trocar Placement, and Surgical Team Position
			2.1 Anesthesia Method
			2.2 Patient Positioning
			2.3 Trocar Placement
			2.4 Surgical Team Position
			2.5 Special Surgical Instruments
		3 Surgical Procedures, Techniques, and Key Points
			3.1 Exploration and Surgical Planning
				3.1.1	 General Exploration
				3.1.2	 Tumor Exploration
				3.1.3	 Evaluation of Anatomical Structures
			3.2 Dissection and Separation
				3.2.1	 The First Point of the Incision
				3.2.2	 Isolation and Ligation of Inferior Mesenteric Artery and Vein
				3.2.3	 Dissection of the Mesorectum
				3.2.4	 Dissection of the Right Rectum Wall
				3.2.5	 Dissection of the Sigmoid Colon, the Left and the Anterior Rectal Wall
				3.2.6	 Isolation of the Mesorectum
				3.2.7	 Dividing the Sigmoid Mesocolon
			3.3 Intersphincteric Specimen Resection and Digestive Tract Reconstruction
				3.3.1	 Transanal Specimen Resection
				3.3.2	 Digestive Tract Reconstruction
			3.4 Postoperative Abdominal Wall and Specimen Pictures (Figs. 6.45 and 6.46)
		4 Key Points, Difficulties, and Hotspots Related to Surgery
			4.1 Precautions for NOSES ID
			4.2 Problems in Conventional Laparoscopic Surgery
	7: Laparoscopic Ultralow Rectal Cancer Resection with Transanal Specimen Extraction: Bacon Method (CRC-NOSES IE)
		1 Indications and Contraindications of NOSES
			1.1 Indications (Figs. 7.1, 7.2 and 7.3)
			1.2 Contraindications
		2 Anesthesia, Patient Positioning, Trocar Placement, and Surgical Team Position
			2.1 Anesthesia Method
			2.2 Patient Positioning
			2.3 Trocar Placement
			2.4 Surgical Team Position
			2.5 Special Surgical Instruments
		3 Surgical Procedures, Techniques, and Key Points
			3.1 Exploration and Surgical Planning
				3.1.1	 General Exploration
				3.1.2	 Tumor Exploration
				3.1.3	 Evaluation of Anatomical Structures
			3.2 Dissection and Separation
				3.2.1	 The First Point of the Incision
				3.2.2	 Isolation and Ligation of the Root of Inferior Mesenteric Vessels
				3.2.3	 Dissection of the Mesorectum
				3.2.4	 Dissection of the Right Side of the Rectum
				3.2.5	 Dissection of the Sigmoid Colon and the Left Side of the Rectum
				3.2.6	 Dissection of the Posterior Wall of the Rectum
				3.2.7	 Dissection of the Pelvic Floor of Rectum
				3.2.8	 Dividing the Sigmoid Mesocolon
				3.2.9	 Perineal Operation
				3.2.10	 Secondary Anoplasty
			3.3 Postoperative Abdominal Wall and Specimen Display (Figs. 7.49 and 7.50)
		4 Key Points, Difficulties, and Hotspots Related to Surgery
			4.1 Indications of NOSES IE
			4.2 Laparoscopic Exposure to the Lowest Realignment Plane of the Pelvic Cavity and the Use of Surgical Instruments and Materials
			4.3 Transanal and Pelvic Free Plane Meeting Operation and Aseptic and Tumor-Free Operation
			4.4 Prediction and Management of Postoperative Complications
			4.5 The Operation Opportunity of the Secondary Anoplasty and the Function of Defecation and Anal Continence
	8: Laparoscopic Lower Rectal Cancer Resection with Rectal Eversion and Extra-Abdominal Resection: Tsarkov Method (CRC-NOSES IF)
		1 Indications and Contraindications
			1.1 Indications (Fig. 8.2)
			1.2 Contraindications
		2 Anesthesia, Patient Positioning, Trocar Placement, and Surgical Team Position
			2.1 Anesthesia Method
			2.2 Patient Positioning
			2.3 Trocar Placement (Fig. 8.4)
			2.4 Surgical Team Position
			2.5 Special Surgical Instruments
		3 Surgical Procedure, Techniques, and Key Points
			3.1 Exposure and Operation Planning
				3.1.1	 Abdominal Cavity Examination
				3.1.2	 Tumor Examination
				3.1.3	 Adjusted Anatomical Structures Evaluation
			3.2 Dissection and Separation
				3.2.1	 Initial Dissection
				3.2.2	 Inferior Mesenteric Vessels Division
				3.2.3	 Dissection of the Mesorectum
				3.2.4	 Rectum Right Side Dissection
				3.2.5	 Detachment and Dissection of the Sigmoid Colon and Left Side of Rectum
				3.2.6	 Distal Rectal Dissection
				3.2.7	 Proximal Division of the Sigmoid Colon and Mesentery
			3.3 Rectal Resection and Digestive Tract Reconstruction
				3.3.1	 Rectal Eversion Through the Anus
				3.3.2	 Rectal Resection
				3.3.3	 Digestive Tract Reconstruction
			3.4 Final View of Abdomen (Fig. 8.25)
		4 Robotic NOSES Operation
			4.1 Trocar Positioning for Operations with the Da Vinci Si System
	9: Laparoscopic Middle Rectal Cancer Resection with Transanal Specimen Extraction (CRC-NOSES II)
		1 Indications and Contraindications of NOSES
			1.1 Indications (Figs. 9.1, 9.2, and 9.3)
			1.2 Contraindications
		2 Anesthesia, Patient Positioning, Trocar Placement, and Surgical Team Position
			2.1 Anesthesia Method
			2.2 Patient Positioning
			2.3 Trocar Placement
			2.4 Surgical Team Position
			2.5 Special Surgical Instruments
		3 Surgical Procedures, Techniques, and Key Points
			3.1 Exploration and Surgical Planning
				3.1.1	 General Exploration
				3.1.2	 Tumor Exploration
				3.1.3	 Evaluation of Anatomical Structures
			3.2 Dissection and Separation
				3.2.1	 The First Point of the Incision
				3.2.2	 Isolation and Ligation of the Root of the Inferior Mesenteric Artery and Vein
				3.2.3	 Dissection of the Mesorectum
				3.2.4	 Dissection of the Right Side of the Rectum
				3.2.5	 Dissection of the Sigmoid Colon and the Left Side of the Rectum
				3.2.6	 Isolation of the Bowel Below the Tumor
				3.2.7	 Dividing the Sigmoid Mesocolon
			3.3 Specimen Resection and Digestive Tract Reconstruction
				3.3.1	 Specimen Resection
				3.3.2	 Digestive Tract Reconstruction
			3.4 Postoperative Abdominal Wall and Specimen Display (Figs. 9.46 and 9.47)
		4 Key Points, Difficulties, and Hotspots Related to Surgery
			4.1 The Concept of “Dog Ear” and “Danger Triangle of the Anastomosis”
			4.2 Management of Denonvilliers’ Fascia in the Dissection of the Anterior Rectal Wall
			4.3 Application of 3D Laparoscopic Technique in Colorectal Surgery
	10: Laparoscopic Middle Rectal Cancer Resection with Transvaginal Specimen Extraction (CRC-NOSES III)
		1 Indications and Contraindications of NOSES
			1.1 Indications (Figs. 10.1, 10.2, and 10.3)
			1.2 Contraindications
		2 Anesthesia, Patient Positioning, Trocar Placement, and Surgical Team Position
			2.1 Anesthesia Method
			2.2 Patient Positioning
			2.3 Trocar Placement
			2.4 Surgical Team Position
			2.5 Special Surgical Instruments
		3 Surgical Procedure, Techniques, and Key Points
			3.1 Exploration and Surgical Planning
				3.1.1	 General Exploration
				3.1.2	 Tumor Exploration
				3.1.3	 Evaluation of Anatomical Structures
			3.2 Dissection and Separation
				3.2.1	 The First Point of the Incision
				3.2.2	 Isolation and Ligation of the Root of Inferior Mesenteric Artery and Vein
				3.2.3	 Dissection of the Mesorectum
				3.2.4	 Dissection of the Right Side of the Rectum
				3.2.5	 Dissection of the Sigmoid Colon and the Left Side of the Rectum
				3.2.6	 Isolation of the Bowel Below the Tumor
				3.2.7	 Dividing the Sigmoid Mesocolon
			3.3 Specimen Resection and Digestive Tract Reconstruction
				3.3.1	 Specimen Resection
				3.3.2	 Digestive Tract Reconstruction
