Laparoscopic low anterior resection and transanal pull-through for low rectal cancer: a Natural Orifice Specimen Extraction (NOSE) technique.

Ultralow anterior resection with coloanal anastomosis has been proven to be oncologically sound and the majority of patients will have acceptable functional outcome. Here we describe a technique that combines laparoscopic ultralow total mesorectal excision with an intersphincteric dissection in order to allow the mobilized rectum and descending colon to be extracted via the muscular anal canal and so avoid any further abdominal incision other than laparoscopic port sites. We believe this novel approach to have significant clinical potential in selected patients.