Abstract：
Vaginal natural orifice transluminal endoscopic surgery (vNOTES) for colorectal cancer utilizes transvaginal access for bowel mobilization, vascular pedicle ligation, oncological resection, and bowel anastomosis, along with subsequent transvaginal natural orifice specimen extraction (NOSE), reducing or eliminating the need for transabdominal access. In this report, we describe the technique of vNOTES right hemicolectomy for cecal cancer, with intracorporeal anastomosis and transvaginal NOSE, including a step-by-step operative video. The patient was a 59-year-old Chinese female (body mass index 32.0 kg/m2) with a cT3N0M0 3 cm cecal adenocarcinoma. Posterior colpotomy was created with insertion of a dual-ring wound protector. vNOTES D2 right hemicolectomy with a fully stapled intracorporeal anastomosis was performed via a homemade transvaginal glove port, using extra-long rigid instruments. A 10 mm, 30° rigid laparoscope was used for operative visualization through a transumbilical port, without additional percutaneous trocars. Operative difficulties pertained to suboptimal instrument reach, lack of triangulation, and frequent clashing within the restricted access space. Surgical duration was 300 min, with 50 ml of blood loss. There was minimal postoperative pain. Return of bowel function occurred on postoperative day 2, with discharge from hospital on postoperative day 3. The patient resumed normal daily activities and regular diet by 1-week post-surgery. Self-reported cosmetic satisfaction score was excellent. No operative complications were observed at 2 months\' follow-up. vNOTES right hemicolectomy with intracorporeal anastomosis is safe and feasible in highly selected colon cancer patients. Operators should be proficient in conventional laparoscopic colectomy and transvaginal NOSE. More experience with the vNOTES technique is required to ascertain best practices.
摘要：
用于结直肠癌的阴道自然腔道内镜手术（vNOTES）利用经阴道途径进行肠动员，血管蒂结扎，肿瘤切除术,肠吻合,随着随后的经阴道自然口标本提取（NOSE），减少或消除经腹通路的需要。在这份报告中,我们描述了vNOTES右半结肠切除术治疗盲肠癌的技术，体内吻合和经阴道鼻，包括一步一步的手术视频。该患者为59岁的中国女性（体重指数32.0kg/m2），患有cT3N0M03cm盲肠腺癌。通过插入双环伤口保护器来创建后结肠切除术。vNOTESD2右半结肠切除术与完全吻合的体内吻合术通过自制的经阴道手套口进行，使用超长的刚性仪器。一个10毫米，通过经脐端口使用30°刚性腹腔镜进行手术可视化，没有额外的经皮套管针。操作困难与仪器到达不理想有关，缺乏三角测量，以及在受限访问空间内的频繁冲突。手术时间为300分钟，50毫升的失血。术后疼痛轻微。术后第2天发生肠功能恢复，术后第3天出院。手术后1周，患者恢复正常的日常活动和饮食。自我报告的化妆品满意度得分优异。随访2个月无手术并发症。vNOTES右半结肠切除术联合体内吻合术在高度选择的结肠癌患者中是安全可行的。操作人员应精通常规腹腔镜结肠切除术和经阴道NOSE。需要更多的vNOTES技术经验来确定最佳实践。