				3.3.3	 Closure of Trocar and Suture of Vaginal Incision
			3.4 Postoperative Abdominal Wall and Specimen Pictures (Figs. 10.54 and 10.55)
		4 Key Points, Difficulties, and Hotspots Related to Surgery
			4.1 The Distribution of Nerves Around the Rectum
			4.2 The Concept of “Neorectum” and Low Anterior Resection Syndrome
	11: Laparoscopic Upper Rectal Cancer Resection with Transanal Specimen Extraction (CRC-NOSES IV)
		1	 Indications and Contraindications of NOSES
			1.1	 Indications (Figs. 11.1, 11.2, and 11.3)
			1.2	 Contraindications
		2	 Anesthesia, Patient Positioning, Trocar Placement, and Surgical Team Position
			2.1	 Anesthesia Method
			2.2	 Patient Positioning
			2.3	 Trocar Placement
			2.4	 Surgical Team Position
			2.5	 Special Surgical Instruments
		3	 Surgical Procedure, Techniques, and Key Points
			3.1	 Exploration and Surgical Planning
				3.1.1	 General Exploration
				3.1.2	 Tumor Exploration
				3.1.3	 Evaluation of Anatomical Structures
			3.2	 Dissection and Separation
				3.2.1	 The First Point of the Incision
				3.2.2	 Isolation and Ligation of Inferior Mesenteric Artery and Vein
				3.2.3	 Dissection of the Upper Mesorectum
				3.2.4	 Dissection of the Lateral Sigmoid Colon and Rectosigmoid Colon
				3.2.5	 Isolation and Transection of the Bowel Below the Tumor
				3.2.6	 Dividing the Sigmoid Mesocolon
			3.3	 Specimen Resection and Digestive Tract Reconstruction
				3.3.1	 Specimen Resection
				3.3.2	 Digestive Tract Reconstruction
			3.4	 Postoperative Abdominal Wall and Specimen Display (Figs. 11.56 and 11.57)
		4	 Key Points, Difficulties, and Hotspots Related to Surgery
			4.1	 Surgical Plane and Operating Procedure of TME
			4.2	 Anatomy of Lateral Ligaments of the Rectum
	12: Laparoscopic Upper Rectal Cancer Resection with Transvaginal Specimen Extraction (CRC-NOSES V)
		1	 Indications and Contraindications of NOSES
			1.1	 Indications (Figs. 12.1, 12.2, 12.3, and 12.4)
			1.2	 Contraindications
		2	 Anesthesia, Patient Positioning, Trocar Placement, and Surgical Team Position
			2.1	 Anesthesia Method
			2.2	 Patient Positioning
			2.3	 Trocar Placement
			2.4	 Surgical Team Position
			2.5	 Special Surgical Instruments
		3	 Surgical Procedure, Techniques, and Key Points
			3.1	 Exploration and Surgical Planning
				3.1.1	 General Exploration
				3.1.2	 Tumor Exploration
				3.1.3	 Evaluation of Anatomical Structures
			3.2	 Dissection and Separation
				3.2.1	 The First Point of the Incision
				3.2.2	 Dissection and Ligation of Inferior Mesenteric Artery and Vein
				3.2.3	 Dissection of the Mesorectum
				3.2.4	 Dissection of the Right Side of the Rectum
				3.2.5	 Dissection of the Sigmoid Colon and the Left Side of the Rectum
				3.2.6	 Isolation of the Bowel Below the Tumor
				3.2.7	 Dividing the Sigmoid Mesocolon
			3.3	 Specimen Resection and Digestive Tract Reconstruction
				3.3.1	 Specimen Resection
				3.3.2	 Digestive Tract Reconstruction
				3.3.3	 Closure of Trocar and Suture of Vaginal Incision
			3.4	 Postoperative Abdominal Wall and Specimen Display (Figs. 12.54 and 12.55)
		4	 Key Points, Difficulties, and Hotspots Related to Surgery
			4.1	 Skills in the Use of Stapler in Anus Preserving Surgery for Rectal Cancer
			4.2	 Application of Air Leak Test
	13: Laparoscopic Left Hemicolectomy with Transanal Specimen Extraction (CRC-NOSES VI A)
		1	 Indications and Contraindications of NOSES
			1.1	 Indications (Figs. 13.1, 13.2, and 13.3)
			1.2	 Contraindications
		2	 Anesthesia, Patient Positioning, Trocar Placement, and Surgical Team Position
			2.1	 Anesthesia Method
			2.2	 Patient Positioning
			2.3	 Trocar Placement
			2.4	 Surgical Team Position
			2.5	 Special Surgical Instruments
		3	 Surgical Procedure, Techniques, and Key Points
			3.1	 Exploration and Surgical Planning
				3.1.1	 General Exploration
				3.1.2	 Tumor Exploration
				3.1.3	 Evaluation of Anatomical Structures
			3.2	 Dissection and Separation
				3.2.1	 Management of the Root of the Inferior Mesenteric Vessels
				3.2.2	 Dissection of Left Mesocolon with Medial Approach
				3.2.3	 Management of the Sigmoid Mesocolon and Mesorectum
				3.2.4	 Management of the Left Transverse Colon and Splenic Flexure
				3.2.5	 Dissection of the Left Paracolic Sulcus
				3.2.6	 Dividing and Isolating the Mesocolon Above the Tumor
			3.3	 Specimen Resection and Digestive Tract Reconstruction
				3.3.1	 Specimen Resection
				3.3.2	 Digestive Tract Reconstruction
			3.4	 Postoperative Abdominal Wall and Specimen Display (Figs. 13.54 and 13.55)
		4	 Key Points, Difficulties, and Hotspots Related to Surgery
			4.1	 Selection of Surgical Approach for Laparoscopic Left Colon Cancer Resection
			4.2	 Common Approaches for Preoperative Tumor Localization
	14: Laparoscopic Left Hemicolectomy with Transrectal Specimen Extraction (CRC-NOSES VIB)
		1	 Indications and Contraindications of NOSES
			1.1	 Indications
			1.2	 Contraindications
		2	 Anesthesia, Patient Positioning, Trocar Placement and Surgical Team Position
			2.1	 Anesthesia Method
			2.2	 Patient Positioning
			2.3	 Trocar Placement
			2.4	 Surgical Team Position
			2.5	 Special Surgical Instruments
		3	 Surgical Procedure, Techniques, and Key Points
			3.1	 Exploration and Surgical Planning
				3.1.1	 General Exploration
				3.1.2	 Tumor Exploration
				3.1.3	 Evaluation of Anatomical Structures
			3.2	 Dissection and Separation
				3.2.1	 Management of the Root of the Inferior Mesenteric Vessels
				3.2.2	 Dissection of Left Mesocolon with Medial Approach
				3.2.3	 Management of the Left Transverse Colon and Splenic Flexure
				3.2.4	 Dissection of the Left Paracolic Sulcus
				3.2.5	 Management of the Sigmoid Mesocolon
				3.2.6	 Dividing the Mesocolon Above the Tumor and Isolating the Bowel
			3.3	 Specimen Resection and Digestive Tract Reconstruction
				3.3.1	 Specimen Resection
				3.3.2	 Digestive Tract Reconstruction (Isoperistaltic Side-To-Side Anastomosis)
				3.3.3	 Specimen Extraction
			3.4	 Postoperative Recovery and Specimen Display (Figs. 14.61, 14.62, and 14.63)
		4	 Key Points, Difficulties, and Hotspots Related to Surgery
			4.1	 Dissection and Anatomy of the Splenic Flexure
			4.2	 The Concept of Complete Mesocolic Resection of the Left Colon Cancer
	15: Laparoscopic Left Hemicolectomy with Transvaginal Specimen Extraction (CRC-NOSES VII)
		1	 Indications and Contraindications of NOSES
			1.1	 Indications (Figs. 15.1, 15.2, 15.3)
			1.2	 Contraindications
		2	 Anesthesia, Patient Positioning, Trocar Placement, and Surgical Team Position
			2.1	 Anesthesia Method
			2.2	 Patient Positioning
			2.3	 Trocar Placement
			2.4	 Surgical Team Position
			2.5	 Special Surgical Instruments
		3	 Surgical Procedure, Techniques, and Key Points
			3.1	 Exploration and Surgical Planning
				3.1.1	 General Exploration
				3.1.2	 Tumor Exploration
				3.1.3	 Evaluation of Anatomical Structures
			3.2	 Dissection and Separation
				3.2.1	 Management of the Root of the Inferior Mesenteric Vessels
				3.2.2	 Dissection of Left Mesocolon with Medial Approach
