Totally Laparoscopic Colectomy for Colorectal Cancer with Natural Orifice Specimen Extraction Combined with Reduced-Port Surgery: Japanese Experience

Natural orifice specimen extraction surgery (NOSES) has become an alternative approach for the treatment of colorectal cancer without additional incisions on the abdominal wall. However, previous studies showed that multiport technique was used when carrying out NOSES. We applied reduced-port surgery (RPS) technique in performing totally laparoscopic colectomy with transanal specimen extraction (TASE) and transvaginal specimen extraction (TVSE) from 2012. The points of our procedures are as follows: (1) In TASE cases, we attached the multiport access platform into the navel and inserted two to three ports in it to reduce the number of abdominal incisions. (2) In TVSE cases, we attached the same platform to the transvaginal route for transvaginal assistance and smooth specimen extraction. (3) We used needlescopic devices as far as possible. The technique is rather complicated and requires advanced surgical skills. We documented two examples of this ultimately minimal invasive surgery.