				3.2.3	 Management of the Sigmoid Mesocolon and Mesorectum
				3.2.4	 Management of the Left Transverse Colon and Splenic Flexure
				3.2.5	 Opening the Left Lateral Paracolic Sulcus
				3.2.6	 Dividing and Isolating the Mesocolon Above the Tumor
			3.3	 Specimen Resection and Digestive Tract Reconstruction
				3.3.1	 Specimen Resection
				3.3.2	 Digestive Tract Reconstruction
				3.3.3	 Closure of Trocar and Suture of Vaginal Incision
			3.4	 Postoperative Abdominal Wall and Specimen Display (Figs. 15.53 and 15.54)
		4	 Key Points, Difficulties, and Hotspots Related to Surgery
			4.1	 Selection and Suture of the Incision of Posterior Vaginal Fornix
	16: Laparoscopic Right Hemicolectomy with Transvaginal Specimen Extraction (CRC-NOSES VIIIA)
		1	 Indications and Contraindications of NOSES
			1.1	 Indications (Figs. 16.1, 16.2, 16.3)
			1.2	 Contraindications
		2	 Anesthesia, Patient Positioning, Trocar Placement, and Surgical Team Position
			2.1	 Anesthesia Method
			2.2	 Patient Positioning
			2.3	 Trocar Placement
			2.4	 Surgical Team Position
			2.5	 Special Surgical Instruments
		3	 Surgical Procedure, Techniques, and Key Points
			3.1	 Exploration and Surgical Planning
				3.1.1	 General Exploration
				3.1.2	 Tumor Exploration
				3.1.3	 Evaluation of Anatomical Structures
			3.2	 Dissection and Separation
				3.2.1	 Anatomy and Transection of the Root of Ileocolic Artery and Vein
				3.2.2	 Management of the Root of Right Colic Artery and Vein
				3.2.3	 Management of the Root of the Middle Colic Artery and Vein
				3.2.4	 Dissection of the Mesocolon
				3.2.5	 Management of the Mesoileum
				3.2.6	 Management of the Greater Omentum and Station Six Lymph Nodes
				3.2.7	 Management of the Transverse Mesocolon
			3.3	 Specimen Resection and Digestive Tract Reconstruction
				3.3.1	 Specimen Resection
				3.3.2	 Digestive Tract Reconstruction
				3.3.3	 Specimen Extraction
				3.3.4	 Suture of Vaginal Incision and Closure of Trocar Sites
			3.4	 Postoperative Abdominal Wall and Specimen Display (Figs. 16.58 and 16.59)
		4	 Key Points, Difficulties, and Hotspots Related to Surgery
			4.1	 Anatomy and Exposure of Surgical Trunk of the Superior Mesenteric Vein
			4.2	 The Anatomical Variation of the Right Colic Artery
	17: Laparoscopic Right Hemicolectomy with Transrectal Specimen Extraction (CRC-NOSES VIIIB)
		1	 Indications and Contraindications of NOSES
			1.1	 Indications (Figs. 17.1, 17.2, 17.3)
			1.2	 Contraindications
		2	 Anesthesia, Patient Positioning, Trocar Placement, and Surgical Team Position
			2.1	 Anesthesia Method
			2.2	 Patient Positioning
			2.3	 Trocar Placement
			2.4	 Surgical Team Position
			2.5	 Special Surgical Instruments
		3	 Surgical Procedure, Techniques, and Key Points
			3.1	 Exploration and Surgical Planning
				3.1.1	 General Exploration
				3.1.2	 Tumor Exploration
				3.1.3	 Evaluation of Anatomical Structures
			3.2	 Dissection and Separation
				3.2.1	 Anatomy and Transection of the Root of Ileocolic Artery and Vein
				3.2.2	 Management of the Root of Right Colic Artery
				3.2.3	 Management of the Right Branch of the Middle Colic Artery and Vein
				3.2.4	 Dissection of the Mesocolon
				3.2.5	 Management of the Mesoileum
				3.2.6	 Management of the Greater Omentum and Station Six Lymph Nodes
				3.2.7	 Management of the Transverse Mesocolon
			3.3	 Specimen Resection and Digestive Tract Reconstruction
				3.3.1	 Specimen Resection
				3.3.2	 Digestive Tract Reconstruction
				3.3.3	 Specimen Extraction
			3.4	 Postoperative Recovery and Specimen Display (Figs. 17.54 and 17.55)
		4	 Key Points, Difficulties, and Hotspots Related to Surgery
			4.1	 The Advantages and Feasibility of Overlapped Delta-Shaped Anastomosis
	18: Laparoscopic Right Hemicolectomy with Transcolonic Specimen Extraction (CRC-NOSES VIIIC)
		1 Indications and Contraindications of NOSES
			1.1 Indications (Figs. 18.1, 18.2, 18.3)
			1.2 Contraindications
		2 Anesthesia, Patient Positioning, Trocar Placement, and Surgical Team Position
			2.1 Anesthesia Method
			2.2 Patient Positioning
			2.3 Trocar Placement
			2.4 Surgical Team Position
			2.5 Special Surgical Instruments
		3 Surgical Procedure, Techniques, and Key Points
			3.1 Exploration and Surgical Planning
				3.1.1	 General Exploration
				3.1.2	 Exploration of Tumor
				3.1.3	 Exploration of Anatomical Structure
			3.2 Dissection and Separation
				3.2.1	 Dissection of Ileocolic Vessels
				3.2.2	 Dissection of Right Colic and Middle Colic Vessels
				3.2.3	 Dissection of Right Mesocolon and Transverse Mesocolon
				3.2.4	 Dissection of Greater Omentum and Hepatocolic Ligament
				3.2.5	 Dissection of Ileocecal Mesentery
				3.2.6	 Division of the Terminal Ileum and Right Transverse Colon
			3.3 Specimen Extraction and Digestive Tract Reconstruction
				3.3.1	 Specimen Extraction
				3.3.2	 Digestive Tract Reconstruction
			3.4 Postoperative Abdominal Wall and Specimen Display] (Figs. 18.46 and 18.47)
		4 Key Points, Difficulties, and Hotspots Related to Surgery
	19: Laparoscopic Total Colectomy with Transanal Specimen Extraction (CRC-NOSES IX)
		1	 Indications and Contraindications of NOSES
			1.1	 Indications
			1.2	 Contraindications
		2	 Anesthesia, Patient Positioning, Trocar Placement, and Surgical Team Position
			2.1	 Anesthesia Method
			2.2	 Patient Positioning
			2.3	 Trocar Placement
			2.4	 Surgical Team Position
			2.5	 Special Surgical Instruments
		3	 Surgical Procedure, Techniques, and Key Points
			3.1	 Exploration and Surgical Planning
				3.1.1	 General Exploration
				3.1.2	 Exploration of the Tumor
				3.1.3	 Evaluation of Anatomical Structures
			3.2	 Dissection and Separation
				3.2.1	 Management of the Root of the Ileocolic Artery and Vein
				3.2.2	 Management of the Root of Right Colic Artery and Vein
				3.2.3	 Management of the Root of the Middle Colic Artery and Vein
				3.2.4	 Management of the Terminal Ileum
				3.2.5	 Management of the Greater Omentum
				3.2.6	 Dissection of the Right Paracolic Sulcus and Its Mesentery
				3.2.7	 Management of the Root of the Inferior Mesenteric Artery
				3.2.8	 Management of the Inferior Mesenteric Vein
				3.2.9	 Management of Left Mesocolon and Left Paracolic Sulcus
				3.2.10	 Dissection of the Mesorectum
				3.2.11	 Isolation of Rectum from the Intended Resection Line
			3.3	 Specimen Resection, Extraction, and Digestive Tract Reconstruction
				3.3.1	 Specimen Resection
				3.3.2	 Specimen Extraction
				3.3.3	 Digestive Tract Reconstruction
			3.4	 Postoperative Abdominal Wall and Specimen Display (Figs. 19.66 and 19.67)
		4	 Key Points, Difficulties, and Hotspots Related to Surgery
			4.1	 The Anatomical Characteristics and Management of the Middle Colic Artery and Vein
			4.2	 The Importance of Preserving the Greater Omentum in Total Colectomy
			4.3	 Other Anastomosis Methods for Total Colectomy
	20: Laparoscopic Total Colectomy with Transvaginal Specimen Extraction (CRC-NOSES X)
		1	 Indications and Contraindications of NOSES
			1.1	 Indications
			1.2	 Contraindications
		2	 Anesthesia, Patient Positioning, Trocar Placement, and Surgical Team Position
			2.1	 Anesthesia Method
			2.2	 Patient Positioning
			2.3	 Trocar Placement
			2.4	 Surgical Team Position
				2.4.1	 The Right Hemicolectomy
				2.4.2	 The Left Hemicolectomy and Rectal Resection
			2.5	 Special Surgical Instruments
		3	 Surgical Procedure, Techniques, and Key Points
			3.1	 Exploration and Surgical Planning
				3.1.1	 General Exploration
				3.1.2	 Exploration of the Tumor
				3.1.3	 Evaluation of Anatomical Structures
			3.2	 Dissection and Separation
				3.2.1	 Management of the Root of the Ileocolic Artery and Vein
				3.2.2	 Management of the Root of Right Colic Artery and Vein
				3.2.3	 Management of the Root of the Middle Colic Artery and Vein
				3.2.4	 Dissection of the Right Mesocolon
				3.2.5	 Management of the Terminal Ileum
				3.2.6	 Dissection of the Right Paracolic Sulcus and Greater Omentum
				3.2.7	 Management of the Root of the Inferior Mesenteric Artery
				3.2.8	 Management of the Root of the Inferior Mesenteric Vein
				3.2.9	 Dissection of the Left Mesocolon
				3.2.10	 Management of the Left Greater Omentum and the Left Transverse Mesocolon
				3.2.11	 Dissection of Mesorectum and the Isolation of Rectum
			3.3	 Specimen Resection, Extraction, and Digestive Tract Reconstruction
				3.3.1	 Specimen Resection
				3.3.2	 Specimen Extraction
				3.3.3	 Digestive Tract Reconstruction
				3.3.4	 Suturing of the Vaginal Incision
			3.4	 Postoperative Abdominal Wall and Specimen Display (Figs. 20.64 and 20.65)
		4	 Key Points, Difficulties, and Hotspots Related to Surgery
			4.1	 The Dissection Sequence and Operation Essentials of Total Colectomy
			4.2	 Total Colectomy with Rectal Ampulla Preserved
			4.3	 Diagnosis and Treatment of Familial Adenomatous Polyposis
			4.4	 Diagnostic Criteria for Lynch Syndrome
	21: Transanal Total Mesorectal Excision (taTME)
		1	 Indications and Contraindications of taTME
			1.1	 Indications
			1.2	 Contraindications
		2	 Anesthesia, Patient Positioning, Trocar Placement, and Surgical Team Position
			2.1	 Anesthesia Method
			2.2	 Patient Positioning
			2.3	 Trocar Placement
			2.4	 Surgical Team Position
			2.5	 Special Surgical Instruments
		3	 Surgical Procedures, Techniques, and Key Points
			3.1	 Laparoscopic-Assisted taTME
				3.1.1	 Transabdominal Operation
				3.1.2	 Transanal Operation
				3.1.3	 Specimen Resection and Digestive Tract Reconstruction
				3.1.4	 Drainage Tube and Protective Stoma
			3.2	 Pure taTME
				3.2.1	 Transanal Dissection
				3.2.2	 Specimen Resection and Digestive Tract Reconstruction
				3.2.3	 Drainage Tube and Protective Stoma
		4	 Key Points, Difficulties, and Hotspots Related to Surgery
Part III: NOSES for Gastrointestinal Cancer
	22: Laparoscopic Distal Gastrectomy (Billroth I) with Transrectal Specimen Extraction (GC-NOSES I)
		1	 Indications and Contraindications of NOSES
			1.1	 Indications
			1.2	 Contraindications
		2	 Anesthesia, Patient Positioning, Trocar Placement, and Surgical Team Position
			2.1	 Anesthesia Method
			2.2	 Patient Positioning
			2.3	 Trocar Placement
			2.4	 Surgical Team Position
			2.5	 Special Surgical Instruments
		3	 Surgical Procedure, Techniques, and Key Points
			3.1	 Exploration of the Abdominal and Pelvic Cavity
			3.2	 Perigastric Lymph Node Dissection
				3.2.1	 Dissection of the Greater Omentum and Dissection of Lymph Nodes of the Subpyloric Region
				3.2.2	 Dissection of Lymph Nodes in the Superior Pancreatic Region
				3.2.3	 Dissection of Lymph Nodes in the Lesser Curvature of Stomach
				3.2.4	 Dissection of the Station 4sb Lymph Nodes
			3.3	 Transection of the Distal Stomach
			3.4	 Transanal Specimen Extraction
			3.5	 Digestive Tract Reconstruction
		4	 Key Points and Difficulties Related to Surgery
	23: Laparoscopic Distal Gastrectomy (Billroth I) with Transvaginal Specimen Extraction (GC-NOSES II)
		1	 Indications and Contraindications of NOSES
			1.1	 Indications
			1.2	 Contraindications
		2	 Anesthesia, Patient Positioning, Trocar Placement, and Surgical Team Position
			2.1	 Anesthesia Method
			2.2	 Patient Positioning
			2.3	 Trocar Placement
			2.4	 Surgical Team Position
			2.5	 Special Surgical Instruments
		3	 Surgical Procedure, Techniques, and Key Points
			3.1	 Exploration of the Abdominal and Pelvic Cavity
			3.2	 Perigastric Lymph Node Dissection
				3.2.1	 Dissection of the Greater Omentum and Dissection of Lymph Nodes of the Subpyloric Region and Station 4sb
				3.2.2	 Dissection of Lymph Nodes in the Superior Pancreatic Region
				3.2.3	 Dissection of Lymph Nodes in the Lesser Curvature
			3.3	 Transection of the Distal Stomach
			3.4	 Transvaginal Specimen Extraction
			3.5	 Digestive Tract Reconstruction
		4	 Analysis of Key Points and Difficulties Related to Surgery
	24: Laparoscopic Distal Gastrectomy (Billroth II) with Transrectal Specimen Extraction (GC-NOSES III)
		1	 Indications and Contraindications of NOSES
			1.1	 Indications
			1.2	 Contraindications
		2	 Anesthesia, Patient Positioning, Trocar Placement, and Surgical Team Position
			2.1	 Anesthesia Method
			2.2	 Patient Positioning
			2.3	 Trocar Placement
			2.4	 Surgical Team Position
				2.4.1	 Abdominal Exploration, Anatomical Separation, and Lymph Node Dissection
				2.4.2	 Digestive Tract Reconstruction
				2.4.3	 Specimen Extraction
			2.5	 Surgical Instruments
		3	 Surgical Procedure, Techniques, and Key Points
			3.1	 Surgical Exploration
				3.1.1	 Comprehensive Exploration
				3.1.2	 Tumor Exploration
			3.2	 Dissection and Separation
				3.2.1	 Dissection of the Anterior Lobe of the Transverse Mesocolon and Separation of the Gastrocolic Ligament
				3.2.2	 Dissection of Group 6 Lymph Nodes
				3.2.3	 Dissection of Group 4sb Lymph Nodes
				3.2.4	 Dissection of Group 11p, 7, and 9 Lymph Nodes
				3.2.5	 Dissection of Group 5 and 12a Lymph Nodes
				3.2.6	 Dissection of Lymph Nodes in Lesser Curvature
			3.3	 Specimen Resection and Digestive Tract Reconstruction
				3.3.1	 Specimen Resection
				3.3.2	 Billroth II Anastomosis
				3.3.3	 Roux-en-Y Anastomosis of the Distal Gastric Jejunum
				3.3.4	 Transrectal Specimen Extraction
			3.4	 Postoperative Specimens and Abdominal Wall Pictures (Figs. 24.33 and 24.34)
		4	 Key Points, Difficulties, and Hotspots Related to Surgery
			4.1	 Difficulties in Surgical Operation
			4.2	 Values and Disputes of Transrectal Specimen Removal
	25: Laparoscopic Distal Gastrectomy (Billroth II) with Transvaginal Specimen Extraction (GC-NOSES IV)
		1	 Indications and Contraindications of NOSES
			1.1	 Indications
			1.2	 Contraindications
		2	 Anesthesia, Patient Positioning, Trocar Placement, and Surgical Team Position
			2.1	 Anesthesia Method
			2.2	 Patient Positioning
			2.3	 Trocar Placement (Fig. 25.3)
			2.4	 Surgical Team Position
				2.4.1	 Abdominal Exploration, Anatomical Dissection, and Lymph Node Dissection
				2.4.2	 Digestive Tract Reconstruction
				2.4.3	 Transvaginal Specimen Extraction
			2.5	 Surgical Instruments
		3	 Surgical Procedure, Techniques, and Key Points
			3.1	 Surgical Exploration
				3.1.1	 Comprehensive Exploration
				3.1.2	 Tumor Exploration
			3.2	 Dissection and Separation
				3.2.1	 Dissection of the Greater Omentum
				3.2.2	 Dissection of Station 4sb Lymph Nodes
				3.2.3	 Dissection of Station 6 Lymph Nodes
				3.2.4	 Transection of the Duodenum (Fig. 25.18)
				3.2.5	 Dissection of Station 8a and 12a Lymph Nodes
				3.2.6	 Dissection of Station 11p, 7, and 9 Lymph Nodes
				3.2.7	 Dissection of Lymph Nodes in the Lesser Curvature and the Right Side of Cardia
			3.3	 Specimen Resection and Digestive Tract Reconstruction
				3.3.1	 Specimen Resection (Figs. 25.32 and 25.33)
				3.3.2	 Billroth II Anastomosis
				3.3.3	 Roux-en-Y Anastomosis of the Gastric Jejunum
				3.3.4	 Transvaginal Specimen Extraction
			3.4	 Postoperative Abdominal Wall and Specimen Display (Figs. 25.50, 25.51, 25.52)
		4	 Key Points, Difficulties, and Hotspots Related to Surgery
	26: Laparoscopic Proximal Gastrectomy with Transrectal Specimen Extraction (GC-NOSES V)
		1	 Indications and Contraindications of NOSES
			1.1	 Indications
			1.2	 Contraindications
		2	 Anesthesia, Patient Positioning, Trocar Placement, and Surgical Team Position
			2.1	 Anesthesia Method
			2.2	 Patient Positioning
			2.3	 Trocar Placement
			2.4	 Surgical Team Position
				2.4.1	 Abdominal Exploration, Anatomical Dissection, and Lymph Node Dissection
				2.4.2	 Digestive Tract Reconstruction
				2.4.3	 Transrectal Specimen Extraction
			2.5	 Surgical Instruments
		3	 Surgical Procedure, Techniques, and Key Points
			3.1	 Exploration and Surgical Planning
				3.1.1	 Comprehensive Exploration
			3.2	 Dissection and Separation
				3.2.1	 Dissection of the Greater Omentum
				3.2.2	 Dissection of the Gastrosplenic Ligament
				3.2.3	 Care Should Be Taken to Protect the Right Gastroepiploic Vessel During the Proximal Gastrectomy
				3.2.4	 Dissection of Station 7, 8a, 9, and 11p Lymph Nodes
				3.2.5	 Dissection of Station 1 and 2 Lymph Nodes and Isolation of Esophagus
			3.3	 Specimen Resection and Digestive Tract Reconstruction
				3.3.1	 Specimen Resection
				3.3.2	 Digestive Tract Reconstruction (Gastroesophageal Overlap Anastomosis)
				3.3.3	 Transrectal Specimen Extraction
			3.4	 Postoperative Abdominal Wall and Specimen Pictures (Figs. 26.39 and 26.40)
		4	 Key Points, Difficulties, and Hotspots Related to Surgery
	27: Laparoscopic Proximal Gastrectomy with Transvaginal Specimen Extraction (GC-NOSES VI)
		1	 Indications and Contraindications of NOSES
			1.1	 Indications
			1.2	 Contraindications
		2	 Anesthesia, Patient Positioning, Trocar Placement, and Surgical Team Position
			2.1	 Anesthesia Method
			2.2	 Patient Positioning
			2.3	 Trocar Placement
			2.4	 Surgical Team Position
				2.4.1	 Abdominal Exploration, Anatomical Dissection, and Lymph Node Dissection
				2.4.2	 Digestive Tract Reconstruction
				2.4.3	 Transvaginal Specimen Extraction
			2.5	 Surgical Instruments
		3	 Surgical Procedure, Techniques, and Key Points
			3.1	 General Exploration and Surgical Planning
			3.2	 Dissection and Separation
				3.2.1	 Suspension of Liver, Dissection of Esophagus, and the Right Diaphragmatic Crus to Enter the Gerota’s Space
				3.2.2	 Dissection of the Greater Omentum and the Gastrosplenic Ligament
				3.2.3	 Dissection of Station 7, 8a, 9, 11p, and 11d Lymph Nodes
				3.2.4	 Dissection of Station 1 and 2 Lymph Nodes and Isolation of Esophagus
			3.3	 Specimen Resection
			3.4	 Digestive Tract Reconstruction
				3.4.1	 Digestive Tract Reconstruction with Instrumental Anastomosis: Anastomosis Between the Posterior Wall of the Esophagus and the Anterior Wall of the Remnant Stomach (Overlap Method)
				3.4.2	 Digestive Tract Reconstruction with Manual Suture
			3.5	 Transvaginal Specimen Extraction
			3.6	 Postoperative Abdominal Wall and Specimen Display (Figs. 27.43 and 27.44)
		4	 Key Points, Difficulties, and Hotspots Related to Surgery
	28: Laparoscopic Total Gastrectomy with Transrectal Specimen Extraction (GC-NOSES VII)
		1 Indications and Contraindications of NOSES
			1.1 Indications
			1.2 Contraindications
		2 Anesthesia, Patient Positioning, Trocar Placement, and Surgical Team Position
			2.1 Anesthesia Method
			2.2 Patient Positioning
			2.3 Trocar Placement
			2.4 Surgical Team Position
				2.4.1	 Abdominal Exploration, Anatomical Dissection, and Lymph Node Dissection
				2.4.2	 Digestive Tract Reconstruction
				2.4.3	 Specimen Extraction
			2.5 Surgical Instruments
		3 Surgical Procedure, Techniques, and Key Points
			3.1 Surgical Exploration and Surgical Planning
				3.1.1	 Comprehensive Exploration
				3.1.2	 Tumor Exploration
			3.2 Dissection and Separation
				3.2.1	 Dissection of the Anterior Lobe of the Transverse Mesocolon and Dissection of the Gastrocolic Ligament
				3.2.2	 Perigastric Lymphadenectomy
			3.3 Specimen Resection
			3.4 Digestive Tract Reconstruction (Laparoscopic Roux-en-Y Esophagojejunal Anastomosis, Overlap Method)
			3.5 Transanal Specimen Extraction
			3.6 Postoperative Specimen and Abdominal Wall Pictures (Figs. 28.53 and 28.54)
		4 Key Points, Difficulties, and Hotspots Related to Surgery
			4.1 Difficulties in Surgery
			4.2 Controversy over Transanal Specimen Extraction
	29: Laparoscopic Total Gastrectomy with Transvaginal Specimen Extraction (GC-NOSES VIII)
		1 Indications and Contraindications of NOSES
			1.1 Indications
			1.2 Contraindications
		2 Anesthesia, Patient Positioning, Trocar Placement, and Surgical Team Position
			2.1 Anesthesia Method
			2.2 Patient Positioning
			2.3 Trocar Placement
			2.4 Surgical Team Position
				2.4.1	 Abdominal Exploration, Anatomical Dissection, and Lymph Node Dissection
				2.4.2	 Digestive Tract Reconstruction
				2.4.3	 Specimen Extraction
			2.5 Surgical Instruments
		3 Surgical Procedure, Techniques, and Key Points
			3.1 Surgical Exploration and Surgical Planning
				3.1.1	 Comprehensive Exploration
				3.1.2	 Tumor Exploration
			3.2 Dissection and Separation
				3.2.1	 Dissection of the Anterior Lobe of the Transverse Mesocolon and Dissection of the Gastrocolic Ligament
				3.2.2	 Perigastric Lymphadenectomy
			3.3 Digestive Tract Reconstruction (Total Laparoscopic Roux-en-Y Esophagojejunal Anastomosis)
				3.3.1	 Digestive Tract Reconstruction with Instrumental Anastomosis: Esophagojejunal Side-to-Side Anastomosis (Overlap Method)
				3.3.2	 Digestive Tract Reconstruction with Hand-Sewn Suture
			3.4 Transvaginal Specimen Extraction
		4 Key Points, Difficulties, and Hotspots Related to Surgery
	30: Robotic Gastric Tumor Resection with Transoral Specimen Extraction (GC-NOSES IX)
		1	 Indications and Contraindications of NOSES
			1.1	 Indications (Figs. 30.1–30.2)
			1.2	 Contraindications
		2 Anesthesia, Patient Positioning, Trocar Placement, and Surgical Team Position
			2.1	 Anesthesia Method
			2.2	 Patient Positioning
			2.3	 Trocar Placement
			2.4	 Surgical Team Position
			2.5	 Surgical Instruments
		3	 Surgical Procedure, Techniques, and Key Points
			3.1	 Exploration and Surgical Planning
				3.1.1	 General Exploration
				3.1.2	 Tumor Exploration
			3.2	 Tumor Resection
			3.3	 Digestive Tract Reconstruction and Specimen Extraction
				3.3.1	 Placement of Specimen in the Gastric Cavity
				3.3.2	 Closing the Incision in the Gastric Wall
				3.3.3	 Gastroscopy-Assisted Specimen Extraction
			3.4	 Postoperative Abdominal Wall and Specimen Pictures (Figs. 30.25 and 30.26)
		4 Key Points, Difficulties, and Hotspots Related to Surgery
			4.1	 Precautions for Transoral Specimen Extraction in NOSES
	31: Laparoscopic Small Intestinal Tumor Resection with Transrectal Specimen Extraction
		1	 Indications and Contraindications of NOSES
			1.1	 Indications (Figs. 31.1, 31.2, and 31.3)
			1.2	 Contraindications
		2	 Anesthesia, Patient Positioning, Trocar Placement, and Surgical Team Position
			2.1	 Anesthesia Method
			2.2	 Patient Positioning
			2.3	 Trocar Placement
			2.4	 Surgical Team Position
			2.5	 Special Surgical Instruments
		3	 Surgical Procedure, Techniques, and Key Points
			3.1	 Exploration and Surgical Planning
				3.1.1	 General Exploration
				3.1.2	 Tumor Exploration
				3.1.3	 Evaluation of Anatomical Structures
			3.2	 Dissection and Separation
				3.2.1	 Determination of the Extent of Resection and the Division of Mesentery of the Small Bowel
				3.2.2	 Transection of the Small Bowel
			3.3	 Digestive Tract Reconstruction
			3.4	 Closure of Mesentery of the Small Bowel
			3.5	 Specimen Extraction
				3.5.1	 Opening of the Anterior Rectal Wall and Placement of Sterile Plastic Protective Sleeve
				3.5.2	 Extraction of the Small Bowel and Mesenteric Specimen
				3.5.3	 Closure of the Incision in the Anterior Rectal Wall
			3.6	 Irrigation of Abdominal Cavity and Indwelling of Drainage Tube
			3.7	 Postoperative Specimen and Abdominal Wall Pictures (Figs. 31.31 and 31.32)
		4	 Key Points, Difficulties, and Hotspots Related to Surgery
	32: Laparoscopic Small Intestinal Tumor Resection with Transvaginal Specimen Extraction
		1	 Indications and Contraindications of NOSES
			1.1	 Indications (Figs. 32.1–32.3)
			1.2	 Contraindications
		2	 Anesthesia, Patient Positioning, Trocar Placement, and Surgical Team Position
			2.1	 Anesthesia Method
			2.2	 Patient Positioning
			2.3	 Trocar Placement
			2.4	 Surgical Team Position
			2.5	 Special Surgical Instruments
		3	 Surgical Procedure, Techniques, and Key Points
			3.1	 Exploration and Surgical Planning
				3.1.1	 General Exploration
				3.1.2	 Tumor Exploration
				3.1.3	 Evaluation of Anatomical Structures
			3.2	 Dissection and Separation
				3.2.1	 Determination of the Extent of Resection and the Division of Mesentery of the Small Bowel
				3.2.2	 Resection of the Small Bowel
			3.3	 Digestive Tract Reconstruction
			3.4	 Closure of Mesentery of the Small Bowel
			3.5	 Specimen Extraction
				3.5.1	 Transvaginal Specimen Extraction
				3.5.2	 Closing the Vaginal Incision
			3.6	 Irrigation of Abdominal Cavity and Indwelling of Drainage Tube
			3.7 Postoperative Specimen and Abdominal Wall Pictures (Figs. 32.26 and 32.27)
Part IV: Special and Extended Resection Surgery with NOSES
	33: Laparoscopic Extended Lower Rectal Cancer Resection with En Bloc Lateral Lymph Node Dissection (Wang’s Approach)
		1	 Indications and Contraindications of NOSES
			1.1	 Indications (Figs. 33.1–33.3)
			1.2	 Contraindications
		2	 Anesthesia, Patient Positioning, Trocar Placement, and Surgical Team Position
			2.1	 Anesthesia Method
			2.2	 Patient Positioning
			2.3	 Trocar Placement
			2.4	 Surgical Team Position
				2.4.1	 Abdominal Operation
				2.4.2	 Perineal Operation
			2.5	 Special Surgical Instruments
		3	 Surgical Procedure, Techniques, and Key Points
			3.1	 Exploration and Surgical Planning
				3.1.1	 General Exploration
				3.1.2	 Tumor Exploration
				3.1.3	 Evaluation of Anatomical Structures
			3.2	 Dissection and Separation
				3.2.1	 The First Point of the Incision
				3.2.2	 Determination of the Extent of Resection
				3.2.3	 Dissection in the Area of the Right Obturator and the Right Iliac Artery
				3.2.4	 Dissection of the Right Ureter
				3.2.5	 Dissection of the Right Common Iliac Artery and Inferior Vena Cava and Dissection of the Presacral Space
				3.2.6	 Dissection of the Abdominal Aorta and Ligation of the Inferior Mesenteric Artery
				3.2.7	 Ligation of the Inferior Mesenteric Vein
				3.2.8	 Dissection of the Left Common Iliac Artery, Internal Iliac Artery, and External Iliac Artery
				3.2.9	 Further Dissection of the Posterior Mesorectal Space
				3.2.10	 Dissection of the Adhesion of the Sigmoid Colon
				3.2.11	 Determination of the Landmark for the Extended En Bloc Dissection of the Peritoneum on the Left Side
				3.2.12	 Dissection of the Left Obturator Region
				3.2.13	 Dissection of the Left Ureter
				3.2.14	 Isolation of the Distal Rectum
				3.2.15	 Division of the Sigmoid Mesocolon
			3.3	 Transanal Operation
			3.4	 Specimen Extraction
			3.5	 Digestive Tract Reconstruction
			3.6	 Postoperative Abdominal Wall and Specimen Pictures (Figs. 33.64–33.67)
		4	 Key Points, Difficulties, and Hotspots Related to Surgery
			4.1	 Anatomical Basis of Lateral Lymph Node Metastasis in Rectal Cancer
	34: Laparoscopic Right Hemicolectomy and Sigmoidectomy with Transvaginal Specimen Extraction
		1	 Indications and Contraindications of NOSES
			1.1	 Indications (Fig. 34.1)
			1.2	 Contraindications
		2	 Anesthesia, Patient Positioning, Trocar Placement, and Surgical Team Position
			2.1	 Anesthesia Method
			2.2	 Patient Positioning
			2.3	 Trocar Placement
			2.4	 Surgeons’ Positions
			2.5	 Special Surgical Instruments
		3	 Surgical Procedure, Techniques, and Key Points
			3.1	 Exploration and Surgical Planning
				3.1.1	 General Exploration
				3.1.2	 Tumor Exploration
				3.1.3	 Evaluation of Anatomical Structures
			3.2	 Anatomy and Dissection of the Right Colon
				3.2.1	 Anatomy and Transection of the Root of Ileocolic Artery and Vein
				3.2.2	 Management of the Root of Right Colic Artery and Vein
				3.2.3	 Management of the Root of the Middle Colic Artery and Vein
				3.2.4	 Dissection of the Mesocolon
				3.2.5	 Management of the Mesoileum
				3.2.6	 Management of the Greater Omentum and Station 6 Lymph Nodes
				3.2.7	 Management of the Transverse Mesocolon
			3.3	 Right Colon Specimen Resection and Digestive Tract Reconstruction
				3.3.1	 Specimen Resection
				3.3.2	 Digestive Tract Reconstruction
			3.4	 Anatomy and Dissection of the Sigmoid Colon
				3.4.1	 The First Point of the Incision
				3.4.2	 Isolation and Ligation of the Root of Inferior Mesenteric Artery and Vein
				3.4.3	 Dissection of the Mesorectum
				3.4.4	 Dissection of the Sigmoid Colon and the Left Side of the Rectum
				3.4.5	 Isolation of the Bowel Below the Tumor
				3.4.6	 Dividing the Sigmoid Mesocolon
			3.5	 Specimen Extraction and Digestive Tract Reconstruction
				3.5.1	 Specimen Extraction
				3.5.2	 Digestive Tract Reconstruction
				3.5.3	 Close the Vaginal Incision and Trocar Sites
			3.6	 Postoperative Abdominal Wall and Specimen Display (Figs. 34.53–34.55)
	35: Laparoscopic Right Hemicolectomy and Rectal Cancer Resection with Transrectal Specimen Extraction
		1	 Indications and Contraindications of NOSES
			1.1	 Indications (Fig. 35.1)
			1.2	 Contraindications
		2	 Anesthesia, Patient Positioning, Trocar Placement, and Surgical Team Position
			2.1	 Anesthesia Method
			2.2	 Patient Positioning
			2.3	 Trocar Placement
			2.4	 Surgical Team Position
			2.5	 Special Surgical Instruments
		3	 Surgical Procedure, Techniques, and Key Points
			3.1	 Exploration and Surgical Planning
				3.1.1	 General Exploration
				3.1.2	 Tumor Exploration
				3.1.3	 Evaluation of Anatomical Structures
			3.2	 Anatomy and Dissection of the Right Colon
				3.2.1	 Anatomy and Transection of the Root of Ileocolic Artery and Vein
				3.2.2	 Management of the Root of the Right Colic Artery and Vein
				3.2.3	 Management of the Root of the Middle Colic Artery and Vein
				3.2.4	 Dissection of the Mesocolon
				3.2.5	 Management of the Mesoileum
				3.2.6	 Management of the Greater Omentum and Station 6 Lymph Nodes
				3.2.7	 Management of the Transverse Mesocolon
			3.3	 Right Colon Specimen Resection and Digestive Tract Reconstruction
				3.3.1	 Specimen Resection
				3.3.2	 Digestive Tract Reconstruction
			3.4	 Anatomy and Dissection of the Rectum
				3.4.1	 The First Point of the Incision
				3.4.2	 Isolation and Ligation of the Root of Inferior Mesenteric Artery and Vein
				3.4.3	 Dissection of the Mesorectum
				3.4.4	 Dissection of the Sigmoid Colon and the Left Side of the Rectum
				3.4.5	 Isolation of the Bowel Below the Tumor
				3.4.6	 Dividing the Sigmoid Mesocolon
			3.5	 Specimen Extraction and Digestive Tract Reconstruction
				3.5.1	 Specimen Extraction
				3.5.2	 Digestive Tract Reconstruction
			3.6	 Postoperative Abdominal Wall and Specimen Display (Figs. 35.55 and 35.56)
		4	 Key Points, Difficulties, and Hotspots Related to Surgery
			4.1	 Application of Minimally Invasive Treatment in MPCRC
			4.2	 Differences Between Combined Organ Resection and Multiple-Organ Resection
	36: Laparoscopic Rectal Cancer Resection Combined with Liver Metastasis Resection with Transanal Specimen Extraction
		1	 Indications and Contraindications of NOSES
			1.1	 Indications (Figs. 36.1–36.4)
			1.2	 Contraindications
		2	 Anesthesia, Patient Positioning, Trocar Placement, and Surgical Team Position
			2.1	 Anesthesia Method
			2.2	 Patient Positioning
			2.3	 Trocar Placement (Fig. 36.6)
			2.4	 Surgical Team Position
			2.5	 Special Surgical Instruments
		3	 Surgical Procedure, Techniques, and Key Points
			3.1	 Exploration and Surgical Planning
				3.1.1	 General Exploration
				3.1.2	 Tumor Exploration
			3.2	 Anatomy and Dissection
				3.2.1	 Opening the Sigmoid Mesocolon
				3.2.2	 Exposure and Transection of the Root of the Inferior Mesenteric Artery
				3.2.3	 Dissection of the Rectum
			3.3	 Specimen Resection and Digestive Tract Reconstruction
				3.3.1	 Rectal Specimen Resection and Extraction
				3.3.2	 Digestive Tract Reconstruction
			3.4	 Resection of Liver Metastases
		4	 Key Points, Difficulties, and Hotspots Related to Surgery
			4.1	 Surgical Strategies for Liver Metastases of Colorectal Cancer
			4.2	 Discussion on the Resection Margin of Liver Metastases
			4.3	 Specimen Extraction Skills
			4.4	 Nerve Preservation
	37: Laparoscopic Right Hemicolectomy Combined with Pancreaticoduodenal Resection with Natural Orifice Specimen Extraction
		1	 Indications and Contraindications of NOSES
			1.1	 Indications (Fig. 37.1)
			1.2	 Contraindications
		2	 Anesthesia, Patient Positioning, Trocar Placement, and Surgical Team Position
			2.1	 Anesthesia Method
			2.2	 Patient Positioning
			2.3	 Trocar Placement
			2.4	 Surgical Team Position
			2.5	 Special Surgical Instruments
		3	 Surgical Procedure, Techniques, and Key Points
			3.1	 Exploration and Surgical Planning
				3.1.1	 General Exploration
				3.1.2	 Tumor Exploration
				3.1.3	 Evaluation of Anatomical Structures
			3.2	 Dissection and Separation
				3.2.1	 Anatomy and Transection of the Root of Ileocolic Artery and Vein
				3.2.2	 Management of the Root of Right Colic Artery and Vein
				3.2.3	 Management of the Middle Colic Artery and Vein
				3.2.4	 Management of the Mesoileum
				3.2.5	 Management of the Stomach and Greater Omentum
				3.2.6	 Management of the Transverse Mesocolon
				3.2.7	 Management of the Duodenum
				3.2.8	 Management of the Jejunum
				3.2.9	 Transection of the Pancreas
				3.2.10	 Management of the Gallbladder
			3.3	 Digestive Tract Reconstruction
			3.4	 Specimen Extraction
				3.4.1	 Transvaginal Specimen Extraction
				3.4.2	 Transanal Specimen Extraction
			3.5	 Postoperative Abdominal Wall and Specimen Pictures (Figs. 37.50 and 37.51)
		4	 Key Points, Difficulties, and Hotspots Related to Surgery
Part V: Complications and Management of NOSES
	38: Complications and Management of NOSES for Gastrointestinal Tumor
		1	 Intra-Abdominal Infection
		2	 Anastomotic Bleeding
		3	 Intra-Abdominal Bleeding
		4	 Anastomotic Leakage
		5	 Rectovaginal Fistula
		6	 Intestinal Obstruction
		7	 Intestinal Volvulus
		8	 Internal Abdominal Hernia
		9	 Tumor Implantation of Trocar Sites and Vaginal Incision
		10	 Duodenal Stump Leakage
		11	 Afferent Loop Obstruction
		12	 Efferent Loop Obstruction
		13	 Postoperative Pancreatitis and Pancreatic Fistula
		14	 Postoperative Lymphatic Leakage
		15	 Postoperative Gastroparesis
Part VI: Collection of Expert Experience on NOSES
	39: Experience Sharing in NOSES for Colorectal Cancer
		1	 Experience Sharing on Aseptic and Tumor-Free Operation in Modified NOSES II
			1.1	 Specimen Resection and Extraction
			1.2	 Digestive Tract Reconstruction
		2	 Functional Side-to-Side Anastomosis for Digestive Tract Reconstruction of NOSES
		3	 Functional End-to-end Anastomosis for Digestive Tract Reconstruction of NOSES
		4	 How to Perfectly Follow the Aseptic and Tumor-Free Principles in NOSES
		5	 The Concept and Application of Passing by-NOSES and Like-NOSES
		6	 Application of “Reverse Parallel Division of Sigmoid Mesocolon” and “Wang’s Isolation” for the Isolation of Mesorectum in NOSES
			6.1	 Division of the Sigmoid Mesocolon (Reverse Parallel Division)
			6.2	 Isolation of the Mesorectum (Wang’s Isolation)
		7	 The Past and Present of NOSES with Enhanced Recovery After Surgery
		8	 Experience Sharing on NOTES: Transvaginal Radical Resection of Rectal Cancer Through Rigid Endoscopy (Rectal Tv-NOTES)
			8.1	 Anesthesia and Surgical Preparation
			8.2	 Surgical Procedures and Techniques
		9	 Skills and Experience Sharing on the Use of Gauze in NOSES Operation of Colorectal Cancer
			9.1	 Action One “Block”
				9.1.1	 Applicable Scene
				9.1.2	 Method of Operation
			9.2	 Action Two “Pad”
				9.2.1	 Applicable Scene
				9.2.2	 Method of Operation
			9.3	 Action Three “Press”
				9.3.1	 Applicable Scene
				9.3.2	 Method of Operation
			9.4	 Action Four “Steady”
				9.4.1	 Applicable Scene
				9.4.2	 Method of Operation
			9.5	 Action Five “Support”
				9.5.1	 Applicable Scene
				9.5.2	 Method of Operation
			9.6	 Action Six “Blunt Dissection”
				9.6.1	 Applicable Scene
				9.6.2	 Method of Operation
			9.7	 Action Seven “Protect”
				9.7.1	 Applicable Scene
				9.7.2	 Method of Operation
			9.8	 Action Eight “Mark”
				9.8.1	 Applicable Scene
				9.8.2	 Method of Operation
			9.9	 Action Nine “Sterilize”
				9.9.1	 Applicable Scene
				9.9.2	 Method of Operation
			9.10	 Action Ten “Suction”
				9.10.1	 Applicable Scene
				9.10.2	 Method of Operation
			9.11	 Action Eleven “Spread”
				9.11.1	 Applicable Scene
				9.11.2	 Method of Operation
			9.12	 Action Twelve “Withstand”
				9.12.1	 Applicable Scene
				9.12.2	 Method of Operation
		10	 NOSES for Total Laparoscopic Left Hemicolectomy with Inferior Mesenteric Vein Preserved
	40: Totally Laparoscopic Colectomy for Colorectal Cancer with Natural Orifice Specimen Extraction Combined with Reduced-Port Surgery: Japanese Experience
		1	 Indications
		2	 Technique
			2.1	 Totally Laparoscopic Sigmoidectomy with TASE (NOSES IV)+ RPS
			2.2	 Totally Laparoscopic Ileocecal Resection with TVSE (NOSES VII)+ No Minilaparotomy
		3	 Conclusion
	41: Laparoscopic-Assisted Natural Orifice Specimen Extraction Colectomy Using a Cai Tube for Left-Sided Colonic Carcinomas
		Reference
	42: Laparoscopic Total Colectomy Combined with NOSES: Turkish Experience
		1	 Introduction
		2	 Material and Method
		3	 Surgical Technique
		4	 Results
		5	 Discussion
	43: Operating Points of Aseptic and Tumor-Free Operation in NOSES for Rectal Cancer
	44: Application of Reverse Puncture Technique to Place Anvil for Laparoscopic Colorectal Resection with NOSES
		1	 Data and Methods
			1.1	 General Data
			1.2	 Operative Technique
				1.2.1	 Preparation of the Patients
				1.2.2	 Surgical Procedures
				1.2.3	 Summary of Technical Points
			1.3	 Follow-Up
		2	 Results
		3	 Discussion
	45: New Method of Modified NOSES I
		1	 Surgical Procedure of a Modified NOSES I
		2	 Discussion
		Reference
	46: Laparoscopic Resection of Tumors of Left Colon, Sigmoid Colon, and Upper Rectum with Transanal Specimen Extraction (NOSES IV and VI): Portuguese Experience
		1	 Patient Positioning
		2	 Trocar Placement
		3	 Steps of Surgery
			3.1	 Left Colon Mobilization
			3.2	 Medial Approach and Ligation of the Inferior Mesenteric Artery at Its Origin
			3.3	 Section of the Mesentery of Upper Rectum to Define the Transection Zone of the Rectum
			3.4	 Section of the Mesentery of the Left Colon to Define the Proximal Transection Area
			3.5	 Occlusion of the Distal Colon
			3.6	 Transanal Washing of the Rectum with Saline
			3.7	 Transection of the Colorectal Transition
			3.8	 Anvil Delivery
			3.9	 Start the Extraction of the Specimen Through the Anus
			3.10	 Anvil Placement in the Proximal Colon
			3.11	 Colon Transection
			3.12	 Complete the Extraction of the Specimen and Removal of the Alexis® Device
			3.13	 The Rectal Stump Is Closed with an Endoscopic Linear Stapler (Fig. 46.11)
			3.14	 Removal of the Spike of the Anvil Through the 12 mm Port (Fig. 46.12)
			3.15	 Wash the Pelvis with Saline and Perform a Side-to-End Colorectal Anastomosis (Fig. 46.13)
			3.16	 Test the Anastomosis for Leaks (Fig. 46.14) and Placement of a Transanal Tube
		4	 Postoperative Care
	47: NOSES in Colorectal Surgery: Vietnamese Experience
		1	 Transrectal NOSE
		2	 Transanal NOSE
		3	 Transvaginal NOSE
		4	 Indications and Contraindications
	48: Robotic Radical Resection for Lower Rectal Carcinoma with Transanal Pullout of Rectum Eversion and Extracorporeal Resection Technique
	49: Application of OrVil™ and NOSES in Total Laparoscopic Gastrectomy for Female
	50: Experience Sharing of Key Points in NOSES for Colorectal Cancer
		1	 Aseptic Principle and Tumor-Free Technique
		2	 The Skills and Tips in the Application of Stapler in Rectal Resection
	51: Experience and Skill Sharing on NOSES in the Left and Right Colon
		1	 NOSES for Left-Sided Colon Cancer
			1.1	 Preoperative Localization
			1.2	 Surgical Approach
			1.3	 Mobilization of Splenic Flexure
			1.4	 Specimen Extraction
		2	 NOSES for Right-Sided Colon Cancer
			2.1	 Indications
			2.2	 Surgical Approach
			2.3	 Digestive Tract Reconstruction
			2.4	 Specimen Extraction
	52: Natural Orifice Specimen Extraction in Laparoscopic Anterior Resection (NOSE-LAR): Taiwanese Experience
		1	 Introduction
		2	 Surgical Indications
		3	 Results
		4	 Technical Description
			4.1	 Pre-operative Management
			4.2	 Ports Placement
			4.3	 Splenic Flexure Mobilization
			4.4	 Inferior Mesenteric Artery (IMA) Ligation and Colonic Mobilization
			4.5	 Distal Bowel Preparation
			4.6	 Proximal Bowel Preparation
			4.7	 Specimen Extraction
			4.8	 Securing the Anvil
			4.9	 Distal Purse String
			4.10	 Procedural Variations
		5	 Conclusion
	53: Reduced Port Laparoscopic Anterior Resection with Transrectal Specimen Extraction and Single-Stapled Anastomosis: Taiwanese Experience
		1	 Introduction
		2	 Materials and Methods
		3	 Surgical Technique
		4	 Results
		5	 Conclusion
	54: Robotic Single Stapling Coloanal/Colorectal Anastomosis with Transanal Specimen Extraction for Anterior Resection of Rectosigmoid Tumor
	55: Conformal Sphincter-Preserving Operation + NOSES I (CSPO + NOSES I) for Extremely Low Rectal Cancer
		1	 Indications and Contraindications
		2	 Surgical Procedures
			2.1	 Number and Sites of Laparoscopic Trocars
			2.2	 Intraoperative Exploration
			2.3	 Dissection and Reconstruction
		3	 Conclusion
	56: Laparoscopic Complex NOSES Surgery of Colorectal Tumor
		1	 Indications
		2	 Contraindications
		3	 Key Surgical Points
			3.1	 Anterior Rectal Resection Combined with Right Hemicolectomy Complex NOSES Surgery
			3.2	 Subtotal Colectomy Complex NOSES Surgery
		4	 Notifications
Appendix A: International Consensus on Natural Orifice Specimen Extraction Surgery (NOSES) for Colorectal Cancer
	Introduction
	Definition
	Classification
	Indications
	Technology
	Technical Difficulty
	Clinical Research
	Prospects
	References
Appendix B: International Consensus on Natural Orifice Specimen Extraction Surgery (NOSES) for Gastric Cancer (2019)
	Introduction
		Definition and Classification
			Definition
			Classification
			Naming of GC-NOSES
		Indications and Contraindications
			Indications
			Relative Contraindications
		Surgical Devices for GC-NOSES
		Gastrectomy and Digestive Tract Reconstruction
		Aseptic Operation and Tumor-Free Operation
		Requirements of Surgical Procedures for Specimen Extraction
			The Principles of Specimen Extraction
			Requirements for Transoral Specimen Extraction Procedures
				Preoperative Preparation
				Operative Essentials
				Complication Prevention and Therapy
			Requirements for Transvaginal Specimen Extraction Procedures
				Preoperative Preparation
				Operative Essentials
				Complication Prevention and Therapy
			Requirements for Transrectal Specimen Extraction Procedures
				Preoperative Preparation
				Operative Essentials
				Complication Prevention and Therapy
		Clinical Research and Technical Training
	References
Postscript
Content Summary